Issued Guidelines for Covid-19 Insurance Claims | Explained

IRDAI has taken into account the rising number of Covid-19 cases in India and the impact it could have on your physical and financial health. Not only has the government urged the insurers to cover Covid-19 cases, such cases will also be covered by the government’s Ayushman Bharat scheme. As per the new guidelines released by the government, the policies which cover hospitalisation expenses would follow certain norms:

1. The government has requested the insurers to come up with new products that can specifically cover Covid cases and provide financial assistance with all the related health costs. The circular said: “In order to provide need based health insurance coverage, insurers are introducing products for various specific diseases including vector borne diseases. For the purpose of meeting health insurance requirements of various sections, insurers are advised to design products covering the costs of treatment for Coronavirus.”
2. The government has issued rules regarding handling of Covid claims that says: “Where hospitalization is covered in a product, insurers shall ensure that the cases related to Coronavirus disease (COVID-19) shall be expeditiously handled.” This means that Covid-19 claims would be prioritised by the insurers and all such claims would have to be settled quickly, efficiently, and in a hassle-free manner. 
3. There is a 2-hour timeline on decision making with regard to Covid insurance claims. The insurer would have to process the claim within two hours of receiving a claim from the competent authority. The insurer would have to get a thorough review done by the claims review committee in case of all rejections, ensuring an additional protection layer so that a valid claim doesn’t get rejected.
4. IRDAI has said that “The costs of admissible medical expenses during the course of treatment including the treatment during quarantine period shall be settled in accordance to the applicable terms and conditions of policy contract and the extant regulatory framework.” This implies that the policies formulated by the insurers would also need to keep in mind the treatment costs during the quarantine period and the claims must strictly adhere to the contract between the insurer and the insured.

Aside from the government guidelines, you may also need to keep the following in mind:

1. Insurance companies are launching Covid-specific products and some of them are including it in their current policies with slightly raised premiums. You will need to purchase this cover or pay extra over your current premium based on the policy you have. You may not be automatically covered for Covid under your current policy and may need to get in touch with your insurer for clarification.
2. The novel insurance products may be available for a limited time period (currently 1 year) and they may not be available for renewal.
3. A person without any health cover may also buy a Covid-specific plan and ensure financial safety in case of infection.

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