Insurance scheme for health workers

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The COVID-19 outbreak in India started towards the end of January posing serious health risks. Hospitals and health workers have been playing a huge role in treating patients. They are facing a new challenge as there is no fixed medical protocol to treat patients affected by this virus. The outbreak has led to an increased demand for health care workers and has put them on the front line of managing and treating patients. This has also called for maintaining the quality as well as the quantity of the available health care workers. The countrywide lockdown has further aggravated the situation for the health sector. The government has, thus, taken various steps to protect the health care workers from possible exposure to the virus and also to help their families.

Pradhan Mantri Garib Kalyan package: Insurance scheme for health workers fighting COVID-19

The Union Ministry of Finance launched a nation-wide insurance scheme allocating 1.7 lakh crore rupees to help the poor and the vulnerable fight the pandemic. This included various schemes to help the needy in this time of distress. To support the health care workers who have taken the lead and are treating the patients affected by COVID-19, the government has also introduced an insurance scheme specifically for them. This scheme was introduced as the health care workers are exposed to huge risks of health and life while treating the patients. The lesser availability of personal protection equipment has led to this risk.

Details and significance of this scheme 

Insurance cover:

This is an accident insurance scheme that covers the loss of life due to COVID-19 as well as accidental death caused due to COVID-19 related duties. It will provide the health care workers with coverage of 50 lakhs for the next ninety days and is applicable from 30th March 2020 till 30th June 2020. This will be extended in case the pandemic is not controlled.

Who is covered:

The scheme has considered all those health care providers who will be in direct touch with assisting and treating the patients. According to the notification released by the ministry, “Safai karamcharis, ward-boys, nurses, ASHA workers, paramedics, technicians, doctors and specialists, and other health workers” are covered under this scheme.

This scheme covers not only the health care providers working in government hospitals but also those working in private hospitals. The notification specifies that 22 lakh health care providers will be covered under this scheme. The scheme also covers daily wage workers working in the hospitals; outsourced staff of the government hospitals and workers hired through other contracts.

Process of claiming:

The process of claiming insurance has also been simplified. A family member of the deceased, the claimant, is required to fill up certain forms for making such a claim and also submit the necessary documents to the institution in which the deceased was working. The institution will then forward the same to the competent establishments such as the Director-General of Health Services as authorized by the State Government or the Central Government. This will then be sent to the insurance companies for approval of the claim.

Significance:

The significance of this scheme can be explained based on the fact that health service providers have taken an immense risk in treating patients affected by this virus. Though it is similar to SARS, it was newly discovered in Wuhan, China in December 2019. As no existing protocol was present, the healthcare providers had to treat the patients in the way they thought to be the best. Worldwide, healthcare providers have developed symptoms and have contracted the virus while performing their duties.

Data shows that a significant percentage of the working health care providers in Italy have contracted the virus from the infected and few of them have died. Apart from this, the health care providers are short of the personal protective equipment, which puts them at higher risk levels.

In a hospital in Bihar, a patient was treated by doctors and nurses without personal protective equipment. Almost all of them started showing symptoms. So far, fifty doctors and nurses in India have tested positive for Coronavirus. After nearly thirty health care providers were tested positive in a Mumbai hospital, it was declared to be a containment zone.

Apart from doctors and nurses, daily wage workers and ward-boys are also exposed to the virus daily owing to the nature of their work. In a few hospitals, the health care providers have gone on strikes and some have even rendered their resignations due to the unavailability of basic protective equipment to treat the patients. Apart from the personal protective equipment, factors such as the increased exposure to the infected patient and a lack of training to treat respiratory disorders have also contributed.

Healthcare providers across the world have been exposed to such risks. The need to protect the health care providers has hence increased even more in this current situation. With many healthcare providers in India having gone into isolation, and many of them protesting, this scheme, which provides 50 lakhs to the legal heir of the deceased health service provider, is seen as a good move by many medical associations in the country. The Government has allotted the budget of the National Disaster Response force for managing the costs involved in the above scheme.

Salient features

Unlike a usual health insurance cover, this scheme provides for insurance coverage only after death. This scheme does not cover the expenses incurred in case the health care provider is admitted to a hospital after being tested positive for corona. This insurance scheme is in addition to the coverage taken by the person in his/her capacity.

The Government has also stated that the Central Government and the concerned State Governments will be required to give certificates to the health service providers based on which the insurance can be claimed. The New India Assurance Company has come forward and released the guidelines for the same. The company has also stated that the amount will be paid almost immediately. The positive test certificate is only necessary in cases of death due to COVID-19. Accidental death caused due to treating patients affected with COVID-19 does not require the test certificate.

The Government has, thus, tried to introduce a scheme for the safety and security of health care workers at risk and has also has tried to make the claiming process as hassle-free as possible.

