You can make a claim if your health policy covers domiciliary hospitalisation
As the fight against the pandemic gets intense, the shortage of beds and unavailability of medical staff across top cities have become major challenges for hospitals and patients. Some private hospitals have started offering home-care packages to COVID-19, patients. These include Medanta, Sir HN Reliance Foundation Hospital, and Fortis Healthcare. Individual initiatives such as Onerupeeclinic, which have devised such packages for mildly symptomatic patients, starting at Rs 300-375 per person a day. Depending on the service provider and type of package chosen, these charges cover doctor’s consultation through video calls, nurse visits and also COVID-19 tests after the treatment, among others.
Covered under health policies, but conditions apply
If your medical practitioner does recommend this mode of treatment for you or your family members, turn to your health insurance policy wordings and document to know if the insurer will pay the bill. As a general rule, a regular, indemnity-based health policy reimburses the hospitalisation expenses as well as listed day-care procedures (that is, treatment processes that do not require 24-hour hospitalisation) up to the sum insured.
Several health insurance products today include a domiciliary hospitalisation cover, which pays for treatment taken at home under specific circumstances. A relatively lesser-known feature, it could turn out to be policyholders’ unlikely saviour during Corona times. In simple terms, domiciliary hospitalisation refers to treatment prescribed by a medical practitioner that requires hospitalisation, but can be provided at home if the patient’s health condition does not permit her to be moved to a hospital or rooms are simply not available at hospitals. It’s the latter part of the definition that can come to your aid now.
“This is the need of the hour and we will honour such claims. It is quite clear now that the magnitude of the healthcare crisis induced by the pandemic has overwhelmed our hospitals. Not only are we facing a scarcity of hospital beds, but also the risk of contracting infection while visiting hospitals,” explains Nikhil Apte, Chief Product Officer, Royal Sundaram General Insurance.
Not all products include this clause in their documents. But a few general insurers such as ICICI Lombard have now decided to foot the bill for home-care expenses incurred by their policyholders until March 31, 2021. “Nearly 80-85 per cent of COVID-19 cases are mild and do not require hospitalisation. So we have decided to cover home healthcare expenses for treatment and self-isolation for suspected cases, besides certain other ailments, as long as a protocol is in place and this course of action is recommended by a registered medical practitioner or a hospital,” says Sanjeev Mantri, Executive Director, ICICI Lombard. Even in the case of regular domiciliary hospitalisation claims, you will need to submit the doctor’s recommendation and the relevant bills.
Mind the restrictions
Since home care expenses will be paid for only if your policy includes domiciliary hospitalisation cover, go through your policy document to find out whether it is covered or is listed an exclusion. Also, ascertain if your product imposes sub-limits. For example, your policy could specify that treatment at home will be covered only up to 10 per cent of the sum insured. “Most good insurance plans, the newer ones in particular, cover domiciliary hospitalisation up to the sum assured, while some have a separate limit for the purpose. Also, the cover could be triggered only if the hospitalisation is necessary for three days or more,” says Mahavir Chopra, an independent health insurance expert. However, self-isolation or precautionary quarantine at home will not be covered unless your insurer has decided to extend a special facility in the current context. “Anything that does not necessitate hospitalisation will not fall in the ambit of domiciliary expenses. If you have simply been asked to isolate yourself and no active treatment is prescribed, this cover will not come into the picture,” he adds.
The devil in the details
The devil could lie in the details of your policy terms and conditions as some insurers specifically exclude certain illnesses from this cover. “Domiciliary hospitalisation could exclude upper respiratory infections such as cough and cold, asthma, bronchitis and laryngitis, and many insurers can consider COVID-19 under this category and exclude the treatment. It would be helpful if insurers or the regulator can issue a clarification on this,” says Chopra.Go through your policy document and enquire with your insurance company about the coverage for COVID-19 home treatment while signing up for the packages.