The General Insurance Council has prepared a reference rate chart for COVID 19 treatment, taking into account rates published by various state governments.
The cost of hospitalisation due to COVID-19 may run into a few lakhs as the hospital stay is generally around 14 days. The treatment for dealing with Coronavirus appears to be different from treatments done in other medical conditions as it entails the use of PPE Kits and specific procedure for medications. It is important that the hospitals across the country follow a standardised rate chart and the insurance companies keep the claim settlement process smooth and simple for the policyholders.
The General Insurance Council (GI Council) has prepared a rate chart for COVID 19 treatment, taking into account rates published by various state governments and also after discussions with health claims experts. The rates are proposed by the GIC to be considered during treatments in hospitals.
These rates will be applicable to both cashless and reimbursement Covid-19 claims 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 shall be applicable to insurance claims with member companies.
The GI Council maintains that the rates provided in the Schedule of Charges for Covid-19 Treatment costs in Hospitals (Schedule) are reference rates for management of COVID 19 insurance claims. These rates are, however, dynamic and will be revisited every month. The General Insurance Council is an important link between the Insurance Regulatory and Development Authority of India and the non-Life insurance industry.
The GI Council in its communication says that Covid-19 is a new illness with no established protocols and standardized treatment costs. This may at times result in an insurance company raising questions on the amounts spent on the Covid-19 treatment. This creates a huge uncertainty in the minds of unsuspecting COVID-19 patients.
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 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 NitiAyog Panel.
The document of GI Council proposes to create a consensus on the billing pattern for COVID patients, on a Per Diem Bases, rather than line-item billing, based on the following criteria –
a. Type of stay & treatment, during hospitalization
b. City/District of Hospital
c. Type of Hospital
The Proposed Cost per day as a ceiling for the various types of stay in hospitals are as follows –
Inclusions are –
• Nursing Charges
• Room Stay & Meals
• COVID testing
• Monitoring & Investigations –Biochem& Imaging; Physiotherapy
• Drugs & Medical Consumables
• Biochemical Waste Management & other Protective gear
• Bed side procedures like Ryles tube insertion, urinary tract Catheterization
Exclusions Per Diem Bases are –
• 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 of Rs 5000
• Treatment of any co-morbid conditions, an additional amount of up to Rs 5000 would be allowed
Geographically, the proposed rates are for hospitals as given below –
As per the type of Hospital, based on the infrastructure & expertise available
** Each Hospital to have an Operational ICU& OT
Investigations are a part of the Per Diem cost, however, in exceptional cases, some of the diagnostics have to be conducted more frequently than 90% of all cases.
In order to bring about a cost optimization for the most utilised Investigations, some of the capping proposed are –
a. Arterial Blood Gases (ABG) – Rs 400
b. Blood Sugar Level (BSL) – Rs 100
c. D- Dimer Levels – Rs 800
d. Haemograms– Rs 150
e. CT Chest – Rs 3500
f. X Ray Chest – Rs 500
g. ECG – Rs 300
** Metropolitan Cities include –
• Delhi & NCR
• Mumbai Metropolitan Region
• Kolkata Metropolitan Region
• Chennai Metropolitan Region