These health plans cover home care: Does yours? | Economic Times

Domiciliary hospitalisation is a situation where the insured person is considered or treated as hospitalised even when he/she is at home. Many of the expenses incurred towards the treatment are covered by the insurance company. This is a feature of many health insurance policies, especially those that have been issued in the past 4-5 years. The domiciliary hospitalisation feature is especially useful now as many Covid-19 patients are being turned away by hospitals due to shortage of resources such as oxygen, medicines, beds etc. These patients have no choice but to opt for home treatment. Further, where one cannot avail the cashless claim facility for home care treatment, if the insurance policy has the domiciliary hospitalisation feature, one can use it to claim reimbursement for the treatment.“There are health plans which have feature of Home Care reimbursement; some insurance companies offer it as in-built feature whereas some provide it as an add on cover,” says Balachander Sekhar, CEO RenewBuy, an insurance aggregator. And since this is not a standard or mandatory feature in health insurance plans, the coverage offered will differ from one policy to another. Here is a look at what is covered under the domiciliary feature in an insurance policy, its limitations, the cost, how to make such a claim and what to watch out for. How does domiciliary hospitalisation cover work?This is not just limited to the treatment of Covid-19 as it can be availed for many other diseases as well. There are various circumstances in which you may avail this facility.“Domiciliary hospitalisation basically means that there is a need for hospitalisation but it is not possible because of three reasons; there could be shortage of beds which is the situation right now, other is due to some reason such as a comorbid patient cannot come to the hospital hence the hospital can come home; and the third reason is the doctor prescribing that you get hospitalised at home instead of a hospital,” says Amit Chhabra, Head-Health & Travel insurance , Policybazaar.comWhen domiciliary hospitalisation is neededDespite all efforts hospital bed is not availablePatient cannot come to hospital due to reasons such as existing comorbiditiesWhen a doctor recommends homecare instead of hospitalisationWhat treatment costs will be covered?Now, let us take a look at the kind of expenses that are covered under this homecare facility. “By all practical means all the costs that are covered under hospitalisation, will be covered in the domiciliary hospitsalisation, be it cost of medicines, doctors consultation fee or medical equipment rental like oxygen cylinder,” explains Chhabra.In the current scenario many medicines and equipment are available at highly inflated prices. So, will policyholders get the entire money reimbursed? Chhabra informs that even under normal circumstances it is not possible for insurers to pay inflated prices as the insurer will honour a claim up to a ‘reasonable cost’. Though policyholders may get reimbursed for a good part of their expenses, the burden of the difference between the normal price and current inflated price will fall on them. Health plans covering homecare treatment Insurer - Plan Name Hospitalisation at home Alternate Medicine Annual Premium (SI Rs 10 lac) Care Health Insurance – Care Treatments done at home due to patient condition or unavailability of hospital bed are covered up to 1 Lac Up to Rs 20K for utilizing ayurveda, unani or other alternate medicine methods Rs 9,031 Max Bupa Health Insurance - Health ReAssure Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Sum Insured Up to SI for utilizing ayurveda, unani or other alternate medicine methods Rs 12,012 ABHI - Activ Assure-Diamond Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Rs 1 Lac Up to Rs 20K for utilizing ayurveda, unani or other alternate medicine methods Rs 9,216 Edelweiss - Edelweiss Health Insurance Gold Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Sum Insured Up to Sum Insured for utilizing AYUSH Rs 14,743 Raheja QBE - Health QuBE Comprehensive Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Rs 50,000 NA Rs 7,584 Universal Sompo - Complete Healthcare Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Sum Insured Up to SI for utilizing ayurveda, unani or other alternate medicine methods Rs 13,642 Manipal Cigna - ProHealth - Protect Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Sum Insured Up to Sum Insured for utilizing AYUSH Rs 11,852 TATA Aig – Medicare Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Sum Insured Up to SI for utilizing ayurveda, unani or other alternate medicine methods Rs 11,671 SBI General - Arogya Premier Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Sum Insured Coverage up to sum insured for utilizing ayurveda, unani or other alternate medicine methods in Govt. & accredited hospitals Rs 12,174 Royal Sundaram - Lifeline Supreme Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Sum Insured Up to Rs 30K ; Up to 10 Lacs in govt hospitals for utilizing ayurveda, unani or other alternate medicine methods Rs 13,758 Reliance General Insurance - Health Infinity (More Time) Covered up to SI, No Sub-limits Up to SI for utilizing ayurveda, unani or other alternate medicine methods Rs 12,771 Liberty General Insurance - Basic Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Sum Insured NA Rs 10,909 Oriental Insurance - Individual Mediclaim Policy Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Sum Insured Coverage up to sum insured for utilizing ayurveda, unani or other alternate medicine methods in Govt. & accredited hospitals Rs 16,339 Magma HDI - OneHealth Support Plus Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Sum Insured Up to Rs 5 Lac for utilizing ayurveda, unani or other alternate medicine methods Rs 10,343 Chola MS General Insurance - Flexi Health Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Sum Insured Up to Sum Insured for utilizing ayurveda, unani or other alternate medicine methods Rs 91,52 Future Generali - Health Total Vital Treatments done at home due to patient condition or unavailability of hospital bed are covered up to Sum Insured Up to Sum Insured for utilizing AYUSH 10,194 All premiums for 40 years old male, premium includes domiciliary hospitalisation feature Source: Policybazaar.com The limits of domiciliary reimbursementIf there is a sub limit in the insurance policy, then the entire cost, even the reasonable ones, may not get reimbursed if it goes beyond the sub-limit. “Some health insurance companies offer the domiciliary treatment up to a certain percentage of the sum insured, whereas some companies provide it as a supplement,” says Sekhar. He further explains: “In case of providing certain percentage of sum insured (SI), the insurance company will not completely reimburse the treatment cost. For example, if one has a health policy of Rs 10 lakh and the health policy covers domiciliary hospitalisation up to 10% of the sum insured; then the policy holder’s domiciliary expense compensation will come to around Rs 1 lakh.” How to claim reimbursement?The reimbursement process works on the basis of documents, so you need to be mindful of saving all relevant documents to have a hassle-free claim experience. "What customer needs to do is to submit the proof that hospitalisation was required. Like in case of Covid a doctor would have prescribed for hospitalisation. All the investigation reports such as CT scan, and various other tests would be required. All the bills of expenditure would be required for reimbursement," says Chhabra. Be it a consultation through video call or online telemedicine call or a phone call, doctors do give a prescription which clearly states that hospitalisation is advised. So, you need to make sure that you follow up the call to get a prescription for domiciliary hospitalisation. As far as medical supplies are concerned it may be difficult to get receipts in some cases but you should make it point to get the receipt as far as possible. Be cautious while buying a new policyIf your existing policy does not cover domiciliary hospitalisation you may upgrade it by porting it to a new policy that has this feature. However, if you are planning on buying a new policy, then make sure to read the features in detail. “Home care treatment is not covered by default in every health insurance policy. Hence, if a consumer feels the need of home care treatment in future may arise, he should take note whether the policy he is purchasing provides domiciliary treatment as a feature,” says Sekhar. Do keep in mind that plans with lower sub-limit for domiciliary treatment may come with a lower premium and you will have to dole out higher premium to get the policy with higher domiciliary treatment limit up to the sum insured.