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10 reasons why your COVID-19 claim may get rejected

Team AckoDec 24, 2023

The COVID-19 pandemic has led to many severe cases requiring hospitalisation and medical treatment. Health insurance claims for the treatment have increased accordingly with the rise in cases. There are chances that your policy claims may be rejected if you are unaware of the inclusions and exclusions. In this article, we list 10 reasons why COVID-19 claims get rejected by the insurance company.

Contents

10 reasons why insurers may reject your COVID-19 policy claim
Frequently asked questions

10 reasons why insurers may reject your COVID-19 policy claim

Here are the primary grounds on which insurance companies may deny your COVID-19 claim.

Unnecessary hospitalisation:
When a person with a mild infection is admitted to a hospital when it is not covered under the policy, the claim may be rejected for the same reason.
Unnecessary tests:
The insurer may reject your claim if you raise claims for unnecessary lab tests or bills of OPD (Out-patient Department) that may not lead to hospitlisation.
Domiciliary hospitlisation:
Treatment at home is known as domiciliary hospitlisation. Your claim may be rejected if you opt for domiciliary hospitalisation without prior approval from your insurer.
Waiting period:
Most insurance companies offer policies with an initial waiting period before submitting a claim. Claims raised during the initial waiting period are not eligible for settlement.
Non-disclosure of illnesses:
Insurance companies may not settle your COVID-19 claim if you have not disclosed a pre-existing disease, especially a COVID-19 based health insurance policy.
Documentation problems:
Failure to provide relevant documentation may result in the rejection of your claim. Hospitals may not share sufficient documents for a smooth claim settlement process with the insurer.
Not following standard treatment guidelines:
There are standard treatment guidelines for COVID-19 issued by the local authorities. Failure to adhere to these set guidelines can lead to the rejection of your claim by the insurer.
Mild symptoms:
Some insurers reject COVID-19 claims since patients with mild symptoms were hospitalised when it was not required.
Lapsed policy:
Whether a COVID-19 health insurance policy or a regular health insurance plan, insurers reject claims raised on a lapsed policy. Ensure you renew your health insurance policy within the due date to avoid claim rejections.
Specific exclusions:
If you purchased a health insurance plan, that specifically states that it does not cover claims related to pandemics, then your insurer may reject COVID-19 claims. Some plans do not cover pre- and post-hospitlisation for COVID-19 treatment. If you raise claims against such specific exclusions, the insurer is bound to reject your claim.

In a nutshell

The COVID-19 pandemic has left us wanting more, especially medical attention. While there is confusion about the type of medical attention an infected person requires, it is vital that you read the inclusions and exclusions of the COVID-19-specific and the regular health insurance policies for a smoother claim settlement. The above 10 reasons why your COVID-19 claims may get rejected helps you understand in which situations you can raise a claim.

Frequently asked questions

Here are some of the common questions about COVID-19 claims in health insurance.

I have a COVID-19 infection. Can I purchase a new health insurance plan to cover my hospitlisation expenses?

You may have to complete the waiting period before your health insurance plan covers in-patient hospitalisation to treat the COVID-19 infection. Your insurer will reject the COVID-19 hospitalisation claim if you have raised a claim during the waiting period.

What are the types of COVID-19 health insurance policies offered in India?

There are COVID-19-focused health insurance plans, they are Corona Kavach and Corona Rakshak. The Corona Kavach is a standard health insurance plan wherein only the medical or hospital bills get reimbursed up to the sum insured subject to terms and conditions of the policy. The Corona Rakshak is a standard fixed benefit health insurance plan wherein the insurer pays the sum insured in a lump sum (subject to the terms and conditions of the policy).

How can I register a claim if COVID-19 infects me?

If a government-authorised testing lab or diagnostic centre has diagnosed that you are infected with COVID-19 disease, then contact your insurer, in this case, ACKO, immediately. Our support team will guide you through the process.

What is the waiting period in the two types of corona policies?

The waiting period in both the COVID-19-based policies is 15 days. You cannot raise any claims against your policy during this waiting period.

Is there a possibility to buy COVID-19 specific health insurance policies online?

Yes, you can purchase Corona (Kavach and/or Rakshak) policies online from ACKO.

Are there short-term COVID-19-based health insurance policies?

Yes, you can purchase the Corona (Kavach or Rakshak) health insurance policies that come with a tenure of 3.5 months (105 days), 6.5 months (195 days), 9.5 months (285 days).

What is the sum insured amount under Corona (Rakshak and/or Kavach) policies?

Under the Rakshak plan, it starts from Rs.50,000 and goes up to Rs. 2,50,000 in multiples of Rs. 50,000. As for the Kavach policy, it begins from Rs. 50,000 and goes up to Rs 5,00,000 in multiples of Rs. 50,000.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.