As India confronts the second wave of COVID-19, questions about health insurance coverage for treatment and hospitalisation have increased. Many policyholders want to know the exact procedures and documents required when filing a claim for COVID-19-related medical expenses.
If you need to claim health insurance for COVID-19 hospital care, there are two main options: a cashless claim settlement and a reimbursement claim for medical expenses.
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COVID-19 Cashless Claims Settlement Procedure
With a cashless claim, the insurer directly settles the hospital bill, so you typically do not pay at the point of care. Any treatment or medication specifically excluded under your policy must be borne by you.
Cashless claims are available only at network hospitals—facilities that have tie-ups with your insurer to provide this service. In emergencies, you should notify the insurer within 24 hours of admission. Cashless settlements are preferred by many insured individuals because they require less paperwork and immediate cash outlay.
Documents generally required for a cashless claim:
- Your health insurance policy or member ID card (digital or physical).
- Identity and address proof of the patient (Aadhaar, PAN, driving licence, etc.).
- Completed pre-authorisation form, available from the hospital.
Steps
Step 1. Confirm that the hospital is part of your insurer’s cashless network.
Step 2. Fill out the pre-authorisation form and submit it to the hospital; the hospital forwards it to the insurer. The insurer will review the submission and the supporting documents. If all details are in order, the hospital will be authorised for cashless treatment.
Step 3. Receive treatment authorisation from your insurer.
Step 4. The insurer will pay the covered charges directly. Before discharge, settle any costs for treatments or services not covered by your policy.
COVID-19 Reimbursement Claim Settlement Procedure
Under the reimbursement route, you pay for the hospitalisation and later submit a claim to your insurer to recover eligible expenses. As hospitals face capacity constraints in many areas, you may need to seek care at a non-network facility or pay upfront, making reimbursement claims more common during surges.
Typical documents required for reimbursement claims include:
- Pre-admission enquiry records.
- Relevant test results and medical reports.
- Receipts for medicines, medical supplies, oxygen, personal protective equipment, and related items.
- Detailed hospital bills, including ICU, doctor fees and investigations.
- Hospital discharge summary.
Steps
Step 1. Collect all original hospital bills, prescriptions, investigation reports and discharge documents at the end of treatment. Ensure you have a complete folder of records at discharge.
Step 2. Submit a completed reimbursement claim form along with originals or copies of medical records to your insurer.
Step 3. After verification, the insurer will process the claim and transfer the admissible amount to the insured’s account within the timeframe specified in the policy.
Step 4. If a claim is denied, the insurer will issue a denial letter explaining the reason for rejection.
For patients receiving home care
Due to bed shortages in some regions, many COVID-19 patients are managed at home using online consultations, nurse visits, medicine delivery, and home monitoring devices such as thermometers and pulse oximeters. Some providers even offer home ICU setups.
Standard health policies generally do not cover routine at-home treatment; most plans cover only hospitalisation (24-hour admission) or specified day-care procedures and outpatient services if OPD benefits are included. However, specific COVID-19 products such as the Corona Kavach and Corona Rakshak policies include provisions for home care under defined conditions.
Corona Kavach Policy
The Corona Kavach policy is a standardized product mandated by the Insurance Regulatory and Development Authority of India (IRDAI) for sale by general and standalone health insurers. It aims to cover hospitalisation for COVID-19, pre- and post-hospitalisation expenses, home care costs during recovery, and AYUSH treatments when applicable.
The policy covers COVID-19-related comorbidities arising during hospitalisation. It is available as an individual or family floater policy for those aged 18–65, and it covers only expenses directly related to the pandemic condition.
Corona Rakshak Policy
Corona Rakshak is another IRDAI-specified product designed to address the financial risk of COVID-19. It is suitable for individuals without existing health insurance. Coverage is offered in multiples of Rs. 50,000, from Rs. 50,000 up to Rs. 2.5 lakh, and the policy does not require pre-medical screening.
IRDAI push for faster claims
To expedite COVID-19 claim settlements, IRDAI has issued guidelines requiring insurers to speed up approvals. Insurers must communicate cashless authorisations to network hospitals within 60 minutes of receiving the pre-authorisation request and all necessary hospital details.
Additionally, once the final bill and related documents are submitted by the hospital, the insurer should convey a decision regarding final discharge within one hour. These measures aim to reduce delays and ease patient discharge processes during the pandemic surge.
Conclusion
Health insurance is a critical tool for managing the financial burden of COVID-19 treatment. Before you need to file a claim, review your policy terms, understand covered benefits, and confirm network hospital lists and required documents. That preparation will help you choose the appropriate claim route—cashless or reimbursement—and speed up settlement when timely care is essential.