Hospitalized in a makeshift covid-19 hospital? You can claim health insurance1 min read . Updated: 17 Jul 2020, 11:38 AM IST
- The Insurance Regulatory and Development Authority of India said it is important to recognize the makeshift hospitals permitted by the government for settlement of health insurance by insurers.
With the number of fresh covid-19 cases hitting a new high with every passing day, hospitals in most metros are running out of beds, resulting in governments and private healthcare providers provisioning for makeshift or temporary hospitals. But disputes around the settlement of claims are on the rise in some parts of the country.
To ensure that policyholders are not denied health insurance claims in case of hospitalization in such temporary or makeshift premises, the Insurance Regulatory and Development Authority of India (Irdai) on Thursday said it is important to recognize the makeshift hospitals permitted by the government for settlement of health insurance by insurers.
"In order to ensure that the cost of treatment of covid-19 is covered as per terms and conditions of policy contract, a makeshift or temporary hospital permitted by central or state government shall be regarded as a hospital or network provider and insurers shall settle the claims," said Irdai in its circular.
Naval Goel, CEO and founder, PolicyX said, this move will benefit policyholders because earlier they were facing a lot of issues when it comes to filing covid-19 claims. "This is definitely going to improve claims experience up to a great extent."
Further, Irdai said if a policyholder tests positive for covid-19 and is admitted into a makeshift hospital on the advice of a medical practitioner or government authorities, then notwithstanding the definition of hospital mentioned in the policy contract, the claim shall be settled by insurance companies.
Also, if an insurer's network provider has arranged for a temporary hospital then such a hospital shall be considered as an extension of the network provider and cashless settlement of claims will have to be made available. Third-party administrators have also been asked to take note of this.
"Policyholders are facing a lot of issues because many hospitals in spite of being in the network list are not allowing cashless claims. This is resulting in policyholders dealing with poor claims experience because there is uncertainty whether the claim will be reimbursed in full or not. If this new directive from the regulator is implemented properly, it will be a big relief. The covid-19 treatment is highly costly and shelling out money from one's own pocket may not be feasible for a lot of people who could be facing pay cuts or job loss. This was a much-needed directive from the regulator," said Goel.