The bed or oxygen unavailability situation at hospitals is pushing families to seek refuge in-home treatments for COVID-19.
Will health insurance firms pay for such treatments? We’ve been receiving several questions on our forum concerning both regular health insurance plans, as well as Corona Kavach. Queries are raised as to when these plans cover home-treatment costs for COVID-19.
Home treatment covered by regular insurance
Regular health insurance includes your personal as well as corporate health insurance policies.
Such long-term hospitalization policies do not always cover the costs of ‘Home-treatments.’ So, you should carefully check your policy document and understand whether ‘Hospitalisation at Home’ or ‘Domiciliary Treatments’ are covered in it. If it isn’t explicitly mentioned, your plan won’t cover your home treatments.
Further, the cover will only be applicable under certain specific circumstances.
Here’s a quick rundown of such situations.
The patient’s needs’ hospitalization cannot be admitted: A medical practitioner/ doctor recommends that the patient is hospitalized and ‘ideally’ takes treatment there. But due to a lack of hospital beds in your area or the patient not being fit enough to move, this isn’t possible. In such a case – the home treatment will be paid for.
Only hospital-like treatments will be covered: The underlying thought is that the treatment itself demands proper hospital infrastructure. Therefore, treatments for mild and moderate symptoms might not be covered. For instance, if your COVID-19 symptoms are mild and the treatment only includes oral pills and self-quarantine at home (not hospital-like treatment), the insurance plan will not cover such costs.
Treatments excluded in the policy will not be covered: All regular health insurance plans have exclusions – conditions for which the insurance company will not pay. If the treatment recommended to you for your COVID-19 symptoms falls in that list of exclusions – the insurance plan will not pay for it. If it is confusing, request your doctor to verify if the treatment they’re recommending could be one of your policy exclusions.
Other exclusions: In addition to medical conditions, there will also be a list of items such as PPE kits, masks, and sanitization expenses that would not be covered. If you’re not aware of these, the unpaid deductions will come as a major surprise to you at the time of billing.
Some important points to note
-Some insurers might require you to get the home-treatment cost approved in advance. Ensure that you connect with your insurer/ financial advisor and check if this applies to your case.
-Most health insurance policies also have an overall limit for ‘Domiciliary treatment’ costs. This could be anywhere between 10-50 percent of your total sum insured. Check this limit ahead of your treatments, so you’re not taken by surprise later.
Corona Kavach coverage
Corona Kavach was introduced last year. It was designed to meet the unique needs of COVID-19 hospitalizations. Providing comprehensive hospitalization insurance that covered costs such as PPE kits, masks, and sanitization expenses (that regular health insurance wouldn’t pay for), offered families the much-needed short-term alternative in the face of an accelerating pandemic.
But, what about home treatments?
-All Corona Kavach plans cover Home Medical Care for up to 14 days. This is in line with the actual need of COVID-19 patients who will need to isolate themselves and get treatment for at least 14 days.
-There is no sub-limit on the amount that can be claimed for treatments at home. You can claim up to the full sum-insured that you’ve purchased for home treatments alone.
-Corona Kavach provides a comprehensive cover for COVID-specific home-treatment needs that regular plans exclude. Here’s a list of things that are covered: (policy terms & conditions would be applicable)
-Tests and diagnostics: All diagnostic charges, including Covid home tests, are covered.
-Medicine bills: All medicine costs are covered as long as a medical practitioner prescribes them.
-Medical treatments and procedures: As long as the treatment is not given orally (tablets, capsules, syrups, etc.) – the treatment costs are covered by the policy.
-Purchases and medical equipment: Any medical equipment you purchase to monitor and treat your Covid condition will be covered. This could include thermometers, pulse oximeters, oxygen cylinders, nebulizers, etc.
Doctor fees and nursing charges are covered: A doctor will need to monitor your health and progress regularly and submit their reports in the form of a daily monitoring chart. All costs for such consultations of a medical practitioner/ doctor and nursing charges related to medical staff who attend to you at home will be covered.
Some important terms and conditions
COVID-19 test: You need a COVID-19 positive test – particularly an RT/PCR test for the insurance plan to be applicable, and the report should have ICMR authorization and SRF number.
Hospitalization is necessary: Like regular health insurance plans, Corona Kavach also requires that a medical practitioner prescribes a hospitalization, and the treatment ‘ideally’ needs hospital infrastructure. But – it isn’t possible due to a shortage of beds (or the patient not being fit enough).
Regular monitoring by a doctor: To get the policy cover, you will need to ensure that a doctor regularly monitors all procedures and treatments throughout the day. Their observations must be updated in a daily monitoring chart every time they check in on the patient.
I hope this article helps you get a gist of all the circumstances under which health insurance plans and Corona Kavach would pay for the treatments you get at home.
Taking all this information into consideration could help you and your family be better prepared – at least as far as the financial aspect is concerned – should you need COVID-19 treatments at home.
Meanwhile – stay safe, wear a mask and take care of yourselves.