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Despite capped prices for COVID treatment, health insurance remains critical

Buying a health insurance plan not just for yourself but for your entire family is important

July 01, 2020 / 09:14 AM IST

Amit Chhabra 

In an attempt to ease the burden of hefty hospital bills for the treatment of COVID-19, various state governments – Delhi, Telangana, Tamil Nadu, Rajasthan and Maharashtra – have capped the prices at listed private hospitals. Patients in these states can now get treatment at listed private hospitals at the rate given by the government. As per the directions of these governments, no hospital will be allowed to charge anything extra to patients above the cap. This will be a relief for people reeling under the severe coronavirus outbreak.

Capped Rates Vary State-wise

In Delhi, while hospitals will not be able to charge more than Rs 8,000-10,000 for an isolation bed, Rs 15,000 is the upper limit for ICU beds without ventilators and Rs 15,000-Rs 18,000 is allowed for ICU beds with invasive or non-invasive ventilator support. In Rajasthan, the government has allowed private labs to charge only Rs 2,200 per test and the private hospitals in the state can charge Rs 2,000 per day for a bed and can charge Rs 4,000 for a ventilator bed in the ICU. Similarly, in Tamil Nadu, the State Health Department has announced three slabs of maximum applicable daily tariff for treatment of COVID-19 patients in private hospitals. For this purpose, the hospitals have been classified under two categories—Grade A1/ A2 and Grade A3/A4.

Grade A1 and A2 hospitals can collect a maximum of ₹7,500 a day from COVID-19 patients who are asymptomatic or have mild symptoms and have been admitted to the general ward. The maximum tariff for such patients in the general ward of Grade A3 and A4 hospitals has been fixed at Rs 5,000 a day. However, in case of admission to the intensive care unit, all hospitals, irrespective of the grades they fall under, have been instructed to ensure that the charges do not exceed Rs 15,000 a day.

COVID-19 Vaccine

Frequently Asked Questions

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How does a vaccine work?

A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

How many types of vaccines are there?

There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

What does it take to develop a vaccine of this kind?

Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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For patients in Maharashtra seeking treatment for COVID-19, there are three slabs on a per-day basis—Rs 4,000, Rs7,500 and Rs 9,000—based on the category of wards in which the patients have been admitted. All the rates for private hospitals beds would be all inclusive as a package. This will include, bed, food and other amenities, monitoring, nursing care, doctors' visits/ consults, investigations including imaging, treatment as per the national protocol for COVID-19 care and standard care for co-morbidities, oxygen, blood transfusion. The package rates would include costs of medical care of underlying co-morbid conditions, including supportive care and cost of medications thereof, for the duration of care for COVID.

Hospitals inflate costs

As different states cap treatment rates, several hospitals have introduced various heads such as care and hygiene charges, staff management and N-95 allocation expenses to increase the medical bills of patients taking treatment for COVID-19. Recently, a 32-year-old man was admitted to a super speciality hospital in Mumbai. He was in the hospital for 12 days and was handed a bill of Rs 3.7 lakh.

His bill included Rs 3,000 per day for PPE kits, Rs 500 per day as gloves charges, Rs 2,000 per day in COVID staff management charges and Rs 3,000 per day for COVID staff management charges in the ICU, Rs 1,000 per day as face shield charges and Rs 1,000 per day as gloves charges in ICU. The hospital also charged Rs 2,000 per day for patient biomedical hygiene charges and Rs 5,000 per day as oxygen charges in the ICU. As per government guidelines, there is no capping on such charges and hospitals are charging the patients as per their own convenience.

Heath Insurance, the best solution  

The only way to stay financially protected against the treatment of the infection is by buying adequate health insurance. If one gets hospitalised for coronavirus treatment, a health insurance plan will take care of medical expenses.

Buying a health insurance plan not just for yourself but for your entire family is important to make sure your hospital admission and treatment expenses are covered seamlessly. Your health insurance policy will cover you for testing and the cost of treatment for the novel coronavirus. However, while buying a health insurance policy, it is important to have an adequate sum insured, as the treatment of such pandemics is quite costly and one must have sufficient coverage to pay for the expenses.

On the directions of the IRDAI, all general insurers and specialised health insurers have been asked to come up with a standard covid-19 health insurance policy. The policy will pay for hospitalization expenses incurred by the policyholder for the treatment of COVID-19 on positive diagnosis for the infection from a government-approved diagnostic centre. It will cover room, boarding, and nursing expenses. Surgeons, anaesthetists, consultants, specialist fees, including consultation through telemedicine, will also be covered.

Other costs such as oxygen, operation theatre charges, surgical appliances, drugs and medicines, PPE kits, and gloves among others will be admissible if hospitalized for a minimum of 24 hours. Intensive care unit and intensive cardiac care unit expenses will be covered too.

(The writer is Health Business Head,
first published: Jul 1, 2020 09:14 am