Myth or coverage: experience and expectation of policyholders from health insurance during COVID-19 in the NCR region of India

Abstract

This study intends to determine whether and to what extent policyholders admitted to the hospital for COVID-19 treatment receive financial support from their health insurance. The researcher interviewed 67 health insurance claimants in the NCR region's several cities—some in Uttar Pradesh, Delhi, Haryana, and Rajasthan. They also interviewed various insurance system participants, including branch managers, agents, and hospital staff, to obtain an overview of policyholder experiences and insurer challenges. For analysis, qualitative research techniques have been used. This research is helpful in various situations when people are hospitalised for planned and unanticipated reasons by recommending what insurance companies should do to protect the interests of their customers. For the Indian insurance industry and regulator/supervisory authorities, the COVID-19 pandemic incidents can be a lesson about their strengths and weaknesses. According to this research, service-level agreement violations, procedural bottlenecks, and lack of clarity and awareness are the problems policyholders face when pursuing claims. The challenges insurers confront in serving their client's needs are maintaining operations in the face of financial stress and changing regulatory compliances, on the one hand, and helping policyholders by resolving their claims and raising awareness, on the other.