Mumbai:
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, 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, said GI Council .
These charges will 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 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 NitiAyog Panel.
In case moderate sickness, NABH(National Accreditation Board for Hospitals & Healthcare Providers) accredited hospitals (including entry level) can charge Rs 10,000 (including 1200 for PPE) and for non-NABH accredited hospital) it would be Rs 8,000/- (including including cost of PPE Rs.1200)
In case of severe sickness, ICU without need for ventilator care, in NABH accredited Hospitals (including entry level) , the rates would br 15,000 and for non-NABH Accredited Hospitals it would be Rs 13,000((including cost of PPE Rs. 2000/).
In 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 2000-) and in non-NABH Accredited hospitals, the charges should be Rs 15,000/- (including cost of PPE Rs 2000/-
The above rates will cover following treatments –
• Consultation, • Nursing Charges, Room Stay & Meals, COVID testing, Monitoring & Investigations, –Biochem& Imaging, Physiotherapy, PPE, Drugs & Medical Consumables, Biochemical Waste Management & other Protective gear, Bed side procedures like Ryles tube insertion, urinary tract Catheterization
Exclusions per day will apply to the following–
– Interventional Procedures like, but not limited to, Central Line insertion, Chemoport Insertion,bronchoscopic procedures, biopsies, ascitic /pleural tapping, etc, which may be charges at the rack rate as on 31st December 2019
– High end drugs like Immunoglobulins, Meropenem, Parentral Nutrition, Tocilizumab, etc – to be charged at MRP,
– High end investigations like MRI, PET scan – to be charges at rack rates of hospital as on 31st December 2019,
– Dead body storage & carriage at Rs 5000/-
– Treatment of any co-morbid conditions, an additional amount of up to Rs 5000/- would be allowed
Geographically, hospitals in metropolitan cities will be allowed 100% of the above rates while other state capitals and the rest of the country can charge 90% and 75% respectively
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.Wherever, Covid-19 treatment charges have been published by any government authority, those charges will be applicable to insurance claims with member companies.
National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a constituent board of Quality Council of India (QCI), set up to establish and operate accreditation programme for healthcare organizations.