Insurers typically require proof of hospitalisation to process a health insurance claim. However, what can be done when someone is too old or unwell to be admitted to a hospital and the sole option is to get treatment at home?
Treatment at someone's home or domiciliary treatment covers medical consultation, nursing care, medical consultation fees, medications and diagnostic tests conducted at home, among others. There are certain exceptions to this form of treatment such as the treatment done for the convenience, or for the treatments that do not require hospitalisation.
“Several insurance products offer domiciliary treatment. This caters to people who are unable to go to the hospital and need to be treated at home. This is a less-used feature but relevant as we grow older,” says Kapil Mehta, MD and principal officer of Secure Now Insurance Brokers.
Domiciliary treatment typically covers ailments and diseases that would otherwise require hospitalisation. It is not offered for something as minor as physiotherapy at home.
“Treatments for chronic conditions, therapies that don’t require hospitalisation (such as physiotherapy for minor injuries), or treatments done solely for convenience may not be covered. Policyholders should review their policy documents thoroughly or consult their insurer to understand the scope and limits of domiciliary coverage,” says Siddharth Singhal, Head of Health Insurance, Policybazaar.
“Domiciliary treatment, which involves receiving medical care at home under certain conditions, is an important feature offered by many modern health insurance policies. This benefit is designed for situations where a patient is either too ill to be moved to a hospital or when hospitalisation isn’t possible due to a lack of available beds, a scenario that became particularly relevant during the pandemic,” he adds.
Despite its features, insurance coverage for home healthcare services is still in its nascent stage, with low awareness and even slower adoption. Additionally, it is quite common to spend money out of pocket on the treatment of elderly people in India, thus leaving these plans either unexplored or underutilised.
“As per an IRDAI report, only about 10 per cent of health insurance policies cover home care services, primarily for specific conditions such as fever management and physiotherapy. With over 70 per cent of India’s elderly population suffering from chronic illnesses such as diabetes, hypertension, and cardiovascular diseases, the need for comprehensive insurance for home-based care is urgent," says Vishal Lathwal, CEO of Apollo Home Healthcare, Apollo Hospitals.
"Such policies should cover a broader range of medical services, be affordable, and be endorsed by clinicians. Implementing these measures could significantly reduce hospitalisation rates and improve clinical outcomes, leveraging the personalised approach of home healthcare services,” Lathwal pointed out.
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