The General Insurance Council (GI Council) has 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).
The new rates are being fixed after discussion with expert medical professionals employed by member insurance companies in order to allay the fears of all insurance policyholders and bring complete clarity and transparency in the treatment of Covid-19 insurance claims, it said.
In the case ‘moderate sickness’, NABH-accredited hospitals (including entry level) can charge Rs 10,000 per day (including Rs 1,200 for PPE) and for non-NABH accredited hospital) it would be Rs 8,000 (including including cost of PPE Rs 1,200).
In the case of ‘severe sickness’, for ICU without need for ventilator care in NABH accredited hospitals (including entry level) , the rates would be Rs 15,000 and for non-NABH accredited hospitals it would be Rs 13,000 (including cost of PPE Rs 2,000).
In the case of ‘very severe sickness’, in NABH-accredited hospitals, ICU with ventilator care (invasive/ noninvasive), the charges should be Rs 18,000 (including cost of PPE Rs 2,000) per day and in non-NABH accredited hospitals, the charges should be Rs 15,000 (including cost of PPE Rs 2000. These rates will cover consultation, nursing charges, room stay & meals, Covid testing, monitoring & investigations, biochem & imaging, physiotherapy, PPE, drugs and medical consumables, biochemical waste management & other protective gear, Bed side procedures like Ryles tube insertion, urinary tract catheterization. “These charges will be reviewed by the GI Council every month,” it said.
However, the exclusions per day will apply to interventional procedures like, but not limited to, central line insertion, chemoport insertion, bronchoscopic procedures, biopsies, ascitic and pleural tapping which may be charged at the rack rate as on December 31, 2019. High end drugs like Immunoglobulins, Meropenem, Parenteral Nutrition and Tocilizumab are to be charged at the minimum retail price (MRP). High-end investigations like MRI, PET scan will also be charged at rack rates of hospital as on December 31, 2019.
It said dead body storage and carriage at Rs 5000 and for treatment of any co-morbid conditions, an additional amount of up to Rs 5,000 would be allowed.
Rates based on NITI panel suggestions
Settlement under the COVID-19 cover claims will be subject to limits and terms of the respective insurer’s policy. Rates are based on the schedule of rates suggested by a Niti Aayog panel.
Geographically, hospitals in metropolitan cities will be allowed 100 per cent of these rates while other state capitals and the rest of the country can charge 90 per cent and 75 per cent respectively, GI Council said.
GI Council said insurance companies will be guided by the treatment protocols prescribed by ICMR, GI Council said. The settlement under the Covid-19 insurance claims will be subject to the limits and terms of the policy of respective insurer. These rates are broadly based on the schedule of rates suggested for covid-19 treatment by Niti Ayog panel.
These rates will be applicable to both cashless and reimbursement Covid-19 claims in States, Union territories and cities where any government authority has not published standard charges for Covid-19 treatment. Wherever Covid-19 treatment charges have been published by any government authority, those charges will be applicable to insurance claims with member companies, it said.
NABH is a constituent board of Quality Council of India (QCI), set up to establish and operate accreditation programme for healthcare organizations.
‘No upper limit for Sanjeevani insurance policy’
MUMBAI: People will now have the option of going for higher medical cover of Rs 20 lakh or Rs 30 lakh under the Arogya Sanjeevani Policy, as Irdai has allowed insurers to offer sum insured of greater than Rs 5 lakh. Customers will be allowed to go for health cover below Rs 1 lakh. Earlier, the sum insured was restricted between Rs 1 lakh and Rs 5 lakh for Aarogya Sanjeevani Policy as mandated by Irdai to all insurers from April 2020. —ENS ECONOMIC BUREAU
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