Concern Over COVID Procedure Rates

Read the fine print and choose a policy that covers both out-patient and hospitalisation charges

- Kumud Das

The General Insurance Council (GIC) has recently come out with rate chart for COVID-19 treatment, taking into account rates published by various state governments, after discussion with experts. The council has made it clear that the reference rates are variable and will be revisited every month.

Insurance companies shall be guided by the treatment protocols prescribed by ICMR. 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 claims in states/ union territories/ cities where any government authority has not published standard charges for COVID-19 treatment. Wherever, treatment charges have been published by any authority, those charges shall be applicable to insurance claims with member companies. The settlement under COVID-19 insurance claims shall be subject to the limits and terms of the policy of respective insurer.

The capping of procedure rates comes at a time when the country witnesses more than 10 lakh active cases. Moreover, the insurers have already made claim payout to the tune of ₹900 crore while settling 55,000 COVID related claims.

However, the corporate hospitals are not comfortable with the capping of the rates. They are worried the council may go for capping of all the procedures. GIC has come out with a schedule of rates for claims being filed with its member insurance companies, capping the ICU with ventilator care at ₹18,000 per day in the case of ‘very severe sickness’ in hospitals accredited with National Accreditation Board for Hospitals & Healthcare Providers (NABH).