Home Healthcare Services Are Not Uniformly Covered By Insurance: What Should Policyholders Keep In Mind?

In many older health insurance policies, you cannot easily avail of the cashless claim for home care treatment. However, if in case your policy includes domiciliary hospitalization, you can use it to claim reimbursement for the treatment. This is a common feature in many health insurance policies, especially those that have been issued in the last seven to eight years. Domiciliary hospitalization is when the insured person is treated as hospitalized even when he/she is at home. The insurance company covers many of the expenses incurred for this treatment. 

However, it is often seen that home health healthcare services are not uniformly covered by insurance. “Offering healthcare services at home requires quick and effective equipment availability, expert homecare doctors and nurses, and more which may not be available under all health insurance plans,” says Naval Goel, founder and CEO, PolicyX.com.

Here are the reasons why home healthcare services are not uniformly covered by insurance: 

According to experts, during COVID- 19 pandemic when hospitals faced critical bed shortages, patients had no choice but to seek care at home. This posed a challenge, as traditional health insurance plans didn't cover home healthcare services. There were a lot of grievances as patients and families had to face financial burdens and logistical challenges. Considering that many insurance companies recognized the need for flexibility in healthcare coverage. They started including home healthcare services as integral features in their plans. Basically, in any of the three crucial scenarios where hospitalization isn't feasible, yet essential care is required patients can avail of home healthcare services or domiciliary hospitalization under their health insurance plan.

These scenarios could be:

i) First, due to shortage of beds, patients can receive necessary treatment at home

ii)Second, if the patient cannot come to the hospital due to reasons such as existing co-morbidities or immobility hence, the hospital can come home

iii) Finally, if a registered medical practitioner prescribes the patient can opt for home-based hospitalization ensuring care tailored to their individual needs.

In these scenarios, the majority of health insurance companies pay for the expenses for that particular situation.

Policies That Cover Home Healthcare Services:

 “There are a couple of policies that offer home healthcare services, for example, Star Assure - Inbuilt, Star Comprehensive-, through the rider, Aditya Birla Health Insurance-Active assure-Diamond, etc. Some of these plans cover home healthcare services to a certain percentage of the sum insured, whereas some companies provide it as a rider where you need to pay a little extra amount to avail of this benefit,” says Siddharth Singhal, business head - health insurance, Policybazaar.com. 

What Policyholders Should Keep In Mind:

Before buying a new policy, the policyholder must thoroughly review the terms and conditions to ascertain whether home healthcare services are covered or not. “It's essential to understand the specific expenses included under this facility and the conditions that must be met to qualify for claims related to home healthcare treatment. Additionally, one should evaluate the extent of coverage provided by the policy in terms of the sum insured for such benefits,” adds Singhal.