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Home Care Medical Insurance

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You can claim the cost incurred for certain procedures carried out at home, but be aware of the limitations
 
Given a choice between staying in a hospital and going home, most would opt to be home. While a hospital's environs are not exactly enticing, the cost involved is also a major cause of this decision. Now, general insurers such as ICICI Lombard and Bajaj Allianz are covering costs of certain procedures that can be carried out at home. With advancement in medical science and availability of portable equipment, certain procedures or follow-up treatment can be done at home. So should you consider it?

The at-home procedures are covered as domiciliary, post-hospitalisation, nursing care, or outpatient benefits. Intravenous procedures, chemotherapy, physiotherapy and wound dressing are eligible for home care claims, depending on your insurer. The highest demand is for nursing or dressing care. Chemotherapy and physiotherapy at home require skilled professionals and specific instruments. The uptake of such facilities is low

HOW IT WORKS

Once insurers receive a pre-authorisation request for cashless facility for treatment that involves prolonged post-procedure care, they swing into action. They intimate the policyholder about the availability of home care options. If the policyholder agrees, insurers send service providers like Care24, Protea and HealthCare At Home to provide recuperative care, which is then covered as part of the claim.

THE BENEFITS

Home care can benefit the policy holder and insurer alike. You tend to recover faster in a homely environment. For insurers, the outgo is considerably reduced, resulting in better claim control.

Reduction in expenses helps policyholders too, as it means a smaller proportion of their cover gets utilised. Expenses for transportation, attendant's food and ancillary costs also come down.

The actual savings, however, can vary. If a policyholder avails of treatment or follow-up procedures at home, the savings could be 10% to 30%.

Room rent, which accounts for a chunk of hospitalisation cost, is eliminated. A patient who has undergone cardiac surgery can shorten hospital stay from 10 to say seven days if she avails of home care for the period when only nursing care is required. The savings also depend on the procedure and hospital. A cardiac patient may be able to save up to 30%, while some one recovering from a stroke and requiring a longer stay at the hospital could save 10%.

THE LIMITATIONS

Do not opt for home treatment without consulting your insurer. Find out if it is covered at all under your policy. In case of cashless settlement, the insurer can proactively make this offer, which may not be the case with reimbursements.

Insurance companies may view the treatment as domiciliary care, which may not be payable unless certain terms and conditions are met. They will approve the home care claim only if the option was used due to the patient's inability to visit the hospital.Usually, admissible domiciliary claims are restricted to 10% of the sum insured. Another limitation could be in terms of instruments for treatment that can be brought home, which may not be similar to those available in the hospital.

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