February 1, 2021 12:27:44 am
The health claims bill of insurance companies is rising sharply. With the Covid-19 pandemic still raging in the country, insurance companies in the country have received 8.53 lakh claims worth Rs 12,923 crore for Covid treatment as on January 22 this year. This works out to 30 per cent of total premium collected by insurers in the nine months ended December.
Insurance firms have so far settled 6.77 lakh claims worth Rs 6,595 crore as on January 22, according to figures compiled by the General Insurance Council.
Insurers say there hasn’t been a let-up in claims under the Covid category with firms receiving a claims bill of over Rs 5,000 crore since November 1, 2020. Insurers had received 5.01 lakh claims for Rs 7,699.50 crore as of October 2020 and settled 3.43 lakh claims worth Rs 3,315.5 crore. With health consciousness rising in the country, total premium collected by the insurance industry under the health category rose to Rs 42,291 crore, showing a spike of 13.73 per cent as of December 2020.
A senior Insurance Regulatory and Development Authority of India (Irdai) official said that 1.28 crore standard Covid policies with a total premium of over Rs 1,000 crore have been sold so far. “Under Corona Kavach sold by general insurers which is the standard product, 42 lakh lives have been protected, while 5.36 lakh lives have been protected through Corona Rakshak sold by life insurers,” the official added.
Although the average claim per person across India was Rs 1,51,340, the average settled amount was Rs 97,369 per person. Maharashtra, which reported the highest Covid infections, also made the maximum Covid insurance claims of 2.96 lakh worth Rs 3,651.5 crore. Insurers settled 2.30 lakh claims worth Rs 1,918 crore till January 22, in the state. The average claim per person settled in Maharashtra was one of the lowest at Rs 83,399 per person.
In Tamil Nadu, there were 69,682 claims worth Rs 1,254 crore, with 58,056 claims worth Rs 594 crore settled so far. There were 1.07 lakh claims for Rs 1,607 crore from Gujarat and 69,679 claims for Rs 1,066 crore crore from Karnataka. Insurers got 26,653 claims for Rs 533.6 crore from Delhi.
However, insurances sources said claimants were forced to shell out part of their hospital bills from their pockets as the claims and settlement depend on the size and other terms of the policies.
The General Insurance Council had recently come out with a schedule of rates for Covid-19 claims being filed with its member insurance companies, capping the ICU with ventilator care at Rs 18,000 per day in the case of ‘very severe sickness’ in hospitals accredited with National Accreditation Board for Hospitals & Healthcare Providers (NABH). However, this has been proven insufficient with patients forced to fork out the balance amount charged by hospitals. “Hospitals ask patients to shell out different amounts for various facilities like ICU and nursing care,” said an insurance official.
The insurance regulator asked all general and health insurance companies to offer standard Covid policy. In the case of Corona Kavach policy of New India Assurance, the sum insured ranges from Rs 50,000 to Rs 5 lakh with a waiting period for 15 days. While the entry age is from day one to 65 years, the policy period is from 105 days to 285 days. Ambulance charges under the policy is Rs 2,000 and there’s no limit on room rent and ICU.
According to government figures, there were 1.07 crore confirmed Covid cases with 1.54 lakh deaths as on January 31, 2021.
Irdai has said that in case of cashless claims under a health insurance policy, the claims should be settled as per the tariff decided by the parties in compliance with provisions of Regulation 31 of Irdai (Health Insurance) Regulations, 2016.
The regulator, however, said that insurance companies should make efforts to have agreements with health providers on the rates for treatment of Covid similar to other diseases. It had also directed all insurers to ensure that reimbursement claims under a health insurance policy should be settled as per the terms and conditions of the respective policy contract.
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