Quarantined At Home? Find Out How You Can Claim Medical Insurance In Home Isolation

Some general health policies have ‘domiciliary hospitalisation’ clauses which is intended to cover home medical management.

Covid patients are having to resort to stay at home despite urgently needing a bed given the current health crisis with bed and oxygen shortages. 

For those opting for home care, they have the facilities of online consultations with doctors, nurse visits, medicine delivery along with thermometers and oximeters. 

There are also companies offering packages covering the necessary in-home medical infrastructure with costs of upto Rs 15,000 a day. 

Provisions Under Regular Health Policies

Those having regular health insurance policies will not receive compensation for home treatment since they can only be reimbursed for 24-hour hospitalisation and day-care facilities unless there is an OPD component. 

However, Corona Kavach policies do offer coverage for home treatment. 

Those who are customers of ICICI Lombard or other companies which include home treatment coverage can claim reimbursement. 

The conditions include mild symptoms and doctor-prescribed treatment at home.

Even if home coverage is included, there are inclusions and exclusions to beware of. 

Terms And Conditions

One must seek authorisation from the insurer prior to setting up home quarters for medical purposes in order to ensure smooth claim payouts.

If one is availing oxygen as part of a line of active treatment, they can claim reimbursement for its cost and refilling costs.

However, the exclusion here is the capital cost of the cylinder itself which is categorised as medical equipment and hence is not payable. 

Bed rest in post recovery is not covered either. This includes nursing costs towards rest and rehabilitation, dietary supplements or lines of unproven or experimental treatments.

Look Out For “Home Care” Or Equivalent Terms

Many policies do come with a provision for cases where one was advised and attempted to procure a hospital bed but without success and had to stay home. 

This is typically referred to as a ‘domiciliary hospitalisation’ clause and is intended to cover home medical management. 

It also applies to patients who are not stable enough to be moved to a hospital, hence requiring home ICU infrastructure including doctor visits, nursing and IV support. 

Conditions to be mindful of include the presence of necessary documentation such as detailed invoices from GST-registered organised companies in charge of the treatment set-up. 

Problems To Prepare For, Consider Fixed-Benefit Plans

Not only does one need to have original bills but they must also inform their insurance provider in advance.

This could be a significant hurdle since there is an acute lack of organised vendors who provide their services with proper invoices. 

In such cases, the safest bet is to opt for fixed benefit COVID-19 policies, which Corona Kavach itself is.

Such policies pay out a sum that is fixed earlier when one tests positive and undergoes a minimum of 3 days of hospitalisation. 

One should also look out for sub-limits, if there are any. 

For example, a policy could state that home care will be covered only upto a limit of 10% of the insured amount. 

Also, if treatment lasts under 3 days, the claim will not be valid. But this is not a big issue since Covid care of any kind lasts more than 72 hours. 

Corona Kavach Policy

As a last line of support one can avail the standard, IRDAI-mandated Corona Kavach policy which was rolled out by insurers last year. 

The policy offers a pay out of upto Rs 5 lakh and is eligible for those availing home treatment of upto 14 days.

Items included are pulse oximeters, oxygen cylinders, costs incurred in home ICU set-up and treatment. 

One should have documents such as doctor’s original prescriptions, diagnostic reports and medicine bills at the ready to claim the same

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