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The King Has No Clothes!<\/b><\/span><\/p>\n Why is your regular health insurance not enough?<\/span><\/p>\n In the fable, the King thought he had an elaborate and magnificent attire and no one had the courage to tell him he was naked. See if you feel vulnerable and unclothed after reading this piece.\u00a0<\/span><\/p>\n This article brings out the hidden risk of having the traditional health insurance cover hoping that your savings will be protected in times of Corona. More than ever before, the evolving situation is throwing up challenges that you never expected. Read further to learn more about the surprises<\/span><\/p>\n The details below will show that Covid hospitalizations are resulting in lacs of rupees unpaid in the hospital bills, despite policyholders having ample sum insured. There are reasons for this which are explained and finally what are your options to cover for that risk.\u00a0<\/b><\/span><\/p>\n The rate at which Covid-19 is rising, one expects that most of you reading this may come close to getting infected by the time the disease gets over. Worse of all, CDC in the US has now confirmed that the spread of the coronavirus is evidenced as airborne.<\/span><\/p>\n Many of us have a regular health insurance policy. At the time of making a health insurance claim, there are 4 areas where you will end up paying out of pocket –<\/span><\/p>\n Although Coronavirus infection is covered under most of the regular health insurance policies, it may not be enough to cover the cost of Covid-19 treatment at a private hospital. People living in metros are spending, on an average, more than half of the amount of the treatment costs out of their own pockets.\u00a0<\/span><\/p>\n A claim may not be settled fully in the following scenarios:<\/strong><\/span><\/p>\n 1.<\/span> There is a capping on the room rent \/ ICU in the Health Insurance Policy:<\/span><\/b><\/span><\/p>\n For example, you have a standard health insurance policy of Rs 10 lacs with 2% capping on Room rent and 5% on ICU, and a co-payment of 10% on the total claim amount. The hospitalisation bill comes for Rs 5 lacs \u2013 Rs 3 lacs room rent and medical expenses and Rs 2 lacs \u2013 Consumables and non medical items. The latter share will not be covered under your regular insurance. And out of the Rs 3 lacs Medical expenses, some more amount will be deducted towards the capping and co-payment. These factors would have a bearing on all associated medical costs. These cappings would result in the insured shelling out a lot of money off their pockets!<\/span><\/p>\n *Capping refers to the limit up to which the insurance will settle a claim.<\/span><\/p>\n 2. Overhead Consumables – may not be covered under a regular health insurance <\/b><\/span>policy Overhead consumables such as PPE kits, gloves and other disposables. Rising cost of disposables and consumables has resulted in an exorbitant rise in the treatment costs in private hospitals.<\/span><\/p>\n PPE kits consist of 7 components i.e Goggles, FaceShield, Mask, Gloves, Coverall \/ Gowns (With or Without Aprons),\u00a0 Head Cover & Shoe Cover. Each component & its rationale use has been defined by Ministry of Health & Family Welfare<\/span><\/p>\n Usually the portion of consumables in a surgical case is almost 10% of the total bill value. When it comes to Covid-19 related hospitalisations, they constitute a much larger portion as much as 50% of the total bill amount! This is because the hospitals (small or large) have to invest heavily in keeping the infection in control. In addition, they have invested in logistical changes like increasing the health insurance cover for the doctors & nurses, spending more on disposable one-time use items, PPE kits, Overall cleanliness and dis-infection, more number of medical machines and equipment etc. Proportionally, with a rise in the operating costs, the treatment costs have gone up. And hospitals are levying higher charges on patients due to the increased operating costs.<\/span><\/p>\n 3. Ceiling on Covid-19 treatment rates by various State Governments and GI Council\u00a0<\/b><\/span><\/p>\n In order to maintain a rational costing, GI Council issued a standard zone-wise rate chart to be followed by the hospitals and all the insurance companies. Most of the prominent private hospitals are not agreeing to the guidelines and charging as per their own tariffs. This is where comes the major dispute between insurers and hospitals over the expenses payable! Ultimately, the patient suffers the loss.<\/span><\/p>\n There is a huge difference between how much an insurance company is willing to pay and what insureds are actually paying out of pocket!\u00a0<\/span><\/p>\n\n
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