Insurance policy will cover in-home treatment, but conditions apply

Cases linked to surgery or recommended by the doctor among those considered.

You have been advised physiotherapy for your chronic back ache and you opt for treatment at home.

Chances are your health insurance policy will not cover it. However, if you had been advised physiotherapy after a surgery, the same policy will cover it, as it falls under domiciliary or post-hospitalisation treatment. 

If your health insurance policy offers cover for out-patient department (OPD) or day-care procedures, physiotherapy would be covered, even if it is not linked to a surgery.

However, premiums for such covers are almost thrice that of a regular health insurance cover. 

According to Vivek Desai, managing director of Hosmac (a healthcare consulting firm) and a practising doctor, in-home treatment comprises three segments.

One is geriatric care, is treatment for senior citizens who find it difficult to go to hospitals. Service providers such as Portea offer in-home medical services catering to this segment.

The second is treatment for chronic ailments, which requires continuous monitoring, such as physiotherapy or diabetes. Firms such as Bengaluru-based Nightingale operate in this segment.

The third is post-discharge treatment such as dressing of wounds, which is often provided by the hospitals themselves. 

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“In-home treatment is a growing health care segment. Currently, only post-discharge treatment is covered under health insurance. In-home treatment for geriatric and chronic ailment is not covered by insurance,” says Desai. 

Any kind of domiciliary treatment will be covered if your doctor recommends it, says Deepak Yohannan, CEO, MyInsuranceClub.com.

This will be based on the doctor’s certification. However, it is better to inform your insurer in advance and take prior approval because it could vary from case-to-case. If it is a genuine case, then the insurance company usually allows the claim.

“Thanks to medical advancement, certain procedures today do not require hospitalisation. So, many of these are covered by health insurance today. But for other treatments, the policy must offer OPD cover, in which case premiums are higher,” says Yohannan. 

Not too many companies offer OPD covers. And given that premiums are almost thrice that of a regular health policy, it might not be very beneficial for everyone.

In fact, most people don’t utilise OPD benefits. While senior citizens might utilise OPD benefits, premiums in their case could be very steep. 

Demand for in-home medical treatment is on the rise, because patients are more comfortable at home, especially if recurrent treatment is required.

However, costs must be reasonable, says Renuka Kanvinde, associate vice-president (health insurance) at Bajaj Allianz General Insurance. Other than cost, insurance companies will also check the quality of service, which, too, is tougher to monitor in case of in-home treatment compared to hospitalisation. 

Max Bupa Health Insurance covers home-care services for the elderly if prescribed by the treating doctor, says Somesh Chandra, chief operations officer and chief quality officer.

“While home care can be instrumental in reducing healthcare costs, standardisation with some basic protocols, including empanelment of doctors, is a key requirement. Standardisation protocols would enable such services to become more streamlined and easier to administer,” adds Chandra. 

Some insurers offer tie-ups with healthcare companies that provide in-home services. The claim might get paid only if you avail the service from those particular service providers.

However, remember that such value-added services will push up your overall premium. Coverage for in-house treatment will often not include alternate medicines such as Ayurveda because it is difficult to clinically evaluate the requirement for the particular treatment.

“In case of Ayurvedic treatment, only hospitalisation at a government-recognised hospital is covered. For instance, if it is a massage taken at home, it will not be covered. But if the massage is taken in a hospital, it means there is diagnosis and doctor's advice,” she says.

Bajaj Allianz is one of the insurance companies offering coverage for Ayurvedic treatment.

Budget 2015: Complete Coverage