Articles

As a fiercer second wave of Covid-19 grips the nation with record daily rise in fresh cases, its not just public health that is impacted, it poses an equally grave threat to the financial health of affected persons. A quick glance at headlines will tell you that medical services in the country are stretched to the brink and black marketing of key life-saving drugs has made the situation especially lethal for finances of common man.

While Covid-19 vaccine protects you physically, health insurance is the only protection for your finances against the pandemic deluge. But just like vaccine jabs, health insurance is not a magic bullet as they come with some exclusions which are not covered, which means some risks are not covered by these policies. For example, all healthcare insurance inexorably have a waiting period for pre-existing ailments—which are not covered for the duration of the said waiting period.

There is also the risk of customers getting stuck in the middle of disputes between hospitals and insurance companies over billing and overcharging. As per reports, policyholders have been receiving only half the claim amount for Covid-19 hospitalisation.

One major dispute initially was the cost of personnel protection equipment (PPE) kits which are classified as consumables. But it was resorted later as insurers began covering this cost as well as it reduced with increased production. PPE kits formed a major part of hospitalisation bill and excess kits above predefined limit are being denied. The indicative rate structure of the General Insurance Council capped PPE expenses to Rs 1,200 to Rs 2,000 per day. Most insurers pay for only 1 PPE kit per day or upto Rs 1,500-2,000 per day.

Hospitals’ increased expenses on regular sanitisation for better hygiene was ultimately passed on to patients which is another area of concern for insurance companies. Costs such as housekeeping, air conditioning, daily charts and infection control charges are being billed separately to patients which some insurers refuse to pay. Insurers argue these should be a part of room charges itself.

Certain other charges such as cost of nebuliser kits, steam inhalers, thermometers, private nurses and attendant charges are completely excluded. However, the situation is better in case you are covered under a group health insurance plan, usually provided by the employer. In these custom-made plans, non-medical expenses are more easily covered as compared to standalone plans depending on built-in limits.

Nearly all health insurance policies have some exclusions which they do not cover so patients are left to fend for themselves when these charges are included in the hospital bill.