Page 14 - Insurance Times July 2021

customers to move to Aarogya health insurance is increasing, but Insurers ask hospitals to
Sanjeevani, a standard health policy families now prefer to take a
that will provide a more comprehensive comprehensive cover rather than opt facilitate faster settlement
health cover. Some insurers said that for the Covid specific Corona Rakshak of claims
customers, too, are preferring to shift or Corona Kavach policies. With the Delhi High Court and
to a full-fledged health cover. "Star Health is still offering Corona insurance regulator IRDAI directing

Rakshak and Corona Kavach policies. insurance firms to complete
Black fungus (mucormycosis) But these were designed with the settlement of Covid claims within an
expectation that the pandemic would hour after discharge, the General
covered by Star Health Insurance Council - the representative
be contained in a few months. Now,
Claims for black fungus or people are preferring to buy a standard body of 34 general insurers in the
mucormycosis are fully covered under mediclaim cover, as they feel that country - has laid down a basic
health insurance covers, said S short term covers are not enough or framework for seeking cooperation
Prakash, Managing Director, Star really meaningful," he said. from hospitals to implement the
Health and Allied Insurance. directives.
The average sum insured for families
"Black fungus has to be 100 per cent has also increased to Rs. 5 lakh, he It has asked hospitals to submit all the
settled by insurance. Insurance has to noted. patient discharge documents in one go
pay for any infection, bet it viral, without having to be reminded of the
bacterial or fungal and such claims He also said the insurer is not missing documents like cashless
differentiating among customers who treatment approval reference, copy of
have to be fully approved by all
have had Covid-19 for medical case sheet, prescriptions, diagnostic
insurance companies and all policies,"
said Prakash, adding that the insurer insurance policies. reports, bills, discharge summary,
Covid positive and subsequent Covid
is honoring all such claims. negative reports. They were also
Insurers receive 790,136
Mucormycosis has emerged as one of advised to ensure billing at pre-agreed
the significant complications of Covid- Covid claims in 2 months rates and provide justification with
19, although it happens in other cases, supporting medical records for any co-
The second wave of the pandemic
too. morbidities necessarily treated.
might have slowed down but the Covid-
The medical costs for treating the related claims for general and health According to the GI Council, when a
disease are high and there is also need insurers have remained at elevated patient's progress is good and
for prolonged hospitalisation. levels. discharge is planned for the next day,
hospitals should inform the insurance
Prakash said insurers are now trying to As of June 11, more than 1.8 million
track Covid-19 complications based on claims have been reported to the company or third party administrator
the International Classification insurers amounting to Rs 24,397.35 (TPA) of the impending discharge the
soonest and submit the available
ofDisease or ICD code. "We have crore, of which 1.46 million claims documents and bills. "Balance
created a separate ICD code, WHO have been settled worth Rs 14,060 documents and bills pertaining to the
has also given an ICD code for Covid crore, thus resolving 81 per cent of the last 24 hours could be submitted at the
complications. With this, we should be claims received. discharge time so that the insurance
able to track more and more
In the past two months (April 10-June company or TPA could also start
complications related to Covid in the
11), Covid-related claims have gone up working on the discharge
days to come," he told in an
by 790,136. This is almost 48 per cent simultaneously," it said.
interaction.
of the total claims received so far since Currently, insurers take up to five or six
The standalone health insurer has the onset of the pandemic. But, the hours for settlement of hospital claims
incurred Covid related claims of Rs. settlement of claims is also in sync with and patients are held up in the hospital
1,530 crore in 2020-21 and worth Rs. the rise in claims being reported as in during this period. Hospitals refuse to
990 crore this fiscal. the past two months, the insurers have discharge patients without getting the
Prakash said that the demand for settled 595,988 claims. insurer's approval.

14 The Insurance Times, July 2021