Health Insurance Compensate COVID-19 expenses

Dr. Daleep Pandita
With the ongoing exponential increase in number of active cases of COVID-19 and subsequent deaths due to this pandemic, now its consequences are assuming different challenging dimensions day by day. World Health Organisation (WHO) predict its presence for a long time and our medical experts also foresee its prolong continuation in India. Conclusively, people have no alternative but to update their mindset and adopt to live with this prevailing COVID-19 atmosphere.
While preventive medical advices including quarantine procedure are being followed strictly which is better than cure, by now people at large, have acquired sufficient awareness and are well versed with precautions to be undertaken for prevention of spread of this pandemic. Additional non medical measures including strong will power with positive attitude to fight this disease, doing meditation, adopting yogic attitude, regular exercise, immunity boosting diet etc. which are easily affordable and less expensive, have successfully reduced the threat of spread of this pandemic.
This alarming rise in number of positive cases have given a different socio economic dimension to this problem. Nearly 15,000 new Corona Virus positive cases are reported in our country on daily basis, out of which about 10,000 cases require hospitalization for its treatment. It becomes huge number in terms of extending quality medical facilities and sustaining its heavy financial burden. So providing low cost affordable and quality treatment to these active COVID – 19 cases is the urgent and important need of the hour, when normally people are not prepared to incur such heavy expenditure on this long term compulsory hospitalization period. Most of the patients are neither aware of advanced medical treatment nor are sound with strong financial background. Less expensive government hospitals are almost full in their capacity with active patients while private medical institutes though providing better medicate, are cost threatening. When getting good quality medical facility at affordable cost remain basic expectation of such patients but their large number of cases and the huge amount involved in the treatment, dilute this fundamental right.
Such uncertain risky circumstances leading to heavy financial involvement, health insurance seems to provide much needed strong alternative to this burning problem, especially for poor citizens. Although our country is already running world’s largest health insurance scheme, Pradhan Mantri Jan Arogya Yojna ( PMJAY ) which covers more than 55 crore persons through about 11 crore families based on Socio Economic Caste Census of 2011 (SECC-2011) to address this important issue to a great extent. But at present this PMSBY lacks its sustained publicity campaign in conveying its benefits down to the masses that this paperless benefit insurance scheme also covers the expenses incurred on the treatment of COVID-19 on cashless basis up to the extent of Rs. Five lacs per family on floater basis for one complete year. This PMJAY covers the expenses incurred on hospitalization including room rent, consultation fees, expenses for laboratory diagnostics and particularly ventilator charges essentially required for treatment of COVID-19 patients, that is undertaken at more than 16,000 designated hospitals all across the country which are already empanelled for implementation of this scheme.
Adequate monitoring need to be enforced to maintain check and balance on quality and cost of treatment besides reasonable control on temptation to inflate insurance claims so as to strengthen efficient and affordable healthcare mechanism for large number incoming COVID-19 patients
Health conscious people of our country, who have already availed different health insurance covers, either from Government of India Public Sector Insurance Companies or from private insurers, are already entitled for cashless benefits against the expenses incurred on treatment of COVID-19 cases, as per limits of their total sum insured of their respective insurance policies. However, costs incurred on various laboratory tests for persons declared COVID-19 negative are not payable under such schemes.
Further, under recently launched Pradhan Mantri Garib Kalyan Yojna (PMGKB) Government of India undertaking, The New India Assurance Company ( NIA ) pre attempted the remedy to ongoing crises by insuring more than 2212 lakh healthcare workers of India across grades, including paramedics, nurses and ASHA workers, who are on the frontline of battle against COVID-19 for a cover of Rs. 50 lakhs. This tailor made comprehensive personal accident insurance scheme not only encourage our warriors to take on COVID-19 head on but also takes care of their financial liabilities in case of their fatality, so that medical fraternity delivers its best.
Now it is fact that we all have to live together with risks of COVID-19 and that too for a pretty long time, when it is predicted that nearly ten percent of our total population will get affected by it, which turns out to be a huge number. Government along with Non Governmental Organizations are completely together in their all out efforts to continue to fight this pandemic and our administration along with medical fraternity, both at government and private levels, are equally competent to take care of varied health risks arising out of present situation. But at present the total finances involved in quality treatment of COVID-19 patients amounts to quite high, which is unexpected and not easily affordable by ordinary people.
Conclusively, under the prevailing global economic recession in all fields at all levels due to this Corona virus crises, important issue of addressing the financial risk involved in treatment of COVID-19 patient assumes utmost importance. Final option for a common citizen ultimately remains to hold on to some health insurance scheme in order to address this vital issue. Those citizens, not covered under any medical insurance scheme, need to rethink of considering this option of taking care of high risk of financial losses in the longer run. Presently, all the medical insurance schemes in the country completely cover all types of expenses incurred on COVID-19 treatment and even does not require any prior medical examination before taking such insurance covers. Further, Government also need to prevail upon insurers to come up with low cost affordable medical insurance schemes under present circumstances, to take care of health risks of its citizens caused by ongoing Corona virus pandemic.
( The author is Senior Divisional Manager with Govt. of India PSU & Nodal Officer of J&K for COVID-19 Health Insurance Scheme )