Chennai/ Hyderabad: Siblings Alpa and Chetan Mehta ran up bills of Rs 65,000 undergoing Covid treatment at home in New Delhi. Despite being covered for domiciliary treatment, their claim was rejected by their insurer as the ‘Standard line of treatment was not followed’. The Mehtas have reached out to the insurance ombudsman, and are awaiting a response.
In another case last month in Hyderabad, 61-year-old T Vijaya lodged a claim for Rs 19,400 for Covid home treatment and received only Rs 12,000 under her family floater plan.
In 2020, industry regulator Irdai had directed all insurers that include domiciliary treatment in their health policies to cover Covid treatment at home. All companies were also asked to offer a specialised Corona Kavach policy to reimburse Covid treatment costs, including for home treatment. Yet many companies are not covering domiciliary treatment for Covid.
Since most victims have mild symptoms, a majority opt for home treatment. They now find their claims rejected or settled for a lesser amount. Companies have limits ranging from Rs 15,000 to Rs 20,000 for homecare. “We have to sit with our actuaries and see if requests for higher limits is possible,” said United India Insurance CMD Girish Radhakrishnan. “The demand is coming from our corporate customers.” United India has a limit of Rs 15,000 for homecare, while for a select category of policies there aren’t any limits.
For those seeking home treatment because of a shortage of oxygen hospital beds, the limits are woefully inadequate. “Oxygen cylinder rentals are enough to wipe off the limits. Besides, tele-consultation with infectious diseases specialists or pulmonologists can cost nearly Rs 1,500 per session,” said ICICI Lombard head (claims & underwriting) Sanjay Datta. ICICI Lombard covers only claims for hospital-like treatment at home and excludes quarantining expenses from the policy.
Star Health, among the first to introduce home plans, offers a kit that includes a pulse oximeter and thermometer. “We set a limit of Rs 20,000, which will be enough to cover mild infections. If the infection is moderate to severe, the insured will head to the hospital,” said Star Health MD S Prakash.
Delhi-based insure-tech startup Insurance Samadhan’s co-founder Shailesh Kumar said, “Many claims under the Corona Kavach get rejected because people would have gone for the Rapid Antigen Test instead of RT-PCR. Besides, home treatment has to be prescribed by a medical practitioner working in a hospital… many people miss out on these details. And claims get rejected.”
General Insurance Council (GIC), an association of general insurers, said that homecare claims must be reasonable. “Our estimates show it can at best be 20% of a hospital bill for a case without comorbidities would be,” a GIC official said.