With hospitals running short of beds across major cities in the country, some have tied up with hotels to act as
Depending on the facilities available, patients could get access to doctor visits, nursing services, monitoring and even oxygen support at such hotels. In fact, a few state governments, too, have converted some hotels into temporary COVID-19 care facilities.
Treated as makeshift facilities
The Insurance Regulatory and Development Authority of India (IRDAI) had, last year, issued a notification recognising ‘makeshift’ or temporary hospitals. You can claim reimbursement for the expenses incurred under your regular health insurance policies.
Insurers were asked to settle claims of patients who seek treatment at such facilities, provided such facilities are approved by central or state governments.
“Where a policyholder who is diagnosed as COVID-19 positive is admitted into any such make-shift or temporary hospital on the advice of a medical practitioner or appropriate government authorities, notwithstanding the definition of hospital specified in the terms and conditions of policy contract, the treatment costs shall be settled by insurers,” the IRDAI notification had said in July 2020. If set-up by hospitals in their cashless networks, the insurance regulator asked insurers to treat such makeshift hospitals as extensions of these hospitals and provide cashless facilities too.
“If hospitals are advising admission into these hotels with which they have tied up due to scarcity of beds, they will be treated as makeshift centres. But these should be authorised hospitals and the centres should be managed by medical professionals. A facility set up by, say, a charitable institution without trained medical staff will not qualify as a makeshift or temporary hospital,” says a senior official at a private general insurer who did not wish to be named.
Several conditions to be fulfilled
But staying in a hotel while recovering from COVID-19 is not a substitute to simple home isolation. It’s a substitute to hospitalisation, if you need it. There are conditions to be fulfilled here, if it has to qualify for insurance reimbursement. “If the admission to the hotels is on the recommendation of the treating doctors and hospitals, the claim will be paid. However, there should be active medical management involved, including doctor’s visits, regular monitoring, medication and supportive care such as oxygen support,” says Sanjay Datta, Chief, Underwriting and Claims, ICICI Lombard. The treatment recommended – for example, administering intravenous (IV) drugs – should merit hospitalisation.
If you simply get quarantined into such hotels or other COVID care facilities merely as a precautionary measure, you will not be eligible to make a claim. ‘If a person diagnosed with COVID-19 needs proper hospitalisation and not just a quarantine facility, the person can get admitted in any of these make-shift hospitals provided the doctor gives a written recommendation. In such a scenario, the insurers shall settle the treatment costs,” says Amit Chhabra, Business Head, Health Insurance, Policybazaar.com. Isolation without any active line of treatment will not be paid for. That is, if you feel the need to isolate yourself only because other members in your family have tested positive or you suspect that you have come in contact with a COVID-positive patient, the claim will not be paid.
“We realise that there is a dearth of beds, but the severity of the patient’s condition should be such that it necessitates hospitalisation. This is the basis for scrutinising such claims,” says the senior industry official quoted earlier. The key is doctor’s advice and the severity of the disease. “Your claim will qualify for payment once the treating physician or the hospital recommend hospitalisation after classifying it as moderate-to-severe case,” says Anuj Jindal, Co-founder, Sureclaim.
As Moneycontrol has reported earlier, mild COVID-19 claims
could get rejected on the grounds that hospitalisation was unnecessary. Likewise, if your doctor has advised treatment at home, but you prefer to go to the hotel that has tied up with a hospital, your claim will not be paid for. It will finally boil down to doctor’s advice on hospitalisation, necessity of hospitalisation and active lines of treatment that such facilities can provide.