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Less than 50% of COVID-related insurance claims settled so far: Report

Around 1.21 lakh claims worth Rs 4,538 crore are pending clearance and 1,337 claims have been so far rejected

November 10, 2020 / 09:19 PM IST

Insurance companies have settled less than 50 percent of the claims of nearly Rs 8,000 crore raised so far by COVID-19 patients.

Around 5.18 lakh insurance claims worth Rs 7,973 crore have been filed till November 3, of which 3.97 lakh or 77 percent have been settled. The amount settled, however, is only Rs 3,436 crore or 43 percent of the claim, the Hindu BusinessLine reported.

Around 1.21 lakh claims worth Rs 4,538 crore are pending clearance and 1,337 claims have been so far rejected, it added.

“Difference in claims made and those settled is due to the time lag between reporting of the claim and submission of final bills,” MN Sarma, Secretary General of the General Insurance Council told the paper.

He however added that insurance companies are “able to honour claims deemed reasonable and customary”, adding that hospitals were “exploiting patients by charging exorbitant rates.”

He said if insurance companies are to cover full bill amounts they would have to raise health cover premiums or exclude COVID-19 from policies.


COVID-19 Vaccine

Frequently Asked Questions

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How does a vaccine work?

A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

How many types of vaccines are there?

There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

What does it take to develop a vaccine of this kind?

Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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“There is a lack of standardisation in treatment cost and hospitals have either refused to treat patients with cashless policies or demanded upfront payment,” S Prakash, Managing Director at Star Health and Allied Insurance said, adding that discussions to solve this are on.

The issue was echoed by Sanjay Datta, Chief Underwriting, Claims & Reinsurance, ICICI Lombard General Insurance, who said “discussions to arrive at a common ground for referral rates” are ongoing and will resolve issues related to reimbursement and cashless treatment.

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Moneycontrol News
first published: Nov 9, 2020 12:20 pm
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