Does Health Insurance cover COVID19 Treatment at Home?
Beds unavailable. Covid wards are full. Take treatment at Home.
We've heard these lines echoing across news channels and social media platforms - over and over the last few weeks. No matter which city or town you are from - the fact remains that the medical and healthcare ecosystems are overburdened. And even in cases where patients manage to find hospital beds, there's a very reasonable fear of contracting a new, serious infection from a hospital full of Covid patients.
Given this unprecedented situation, doctors have been recommending 'Home Care Procedures' to Covid patients - and while this was only for mild/ moderate symptoms initially - several severe cases as well - are being treated at home, right now.
And as a result - there have been many questions floating around on how health insurance providers would deal with such treatments and whether the costs would be paid by them - if the treatment for Covid is taken purely at home.
So, here's a quick article detailing all you need to know about how insurance for Home Medical Care - also known as Domiciliary Treatment works - under both regular health insurance plans as well as Covid19-specific plans that were launched last year.
Coverage in Regular Health Insurance Plans
Some conditions must be fulfilled for your health insurance to pay for your 'home-care or 'hospitalization-at-home' expenses.
1. Your plan offers 'hospitalization at home': You will first need to carefully check if your plan offers such a cover. If it does - it will be mentioned on your policy document clearly. If it isn't mentioned in the document - it means that you will not get the cover.
2. The hospitalization must be 'Necessary': This means that the treatment should be recommended by a medical practitioner/ doctor and the severity of the condition should ideally require the infrastructure of a hospital. Only then, will this treatment be paid for. For example, if you have mild symptoms that can be managed with oral medications - this won't be termed as a 'necessary hospitalization'. So, the insurance plan won't pay for such a treatment.
3. The patient cannot be admitted to the hospital: This could be because of two reasons. One, hospital beds aren't available in your area. Two, the patient might be too weak/ sick to go through the move to the hospital. If either of these cases is true - your home treatment would be covered by the insurance. (But - if you have beds available nearby/ are well enough to reach there - but still choose to get treatment at home - the insurance policy may not cover it)
4. The cost is pre-approved by the insurer: Some insurance companies require that you let them know about the Home-care treatment that you will claim the cover for, in advance. This request will need to be approved - and only in such a case, will the claim be paid. Please check for such a requirement with your insurance advisor or in the policy document.
Things to note:
- Some home treatments might be excluded: All regular health insurance plans have exclusions - and it is important to check what it is and what would not be covered. If you're confused, get your financial advisor to check the list of exclusions in the policy document carefully - verify if any of the treatments suggested for your Covid infection might be excluded, before going ahead with the treatment.
- Overall limits on Domiciliary Treatment allocations: Most health insurance plans only offer a percentage (10% - 50%) of your Sum Insured towards Domiciliary Treatments. It is important to be aware of these limitations as they would mean you'll need to shoulder the unapproved costs personally.
Cover in Covid19 special plans - Corona Kavach
Corona Kavach is short-term health insurance that was specially designed and dedicated to meet the needs of COVID-19 treatments. All Corona Kavach plans cover Home Medical Care.
What are the benefits covered by this Covid-specific cover?
Corona Kavach being a special COVID19 policy pays for several Covid-specific needs that your regular health insurance generally excludes.
- Diagnostics charges are covered: Whether you take the Covid test at home or at a diagnostic facility - the costs for them will be covered under Corona Kavach (policy terms & conditions will be applicable)
- Medicine bills are covered: All medicines prescribed in writing will be covered (policy terms & conditions will be applicable)
- Doctor fees and nursing charges are covered: All consultation charges of the medical practitioner/ doctor, as well as nursing charges related to medical staff who attend to you at home, will be covered under this policy.
- Costs of medical procedures are covered: All medical procedures that are 'parenteral' - meaning not-orally delivered medicine are covered. (Basically - 'Procedure costs' for delivering tablets, capsules, syrups - won't be covered)
- Covid-related purchases are covered: You'll possibly need a pulse oximeter, oxygen cylinders, nebulizers, etc. during the course of your treatment and recovery - and all these costs will be paid for by the Corona Kavach policy.
- No sub-limits on Home-treatment: You can claim up to the sum insured in case of home-treatment procedures.
Here too, there are certain terms and conditions you must fulfill to be able to claim the health insurance cover.
- COVID19 Positive Test: You must be tested COVID positive at a government-registered laboratory. The exact requirement for the test report required is defined by each insurance company differently. It will usually require an RT/PCR test and the report should have ICMR authorization and SRF number. If you do the test from a well-known lab, you shouldn't face any issues.
- The hospitalization must be 'Necessary': Like in the case of regular health insurance, the hospitalization must be prescribed as 'necessary' by a medical practitioner/ doctor, and should 'ideally' need hospital infrastructure to be treated. A mild or moderate condition that can be managed through oral pills will not be considered 'hospitalization at home.
- Regular monitoring & daily records: The Home-treatment must be regularly monitored by a qualified doctor during the day. All procedures, treatments, and observations must be recorded by the treating doctor in the form of a daily monitoring chart - updated every time they check in on the patient.
Failing any of these above points - the hospitalization at home will not be covered by Corona Kavach.
Things to note:
- Maximum limit of 14 days: The policy only covers a maximum of 14 days of Home-treatment.
Comparison of Home Medical Care under regular health insurance and Corona Kavach
Here's a quick comparison of the benefits available under Domiciliary treatment/ Home-treatment under Regular Health Insurance and Corona Kavach.
Which one's better to cover home care for COVID19?
It's clear from the above table, that Corona Kavach has a better, more comprehensive cover for home care coverage for COVID19 than domiciliary hospitalization offered by regular health insurance plans.
It's a fantastic cover for other special COVID charges too. So if you are looking at a temporary fix to cover home care, then this policy could be useful.
However, it's important to note that this does not in any way replace the need for comprehensive health insurance, a policy that covers a lifetime of hospitalization expenses - not only for a specific disease but all diseases and injuries.
What if my regular health insurance does not cover home care and I can't get Corona Kavach.
In this case, you need to be aware of the financial costs, in case the need arises for a home-based hospitalization. Ensure you top-up your emergency funds with additional cash to take care of such times.
Why health insurance does not cover home quarantine, isolation for mild or asymptomatic patients?
Many of you might be wondering, why so many conditions, why only hospital-like treatments are covered, and why is there no coverage for asymptomatic, or mild symptom patients?
Insurance is a tool that helps you tackle any major financial impact capable of eating away your savings and toppling your finances. They are designed to come in handy in situations that could cause major monetary losses - in this case - as a result of a specific healthcare need. Therefore, health insurance is not a solution for minor, low-cost treatments that are comfortably delivered at home - say through oral medicines alone.
On the other hand, if you need complex treatments that should 'ideally' be delivered at a hospital - but cannot do so for a number of reasons listed above - your ' hospitalization at home' or 'domiciliary treatment' will be covered by your health insurance plan or Corona Kavach - without depleting your savings.
Hope this article clarifies all your questions about how you can and cannot use health insurance for home treatments during the Covid19 pandemic. If you haven't already, we urge you to invest in a good health insurance plan for your long-term healthcare needs + a sufficient Corona Kavach plan for Covid specific needs immediately.
Meanwhile - wear a mask, stay home and stay safe! <3
Mahavir is the Founder at Beshak.org. Since 2005, Mahavir has been building tech-based startups that compare and advise insurance products to individual buyers. In his last role, he was the Chief Business Officer at Coverfox. Mahavir is a recognized professional in the personal insurance field. He has contributed to leading business publications, including The Economic Times, Business Standard, Mint, DNA, and Moneycontrol