Siblings Alpa and Chetan Mehta ran up bills of Rs 65,000 undergoing Covid-19 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 April, T Vijaya, 61, of Hyderabad lodged a claim for Rs 19,400 for Covid-19 home treatment but received only Rs 12,000 under her family floater plan.
Last year, the IRDA directed all insurers that offer domiciliary treatment under their health policies to cover Covid-19 treatment at home. The 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 home treatment of Covid-19.
Since most patients have mild symptoms, a majority opt for home treatment. They are now finding their claims rejected or settled for a lesser amount. Companies have limits ranging from Rs 15,000 to Rs 20,000 for home care. For those seeking home treatment because of a shortage of oxygen hospital beds, the limits are woefully inadequate. “We have to sit with our actuaries and see if requests for higher limits is possible,” said the CMD of United India Insurance Girish Radhakrishnan, “The demand is coming from our corporate customers.” United India has a limit of Rs 15000 for home care while for a select category of policies there aren’t such limits.
“Oxygen cylinder rentals are enough to wipe off the limits. Besides, teleconsultation with infectious diseases specialists or pulmonologists can cost nearly Rs 1500 per session,” said Sanjay Datta, who heads claims and underwriting at ICICI Lombard said. ICICI Lombard covers only claims for hospital-like treatment at home and excludes quarantining expenses from the policy.
Star Health, which was among the first to introduce home plans, offers a kit that includes a pulse oximeter and thermometer. “We set a limit of Rs 20000 which will be enough to cover mild infections. If the infection is moderate to severe, the insured will head to the hospital,” said MD of Star Health Dr 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 test. Besides, the home treatment has to be prescribed by a medical practitioner working in a hospital… many people miss out on these details. And their claims get rejected.”
General Insurance Council (GI Council), an association of general insurers, said that home care claims must be reasonable. “You can’t have exorbitant bills under home care. Our estimates show that it can at best be 20% of what a hospital bill for a case without comorbidities would be,” an official at the Council told TOI.