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Home Treatment & COVID - Will my insurance cover its cost?

Yes, if it can be categorized as a domiciliary hospitalization then it will cover all the expenses. The insurance ombudsman recently stated that all COVID positive cases with domiciliary hospitalization should be payable by the insurance company.

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Last Updated - September 6, 2023
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India faced the wrath of COVID-19 during the second wave. There was an acute shortage of hospital beds, oxygen, and medical supplies. This eventually forced many patients to pursue home treatment. According to the GI Council of India, as of 21st May 2021, ₹22,955cr was the health claim registered against COVID. Out of which only ₹11,794cr was settled and the rest 57,443 claims were either rejected or withdrawn. This led to mass hysteria. On 27th July 2021, the Maharashtra insurance ombudsman gave a historic judgment which turned out to be a boon for all the patients whose claims were rejected by their health insurers because their treatment took place in home isolation. Let us understand this judgment better with the help of some FAQs.

What was the insurance ombudsman order?

The insurance ombudsman stated that, since it is a pandemic situation and the government has requested not to burden the infrastructure if hospitalization isn’t required, all COVID positive cases, hospitalization or domiciliary hospitalization should be payable by the insurance company.

What is domiciliary hospitalization?

Domiciliary hospitalization is a home-based treatment in case the patient cannot be moved to a hospital for further treatment.

Can I apply for reimbursement if I’m home quarantined?

Unfortunately no. People often get confused between domiciliary hospitalization and home quarantine. The first thing there has to be is a need for hospitalization. What it simply means is if someone has a very minor COVID infection and has been asked to quarantine, so in such a case, under the standard terms and conditions of health insurance policy, the patient won’t receive any reimbursement. The companies are only liable to pay if it comes under domiciliary hospitalization. 

What are the conditions for domiciliary hospitalization?

  • The medical condition of the patient is preventing him/her from being moved to a hospital.
  • Lack of requisite infrastructure.
  • Unavailability of hospital beds.
  • No transportation facility.
  • The doctor has advised home treatment.

Is domiciliary hospitalization only applicable to COVID-19?

No, from the past few years, most health insurers have started including this feature in the standard health insurance policy. So it can be availed for any illness as long as the conditions for domiciliary hospitalization are met.

Will all my treatment costs be covered?

Yes, if it can be categorized as a domiciliary hospitalization then it will cover all the expenses including medical equipment, consultation fees, medical supplies etc.

How will I get my claim?

Since you’re being treated at home and it isn’t administered in any network hospital, you can’t avail cashless facility. In such a case, you need to apply for reimbursement after your treatment is done.

What documents would I need for reimbursement?

Reimbursement is a hassle-free process. You would need the original copies of all your investigation reports such as CT Scan, RT PCR, etc. All the medical bills with mentioned consultation fees. It is important to keep all documents and invoices for a swift reimbursement process.

Conclusion

It is always better to have such a feature-packed health insurance policy especially to tackle the chaotic situation we’re currently living in. Go check your health insurance right now! If your current health insurance doesn’t have domiciliary hospitalization then you can always upgrade it with a rider or you can port it. If you are planning to buy or port or even just need any guidance, our trained experts at MyInsuranceClub will help you with all your queries. Feel free to reach out.

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Author

Abhishek Kumbhar is an Insurance Analyst with rich experience in the Finance Industry. With his extensive knowledge and exposure of the Insurance sector, he writes articles to provide insights about different aspects of Insurance.