Charges fixed for Insurance COVID cases: GI Council sets Rs 18000 per day for ICU with ventilators, Hospitals cry foul

New Delhi: In order to allay the fears of all insurance policyholders and to bring complete clarity and transparency in the treatment of Covid-19 insurance claims, the General Insurance Council (GI Council) has recently rolled out an indicative Rate Chart for COVID-19 hospitalization claims. These rates are dynamic and will be revisited every month.

The General Insurance Council has been constituted under section 64C of the Insurance Act, 1938 since 2001 by the Insurance Regulatory and Development Authority of India (IRDAI). The GI Council is an important link between the Insurance Regulatory and Development Authority of India and the non-Life insurance industry. 

The recent charges from the Council come in the wake of the increasing number of COVID cases that are being diverted to Private care with caveats on rational costing. This at times results in an insurance company raising questions on the amounts spent on the Covid-19 treatment, thereby, creating huge uncertainty in the minds of unsuspecting COVID-19 patients. 

Marking the need of the hour, GIC, in discussion with expert medical professionals employed by member insurance companies, has brought about a Schedule of rates for Covid-19 claims being filed with its member insurance companies. Insurance companies will be guided by the Treatment Protocols prescribed by ICMR.

The Proposed Cost per day as a ceiling for the various types of stay in hospitals are as follows-

These rates will be applicable to both cashless and reimbursement Covid-19 claims in States/Union Territories/Cities where any Government Authority has not published standard charges for Covid-19 treatment.  These rates are broadly based on the schedule of rates suggested for covid-19 treatment by NitiAyog Panel. 

"Wherever Covid-19 treatment charges have been published by any Government Authority, those charges shall be applicable to insurance claims with member companies. These charges shall be reviewed by Council every month to ensure that these represent Usual, Customary and Reasonable charges prevalent in the Indian market at that time and do not cause any hardship to insurance customers. The settlement under the Covid-19 insurance claims shall be subject to the limits and terms of the policy of the respective insurer," the industry body's statement noted. 

Since the beginning of the COVID outbreak, insurers and hospitals have often been locked in disputes over expenses payable. The recently released charges will act as a reference guide for approving treatment expenses.

However, doctors now cry foul following the proposed charges for COVID cases. Privates hospitals have called the rates as "unrealistic" and not economically feasible.

The Indian Medical Association (IMA) Tamil Nadu have submitted to the GIC stating that it was absurd not to involve service providers before finalizing the rates as assured by Insurance Regulatory and Development Authority (IRDA). The Association further added that the stratification of rates based on the geographical location of hospitals was unfair as the cost involved is almost the same throughout the country.

"What will happen is that many hospitals might not take up insurance patients as it won't be feasible for them. They might say that beds are full and they have no vacancy to admit new patients. So ultimately patients are going to be affected," IMA's Ravikumar told TOI.

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