Is Home Treatment due to COVID-19 Covered Under a Health Insurance Policy?

The increasing number of coronavirus cases had led to an acute lack of hospital beds. Given that, health insurance companies stepped in to offer domiciliary hospitalization cover to policyholders. The shocking flow of patients during the ongoing pandemic prompted health insurers to shed some light on the importance of home treatment facilities under health insurance plans and therefore they started covering home treatment of covid-19 patients.

Domiciliary Hospitalization

It refers to a situation in which insured members enjoy the benefits of availing of medical treatment at home. Unquestionably, it has proven to be extremely helpful to Covid-19 patients since the hospitals had to turn them away because of a shortage of beds, medicines, oxygen, etc. Consequently, patients were left with no choice but to get home treatment. Many patients were also found to battle for breath due to the unavailability of beds.

Look what can be included under the domiciliary feature in a health insurance policy. Also, look at its cost, how to claim, limitations, and what all to watch out for.

When domiciliary hospitalization is required

It is required in conditions when your health practitioner advises getting treatment at home not in a hospital, the policyholder is unable to procure a hospital bed or beds or not available hospital. In addition, some patients are eligible for domiciliary hospitalization due to their co-morbidities and pre-existing diseases.

Home Care Reimbursement

Some health insurance policies are designed to have the feature of Home Care reimbursement. Other insurers provide it as an in-built feature and many provide it as an add-on cover. Since this feature is not standard or compulsory in medical insurance policies, available coverage can vary from plan to plan and insurer to insurer.

What Treatment Costs Are Covered

Don’t be surprised to know medical costs are covered under the home care facility. Typically, the Corona kavach health insurance plan provides coverage for all expenses that come under domiciliary hospitalization, including the cost of medicines, medical equipment, oxygen cylinders, and doctor’s consultation fee. It covers COVID- 19 home treatment up to a maximum of 14 days.

Sub-limits in Domiciliary Reimbursement

Sub-limits means you will have to pay a certain percentage of the amount of the sum insured. There are some health insurance companies that offer the domiciliary treatment benefit up to a certain percentage of the coverage amount. Others provide it as an add-on cover only.

For instance, if you have a health insurance plan with a coverage amount of Rs 10 lakh, and the cover for domiciliary hospitalization is 15% of the sum insured, then the actual payout by the insurance company would be Rs 1.5 lakh.

Note that during treatment at home, a cashless facility is not available. And you can only claim for reimbursement of the treatment expenses if your policy provides domiciliary hospitalization cover.

Homecare Treatment – How to Claim Reimbursement

To have an easy claim experience, it is important to save all your documents.

What do you need to do?

  • Submit proof that ‘home treatment’ was suggested by the treating doctor
  • Submit proof of why hospitalization was required
  • For instance, in the case of hospitalization due to coronavirus, many patients availed treatment at home and then filed for reimbursement
  • Check all the documents required
  • Collect all your investigation reports like prescriptions, medical tests, CT scans and other diagnostic tests
  • Arrange all receipts and bills of the expenditure incurred at the time of claim reimbursement as the insurer can ask.

Be it online consultation through video or voice call, or a personal visit to a clinic, the prescription provided by the doctor is required. The prescription should have mentioned the hospitalization or home treatment. So, rest assured that you follow up the call for getting a prescription for domiciliary hospitalization.

Getting receipts in case of medical supplies is difficult. However, you should try and get the receipts as far as possible. It is important to know that home treatment is not a default feature that will be provided in every health insurance policy. Remember that any health insurance plan with lower sub-limits for domiciliary treatment may have a lower premium when compared with a policy that provides domiciliary treatment cover up to the sum insured.

Takeaway

If you have a health insurance plan with no cover for domiciliary hospitalization cost, it is good to always upgrade it with the add-on benefit. Or you can port it to a new plan while buying a new policy.

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