Home Care Treatment in Health Insurance

What is Home Care Treatment?

Home care treatment in health insurance refers to medical care provided to a patient at home instead of a hospital. It is designed for situations where the patient is unable to visit a hospital or when the patient requires continuous care after being discharged from the hospital.

Most of the mediclaim insurance plans cover some or almost all home care treatments, provided they are prescribed by doctors or are an extension of hospitalisation. However, the extent of coverage varies depending on the insurance company and the policy.

Moreover, it is important to note that some diseases or medical conditions not covered by health insurance companies may fall under the post-hospitalisation treatment, which is covered by the policy. Let's understand it better with an example.

For example, Rajat 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 physiotherapy had been recommended as part of recovery following surgery, the same policy would have covered it under post-hospitalisation treatment.

Treatments Covered Under Home Care Health Insurance

With the rapid development in the world of medical science, follow–up treatment can be easily carried out at home. Several health insurance providers are offering riders for home care insurance, which covers the costs of treatments which can be carried out at home.

Some of the common home care treatments in health insurance are as follows:

• Fever and infectious diseases management
• Uncomplicated urinary tract infections
• Asthma and COPD -Mild Exacerbations needing home nebulisation
• Gastroenteritis
• Acute Vertigo
• Care for spinal and brain injury cases post hospitalisation
• Dengue

Different Categories of Home Health Care Service in Insurance

Here are the different categories of home health care service in mediclaim insurance:

1. Domiciliary Treatment

   Domiciliary treatment refers to treatments that need hospitalisation but are carried out at home. Insurers say that they cover domiciliary treatment if the treatment is suggested by an MBBS doctor, the patient is suffering from a health condition owing to which he cannot go to the hospital, or rooms are not available in the hospital to accommodate the patient.

2. Pre and Post-Hospitalisation

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

3. Day Care Treatments

   Day care treatments are medical procedures that can be done without 24 hours of hospitalisation. Some common day care procedures that are covered under mediclaim insurance include chemotherapy, radiotherapy and haemodialysis.

4. OPD Treatments

   Some of the health insurance providers cover home care treatments that fall under the OPD category, such as consultation, physiotherapy and routine diagnostics. Make sure you go through the policy document to know the exact coverage.

Exclusions Under Home Care Treatment in Health Insurance

If the home care treatment is not related to the primary illness or condition for which the patient was hospitalised, insurers may classify it as unnecessary for the insured's recovery and exclude it from medical insurance coverage. In fact, if the home care treatment is self-initiated and not prescribed by a doctor, then also it is excluded under health insurance.

Benefits of Home Health Care Insurance Cover

Both policyholders and insurers stand to gain from home care insurance cover. Patients can recover better in a homely environment. In fact, the room rent, which accounts for a chunk of the hospitalisation cost, is completely eliminated in such cases. This means that if a policyholder avails treatment at home, he/she can save 10% to 30% of the total cost. But here, it is important to understand that the savings depends, to a large extent, on the hospital and the medical treatment procedure.

For insurers, the outgo is reduced, which in turn results in better claims control.

Points to Consider Before Choosing Home Health Care Service

Before opting for home care health insurance, there are several factors that you must carefully consider:

• It is best to opt for home care services after consulting with the insurer.
• Find out if the intended treatment is covered by your mediclaim policy.
• Be informed about the conditions that are excluded from your policy.
• Obtain home care treatment only if it is suggested by a doctor.
• Ensure you find quality professionals, facilities and equipment for home care treatment.