Shortcomings

The biggest shortcoming of the scheme is that the insurance coverage is only provided in case of death that includes death caused due to COVID-19 and accidental deaths caused due to COVID-19 related duties.

It is known that not everyone who contracts the virus dies. The shortcoming lies in the fact that the expense incurred by the family for treatment will be very high. The Supreme Court has time and again slammed the private hospitals for charging an excessive amount for treatments. Though there are other insurance schemes available such as the Ayushman Bharat, all the health workers are not necessarily covered under this scheme. For instance, in the Ayushman Bharat scheme, eligibility is decided on the basis of the income levels. All the health workers may not fall under the requisite income bracket and might not be able to afford the expense for treatment otherwise.

Though this scheme has tried to include under its ambit a huge population, it is expected that many will be ignored under the category of contract workers as they may not have been categorized, under those contracts, as “health workers”.

The Government, recently, has also released FAQs on the Pradhan Mantri Garib Kalyan Package for health workers that aim to clear the common doubts including the coverage of the scheme. Since its release, after having read the fine print, the concerns against the scheme are being raised.

Legal provisions

Health has been perceived as a public concern in modern times. Though the health of a person is restricted to his/her personal boundaries, a situation like the present pandemic calls for measures to be taken by the Government.

The right to health is not an express right under Article 21 of the Constitution of India. But many judgments have pointed out that the right to health is an implied right under Article 21. No clear boundaries have been laid so far as to determine what falls under the ambit of this right. The courts have time and again dealt with cases that involve reimbursement following the insurance schemes provided by the Government. In State of Punjab v Mohinder Singh Chawala [(1997) 2 SCC 83], the court held that the Constitution places an obligation on the State to provide reimbursement to the patient following the scheme provided by it.

Apart from Article 21, the Directive Principles of State Policy under Article 47 imposes the obligation on the State to improve public health. Article 41 of the Constitution deals with social security schemes.

Various insurance schemes in India introduced by both the Central Government and the State Government fall under the social security blanket. The PM Garib Kalyan insurance scheme is unfunded. The Government will be paying the premium through the budget of a specific department, namely the Ministry of Health and Family Welfare. This scheme has other facets of social security as well for which a fund is created for it specifically.

Article 39(e) also places certain obligations on the state on a similar line. It provides that the State shall protect “the health and strength of workers, men, and women, and the tender age of children are not abused and that citizens are not forced by economic necessity to enter avocations unsuited to their age or strength”. Though the directive principles of State policy cannot be enforced in a court of law like a fundamental right can, they act as a guiding principle for the State.

This scheme does not have a specific legislation drawn out for this purpose and functions solely as an insurance scheme introduced by the Government. In countries like Canada and the United States, they have a statutory framework that acts as a legal backing to all kinds of insurance programs introduced by their respective governments. These frameworks also draw guidelines, and limits as to what is covered under every insurance scheme. Though no such statutory framework has been drawn for the Pradhan Mantri Garib Kalyan Yojana, a person eligible to claim the insurance can enforce his/her right under Article 21 in the court of law through various writs. 

The Central Government is empowered under Article 245 and Article 246 to make such laws. The Parliament can pass a law to back the Pradhan Mantri Garib Kalyan Yojana under Entry 47 of List I. Entry 47 of List I deals with Insurance i.e. the Parliament has powers to pass a law for providing insurance. 

Though the scheme is limited only to the next ninety days (from 30th March 2020), enacting a law for its purpose will result in the proper application of the scheme. Introducing a law for the same gives a “legal guarantee” for the beneficiaries to enforce their rights in a court of law.

Conclusion

The scheme will cover about 22.12 lakh people. All of these are suspected to be at risk due to direct contact with the infected patients. This scheme was a result of numerous letters written by medical associations to take actions for the safety, and security of the health service providers. This move by the Government was invited by many medical associations as this gave security to the families of medical service providers.

The scheme also provides for immediate claiming of the coverage. But some of the medical associations are not very happy with the way the scheme has been designed. The insurance amount will be provided in cases of accidental death caused due to Coronavirus. An inclusion of hospitalization expenses caused due to the COVID-19 would have been a good motivation for the health service providers.

Most of the states in the country are in the second stage of the pandemic. There is already a shortage of nearly 2 million nurses and around six lakh doctors. Apart from this, there is also a demand for ward boys, paramedics, daily workers, etc. who lend a helping hand to the health care professionals. When India enters the third stage, the demand will increase. In such a situation, it is important to protect the health service providers form exposure to the virus.

The present scheme provides some relief but it is also important to provide non-monetary benefits to encourage health service providers in India. Long working hours and non-availability of personal protective equipment is a huge factor that discourages doctors from attending patients with symptoms. In these trying times, much more efforts are needed to save those who are working towards saving us.

Author: Harinie.S from Symbiosis Law School Hyderabad.

Editor: Shalu Bhati  from Campus Law Centre, Faculty of Law, University of Delhi.

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