As the second wave of coronavirus create havoc in the lives of people across India, insurance claims are also on the rise with the rise in the infections. However, there are chances that your COVID-19 policy claims claim may get rejected due to several reasons even though the insurers have been asked to expediate the claim settlement process.
It is important to understand the criteria when the insurer can reject your claims or may not settle your claim completely if you or your family member are hospitalised. Also Read: Planning To Buy Chinese TV? Be Cautious As This Company Admits To Spy On Users - Check Details Here
What are the conditions for hospitalisation?
Remember the hospitalisation must be prescribed by a medical practitioner.
The hospitalisation should follow standard treatment guidelines.
One has to go through an active line of treatment that can only be followed in a hospital.
Time to Hospitalise: It’s important to note that in a present situation getting an ICU bed is difficult for a person with severe condition if a person with mild disease is admitted. Claim can be rejected because of unnecessary lab tests, asking to reimburse bills of the outpatient department (OPD) and also claiming insurance without being hospitalised, as per the business publication Mint report.
Domiciliary Hospitalisation: Also, the report noted that claim rejection can occue in case of domiciliary hospitalisation without prior consent from an insurer.
Waiting Period: It is important to be aware that no claim made during the waiting period whether it is a Covid-19-specific policy or any health policy can be claimed. All health insurance policies come with a waiting period.
Non-disclosure of diseases: Also, the claim can get rejected in case the insured has a pre-existing disease (PED) for a month or more and the same is not disclosed at the time of buying thepolicy, especially a Covid-19-specific policy.
- Documentation Issue: In case of incomplete documentation or sufficient documents subimitted by the insurer, the claims may become difficult to process. Remember that submitting only the customer’s positivity report may not fulfil the purpose of claims.
As per the Mint report, the novel coronavirus is mostly not covered under day care treatment; it’s either covered under home quarantine, which is payable if covered by the policy, or under inpatient treatment, which is payable if policy terms and conditions are met.
Make sure to submit proper bills, discharge summaries, diagnostic reports and doctor’s prescriptions with the claim form because if documents don't indicate hospitalisation as per the established protocols, then the claim may get rejected.
In case of Covid-19-specific policies, the initial waiting period is typically 15 days, while for regular health policies, it can go up to 30 days, four years for PEDs, one or two years for specific illnesses, etc.