COVID-19: Know how home hospitalisation works in health insurance policies

May 18, 2021 11:20 AM

Considering the acute shortage of hospital beds and the rapid pace at which COVID-19 is spreading in India, insurers are also covering domiciliary hospitalization.

Numerous hospitals and healthcare workers across the nation have started giving home treatment to patients wherever needed.

As India continues to battle with the interminable surge in the number of COVID-19 positive cases, the healthcare system across the country is overwhelmed owing to the acute shortage of hospital beds. Multitudes of patients can be everyday seen gasping for breath while their family members plead for admission to health workers outside the overbooked hospital premises. The panicked hunt for hospital beds is a recurrent theme across the country as India only has about 0.5 hospital-bed for every 1,000 people, against a global average of nearly 2.9.

Scenes of family members hoping to prolong the lives of their loved ones infected with COVID-19 with prayers until they find a hospital bed have become the new normal. As per most hospital authorities, they have never ever experienced such a stupendous patient inflow before, and the utter dearth of hospital beds is making things worse.

Domiciliary Hospitalisation to the Rescue

Fortunately, the only ray of relief during such severe crises is that many hospitals due to the immense shortage of hospital beds have started giving home treatment to patients infected with the coronavirus. Numerous hospitals and healthcare workers across the nation have started giving home treatment to patients wherever needed. Something worth mentioning here is the fact that even if you are not able to get a hospital bed for treatment of COVID-19 and are taking treatment at home, you will still be able to claim the expenses from your insurer.

Considering the acute shortage of hospital beds and the rapid pace at which COVID-19 is spreading in India, insurers are also covering domiciliary hospitalization – expenses incurred during treatment at home are covered. However, both these conditions must be met for availing domiciliary hospitalization. First, the patient’s condition is extremely serious and critical to visit a hospital, second; medical facility at the hospital like bed, oxygen, etc. is not available for proper treatment. Only under both these two conditions, a COVID-19 patient can avail the hospitalization at home benefit.

If you have any existing policy, it is better to check and confirm that domiciliary hospitalisation is covered, and if you are buying a policy now, this should form a key decision while choosing your insurer. Some insurers do provide domiciliary hospitalization for other illnesses but do not cover COVID-19 as it is classified under Upper Respiratory Tract Infection. While your insurer may cover regular hospitalisation due for COVID-19, a few insurers may not cover home treatment. It is always advised to check with your insurer beforehand prior to filing a claim.

It is equally important to note that your insurer will only cover you if the treatment lasts for at least three days, that is 72 hours. Treatment at home for less than 72 hours will not be covered by the insurer. The various procedures covered under home treatment include medication, CT scan, X-ray, nurses and doctor’s visit at home to measure vitals, set-up of ICU if need be and all other essential procedures that need to be conducted until you test negative for coronavirus.

Extent of Coverage

Another important thing to know before filing an insurance claim for home treatment is the extent of coverage. While most health insurance plans cover you for domiciliary hospitalization up to the entire sum insured, there are even some plans that have sub-limits on the coverage amount. For instance, for a Rs 10-lakh sum insured policy, treatment costs up to Rs 1 lakh will be covered for domiciliary hospitalization.

The claims process is fairly simple and just needs some basic documentation which includes the Covid Positive report from an ICMR approved lab, all relevant bills, investigation file or line of treatment and any relevant documents supporting which clarify that hospitalisation was needed. Post this, insurers process the claim amount into your bank account as a reimbursement claim.

Take Note

Domiciliary Hospitalization is mostly covered under the reimbursement process wherein the customers first need to make all payments by themselves and later submit the bills to the insurer to get the expenses reimbursed. It is, therefore, advised to keep all the original copies of the expenses done handy as the insurer may ask for every small bill of the expenses made and will only pay for expenses for which original bills are available.

(By Amit Chhabra, Health Insurance, Policybazaar.com)

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