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How you can breathe easy on Covid insurance claims

Bavadharini KS BL Research Bureau | Updated on May 08, 2021

Insurer needs to give cashless claim approval to the concerned hospital within 60 minutes now

Apart from the physical and emotional strain brought on by Covid, unnecessary stress from the paper work and processes for making insurance claims related to the illness is best avoided. Thanks to the lockdown and other control measures put in place by the Centre during the first wave last year, health insurance claim procedure has almost entirely moved online.

While many insurers do settle cashless claims within a maximum of 24 hours, given the severity of the situation, IRDAI, the insurance regulator recently issued norms to the insurers on settlement of Covid health insurance claims. Accordingly, all the general and health insurance companies have been asked to communicate their cashless approvals to the concerned hospitals and establishments within a maximum time period of 60 minutes.

If you or a family member unfortunately falls sick, here is how you can make a claim.

Claim initiation

Almost all insurers have taken to adopting technology such as chatbots and mobile applications for any queries of policyholders starting from policy purchase to premium payment to claim settlement.

For instance, HDFC Ergo General Insurance has its HDFC Ergo mobile application . Similarly, Bajaj Allianz General Insurance (Caringly Yours), ICICI Lombard (IL Take Care) and ManipalCigna (Medi Buddy) have mobile applications for its customers for claims and other services.

Alternatively, you can avail these services from a chatbot on the website of the respective insurer. You can also mail or call your insurer. The policyholders of Digit General Insurance can register claims by calling the insurer on the number provided in the website or register through the claims page, specifically for health claims. Additionally, the insurer provides Whatsapp services where you can register the claim instantly.

Any health insurance claim first starts with initiation. You can reach out to the insurer through any one of the above mentioned modes to initiate your claim.

Once you have initiated the claim, the next step is claim assessment or investigation followed by claim acceptance or rejection. If accepted, the claim is settled.

Settlement

In the case of any unplanned hospitalisation, fret not. If you have availed your treatment in a network hospital, you can inform the insurer/TPA desk for cashless treatment at the hospital. The hospital usually co-ordinates the same and processes cashless mediclaim.The list of hospitals empanelled with the insurer is available in your policy document or can be checked on the insurer’s website.

Most insurers settle cashless claims within an hour of claim intimation. For instance, ICICI Lombard processes claims within an hour (pre-authorisation and discharge). Bajaj Allianz General responds to pre-authorisation (cashless) request within 30 minutes and the final bill is settled within 60 minutes. Digit General Insurance approves cashless claims or pre-authorisation within an hour from the receipt of the last document. The payment is made to the hospital within 48 hours from the receipt of the invoices from the hospital. While Covid related claims were already processed on priority by the insurer, with the IRDAI’s recent circular, the claims settlement with all insurers can be expected to become much quicker.

With the Covid case overload, one may not always have the facility of choosing a network hospital and insurers are also taking cognisance of the situation. Says Priya Deshmukh Gilbile, Chief Operating Office, ManipalCigna Health Insurance “We are allowing cashless facility, with proper trigger from the hospital, for the policyholders admitted in the alternate establishment set-up by hospital under our network.”

Even otherwise, if you get admitted in a hospital which is not part of your insurer’s empanelled hospital list, you can go for reimbursement. Policyholder should submit documents including discharge summary, final bill, payment receipts, medical reports, claim form, ID proof and bank details. All these documents can be soft copies to be mailed to the insurer or uploaded in the mobile application.

Most insurers usually settle the claim within 3-5 working days from the receipt of last document. In the current scenario the reimbursement is much quicker. For instance, Digit Insurance approves the claim within two hours of requisite document submission.

Keep in mind that you may have to pay charges such as non-medical item expenses, registration or admission charges in cash though.

Published on May 08, 2021

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