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Health Insurance Claim Settlement For COVID-19 Explained

Updated On Jul 02, 2021

The importance of a health insurance policy has increased over time due to the pandemic that we all are going through. It can be noted that people who do not have enough financial savings or a health insurance policy are facing financial troubles in getting treatment during the COVID-19 pandemic. Therefore, such a situation must have made you realize that investments made in a health insurance policy can bear fruits in case of an emergency. 

The most important part of having a health insurance policy is knowing its claim settlement procedure. Usually, it is advised to access treatments in a network hospital of the insurer to avail the benefit of cashless treatments. However, in cases like coronavirus attack, you must preferably go for a reimbursement claim settlement process, as in case of an emergency you might have to get admitted to any nearby hospital and the claim settlement process can take time.  

Health Insurance Claim Settlement For COVID-19 Explained

Claim Settlement Process For COVID-19 Health Insurance 

The insurance companies have come up with customized and curated plans to meet the demands of customers suffering from coronavirus. Such policies are meant to primarily provide maximum coverage to a coronavirus patient at an affordable price. The sum assured under these policies is sufficient to meet the basic need of the patients of coronavirus. You can either make a cashless or reimbursement claim for your COVID-19 health insurance policy. Let us look at the steps involved in both processes: 

1. Cashless Claim For COVID-19 Health Insurance Policy 

Cashless claims are applicable only in the network hospitals of the insurance companies. Under such claims, the payment of the bills of the policyholder is made directly by the insurer to the hospital without involving the policyholder, thus enhancing the whole experience for the customer and making the process quick and hassle-free. The steps involved are: 

  • Inform the insurer within 24 hours of hospitalization in one of the network hospitals of the insurer. If it is a planned hospitalization, then inform the insurance company in advance, as it will give them enough time to process the claim. 
  • Show your health card at the hospital desk, which has been provided by the insurer. 
  • Submit the pre-authorization form duly filled and signed by you to either the insurer or your TPA. 
  • After proper verification of your documents, the request will be approved and the bills will be cleared successfully by the insurer by directly coming in contact with the hospital. 
  • If your claim request is denied, then the expense amount will be reimbursed to your account after your discharge. 

2. Reimbursement Claim For COVID-19 Health Insurance Policy

Reimbursement claims are made when you want to seek treatment in the hospital of your choice, and it is not linked with the insurer. In such cases, after the submission of the proper documents along with the medical bills and receipts post-discharge, the claim amount will be transferred to your account. Following are the steps involved: 

  • Get admitted and seek treatment in a hospital of your choice, which is not a network hospital of the insurance company. 
  • After discharge, clear all your dues and collect all the invoices, medical bills, exit file, treatment details file, pharmacy bill, discharge history, doctor’s prescriptions, and receipts.
  • Submit a reimbursement form duly filled and signed by you. Submit all the medical documents in original along with the form. 
  • After proper verification of the documents and the file, your request will be processed and the amount will be transferred to your bank account.  

This is mostly the preferred method to make a claim during COVID-19 treatments, as, during this pandemic, you might get admitted to any nearby hospital in case of an emergency, and it might not be linked with the insurance company. 


In the times of this pandemic, make sure you have short-term COVID-19 health insurance policies like Corona Kavach and Corona Rakshak Policy. These policies have been specifically designed to incur the expenses of the coronavirus treatment and provide wide coverage during its hospitalization. It can also be availed if treated at home. 

Must Read: Difference Between Incurred Claim Ratio And Claim Settlement Ratio

Tips to Choose the Right Health Insurance in Times of COVID-19

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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