Health Insurance

Home Health Care Services Covered Under Health Insurance

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If patients are given a choice between staying in a hospital and undergoing medical procedures at home, a fair share of people would opt for the later. Not only is a hospital’s environment depressing, but the costs involved are a major concern too. But, it is important to ensure whether your insurance policy covers the costs of medical procedures carried at home and home care services.

Before we delve any further, it is important to know that some diseases or medical conditions not covered by an insurance policy may fall under the post-hospitalization treatment, which is covered by the policy.

Let’s understand it better with an example. Rajat Sinha was suffering from chronic backache. He was advised for physiotherapy and he opted for treatment at home. His health insurance policy did not cover the expenses of physiotherapy. However, if the physiotherapy had been advised after a surgery the same policy would have covered it, as it would have fallen under post-hospitalization treatment.

Treatments Covered Under Home Health Care Service

With the rapid developments in the world of medical sciences, follow–up treatment can be easily carried out at home. Several general insurers like Bajaj Allianz and ICICI Lombard are offering riders for home health care insurance, which covers the costs of treatments which can be carried out at home.

Most of the services offered by home care providers are covered, provided they are prescribed by doctors or are an extension of hospitalization.

Home Health Care Service in Insurance Can Be Categorized into the Following:

1. Domiciliary Treatment

It refers to treatments that need hospitalization but are carried out at home. Insurers say that they cover domiciliary treatment, if the patient is suffering from a health condition owing to which he cannot go to the hospital or rooms aren’t available in hospital to accommodate the patient.According to Religare health insurance, home health care insurance coverage can extend up to 10% of the sum insured. This indicates that if you are insured with a sum of Rs. 5 lakhs, the insurer will pay Rs. 50,000 on domiciliary treatment.

2. Pre and Post Hospitalization

Usually medical expenses both before and after hospitalization are covered by the insurer. However, the expenses incurred must be related to the illness which led to hospitalization. It is important to note that the period of pre and post hospitalization varies from one insurer to other. Some policies may cover home care service expenses up to 90 days before and 180 days after hospitalization, whereas some just cover 30 days before and 60 days after hospitalization.

3. OPD and Day Care Treatments

There are some medical procedures that can be done without hospitalization. Some common day care procedures that are covered include chemotherapy, radiotherapy and hemodialysis. Some insurers like Cigna TTK provide maintenance benefits for nursing care, diagnostic tests, consultation and physiotherapy. Additionally, ICICI Lombard also covers home care treatments that fall under the OPD category. Here, the treatments covered include consultation, physiotherapy and routine diagnostics.

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Home Health Care Services Covered by Insurers

Category

What is covered?

Out-patient cover

Physiotherapy, nursing, lab tests, doctor’s consultation

Day care

Procedures which do not require 24 hours hospitalization

Domiciliary care (home care service)

Disease, illness, injury which requires care at hospital, but is treated at home

Value-added services

Some insurers offer discount on home care services

 

Benefits of Home Health Care Insurance Cover

Both policyholders and insurers stand to gain from home care. Patients can recover better in a homely environment. The outgo is reduced for insurers which in turn results in better claims control. Additionally, if a policyholder avails treatment at home, he/she can save 10% to 30% of the total cost.

Room rent which accounts for a chunk of the hospitalization cost is completely eliminated in such cases. But here it is important to understand that the savings depends, to a large extent, on the hospital and the medical treatment procedure.

Points to Consider Before Opting Home Health Care Service

Before opting for home care, there are several factors that one must carefully consider. Here are just five of the most prominent ones that you must remain vigilant about:

  1. It is best to opt for home care services after consulting with the insurer.
  2. Find out if the intended treatment is covered by your policy.
  3. Be informed about the conditions that are excluded from your policy.
  4. Take your health conditions into consideration.
  5. It is crucial to find quality professionals, facilities and equipment when opting for home care.
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