As claims rise, insurers are slow to cover recovered Covid

With the daily number of Covid cases rising sharply, insurance companies are refusing to provide health coverage to people recovered from Covid-19 and are asking them to wait up to six months for policy renewals.

Most insurers are reluctant to welcome customers who have just recovered from Covid, an insurance industry official said. “As a result, insurers have put a cooling-off period of 3 to 6 months after the detection of Covid,” he said.

The delay in renewals has come as insurers refuse to pay in many cases despite a directive from the Insurance Regulatory and Development Authority of India (Irdai) that hospital bills under the “ system cashless ” must be paid within two hours. discharge. “There are even complaints that some insurers are refusing to issue new Covid policies to people without illness, fearing a surge in claims,” ​​a source said.

According to government data, there are 1.87 crore of confirmed Covid cases in the country, of which 1.53 crore have recovered. These people may have to wait a while before they are covered again. “A cooling off period is to ensure that clients have fully recovered, (and that they) are not experiencing any immediate side effects of the infection and are in better health at the policy proposal stage. As most Covid survivors only experience mild symptoms, insurance coverage shouldn’t be an issue, ”said Anand Roy, CEO of Star Health and Allied Insurance.

“This means that you can only take out a health insurance policy after 3 to 6 months after Covid has turned negative. Considering the speed at which Covid is spreading now, everyone is advised to purchase health insurance plan now, and don’t wait, because in case one does get Covid, it will become difficult to get the health insurance plan immediately, ”said Amit Chhabra, Head Health Insurance,

The second Covid wave led to an unprecedented surge in new infections. “Given the lack of clarity on the severity and virulence of this mutant, it is advisable to stay safe, take precautions, and have health insurance coverage. Given the rapid spread of new variants of Covid-19, it’s hard to say anything about the long-term effects of it, ”Chhabra said.

According to Roy, Covid-19 is a new disease and there is still a lot to be understood about this disease to determine the long-term effects on a person’s health. “In the past, we have seen patients who have recovered from Covid-19 undergo reinfection or have other complications. This is exacerbated when the patient has comorbidities. The underwriting of such proposals is more specific to the case, individuals with or without comorbidities, the extent of treatment and the sequelae of Covid, ”Roy said.

Meanwhile, insurance companies settled only 54% of claims received from customers who had purchased Covid health insurance in March 2021. Out of a total of Rs 14,608 crore under insurance plans Covid disease, insurers only settled claims worth Rs 7,900 crore, or 54 percent of the amount claimed by policyholders.

On top of that, while 9.96,804 people made claims in March 2021, insurers settled the claims of 8,55,250 people, leaving out 1,41,554 people who have not yet received the money from the companies. insurance, according to figures available with the General Insurance Council.

“A large portion of insurance claims are cashless and settled by the insurance company on the day the patient is discharged. If 1.41 lakh of patients whose claims have not yet received the money from the insurance company, this is something insurance regulator Irdai should consider and issue an opinion, ”an official said. of the insurance sector. A frequent complaint from customers is that insurers are drastically reducing the claim amount for some fragile reasons, and many of them, including public sector companies, are refusing to reimburse policyholders.

However, insurers said many of the claims were inflated bills that did not fall under policy terms. No less than 66.37% of total claims under Covid health insurance policies come from five states, with Maharashtra representing the maximum number of claims. In the 12 months ended March 2021, insurance companies reported an 18.11% increase in health insurance premium income to Rs 58,584 crore. Of this amount, retail customers amounted to Rs 26,258 crore and group policies amounted to Rs 27,750 crore.

Two specific corona products – Corona Kavach and Corona Rakshak – have been launched by insurers under the leadership of Irdai.

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