Employees say patients are being paid only ₹5000 per day and not ₹7,500; the insurance company has sought a clarification from the government
The Tamil Nadu Government Employees Association has complained that the full daily rental was not being paid for private hospital wards for non-critical COVID-19 treatment, for government employees and pensioners covered under the New Health Insurance Scheme.
It’s Virudhunagar district vice-president, C.E. Kannan, said that the Government Order 280 dated June 24, 2020 had fixed a ceiling of ₹9,500 per day and pharmacy charges for COVID-19 cases for treatment in category A1 and A2 private hospitals. The ceiling for treatment given by other private hospitals (categories A3-A6) is ₹7,500 per day and pharmacy charges.
“We had no problem in getting this insurance compensation till September 2020,” he said. However, patients were now being paid only ₹5,000 a day instead of ₹7,500 a day in the second wave of COVID-19, he said. “Since this is not a cashless treatment scheme, the insurance company is only paying partial compensation under the package. The beneficiary has to pay the balance of the total treatment charges,” Mr. Kannan said.
“When asked, United Insurance Company said that the Government Order 280 had no mention about non-critical COVID-19 treatment in the general ward category (but only for treatment given in individual rooms),” Mr. Kannan said.
The insurance company said that since there was no mention about it in GO 280, it was following the guidelines of GO 240 dated June 5, 2020 in which the Health and Family Welfare Department had fixed ₹5,000 per day for treatment given in the general ward for all categories of hospitals.
“The issue is GO 280 is only for government employees and pensioners while GO 240 was meant for the general public under the government insurance scheme,” Mr. Kannan said.
“The government employees are forced to go to general wards due to non-availability of rooms or due to exorbitant room rentals in private hospitals. The employees cannot afford to pay higher room rentals due to the fixed ceiling,” he added.
Mr. Kannan argued that since the insurance company was only making partial payment towards the package cost, it should consider treatment in general ward also as room in private hospitals and make the payment of Rs. 7,500 as per the G.O.
The insurance company has sought a clarification from Principal Secretary/Commissioner of Treasuries and Accounts to resolve the issue of daily payment as the number of complaints from government employees/pensioners is increasing.
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