Though treatment of Covid-19 is covered by all health care insurance providers since the Insurance Regulatory and Development Authority of India (IRDAI) passed a mandate asking companies to do so in early April, patients and potential healthcare policy owners should be aware that consumables including Personal Protective Equipment (PPE) kits, N-95 masks and sanitisers are not covered under most health care insurance plans.
“This can potentially lead to out of pocket costs of more than a lakh even if you have to stay at a hospital for ten days or so, despite having health insurance,” said a senior manager at a bank which provides third party health insurance packages to its customers.
The senior manager added that there has been a surge in the demand for health insurance coverage since the pandemic.
“Many people have been contacting us from places where we never received demands before. A lot of people from rural Punjab have also been getting in touch to get their family covered, which is generally unusual because people do not like to purchase insurance in India and would rather invest in property and such,” explained the senior manager, whose banks has also been receiving increasing demands for death claims and insurances.
The Indian Express also contacted sales managers from regional offices of major insurance companies who stated that they have also recorded a similar surge in demand since the pandemic.
“Everyone is rightfully worried, and everyone knows how expensive private healthcare is, so they are waking up to how important purchasing health insurance can be,” said a sale manager for Religare Health Insurance, who wishes to remain anonymous.
Cost of consumables
The IRDAI has a compiled a list of services and products which do not have to be covered under health insurances. According to this list, many costs which are deemed non-medical and products used during hospitalisation and treatment which are called “consumables” do not have to be covered under such a policy.
These consumables can include anything between bandages, adhesive bandages, gauze, cost of attendants, cost of toiletries, air conditioning and so on, which can be labelled as non-medical charges.
These charges, if billed separately by the hospital, are often non claimable under health insurance.
“People also have other overhead costs like travel to and from the hospital, special food for medical needs, even television charges. We offer riders where you can add a daily cost of a few thousand rupees to your insurance policies for cashless pay of these overhead charges in case you get hospitalised,” said one sales manager from the city.
Adding these “riders” to the policy is like a daily allowance which can be used to purchase consumables which are not covered under the insurance. But these additions need to be paid for above and beyond the insurance premium and are usually limited to two to three thousand rupees per day.
Though these consumable costs might be affordable under normal circumstances, due to the safety equipment used for Covid-19 treatment, patients can be charged exorbitantly for these. “There have been patients who paid more than Rs 1 lakh for consumables alone,” said the senior manager from the bank.
A sales manager from HDFC ERGO highlighted how insurance companies are under no obligation to cover such safety equipment, hospitals are at liberty to bill their patients as they please.
“Though HDFC EHO decided to cover charge of PPE and N-95 masks, there are other companies in the market who have decided not to cover these costs, because there is no specific IRDAI guideline asking them to include these costs,” said the sales manager.
In the Tricity, the average cost of a PPE kit billed to patients at private hospitals ranges between Rs 1,500 to Rs 2,000. Even if doctors and healthcare workers wear only an N-95 mask and a gown while treating a patient, some private hospitals will charge Rs 800 per set of gown and mask used.
Furthermore, a private hospital based in Gurgaon was charging between Rs 3,900 and Rs 7,900 per PPE kit depending on whether the patient was admitted to the general ward, a private room, or the ICU. “So if you put together all these charges, you might be paying if you have not chosen a policy wisely,” concluded the senior bank manager.
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