Insuring Covid home care helps the needy

Mumbai Commissioner Iqbal Singh Chahal has blamed the shortage of beds in private hospitals for Covid treatment to rigid insurance rules. He is not entirely wrong. Medical insurance policies that cover hospitalisation mandate a stay of at least 24 hours for releasing payments. So, hospital beds are being blocked by patients who can be treated at home, depriving those who require hospitalisation for Covid treatment. This is unacceptable. Hospitals must admit patients only when warranted. With Omicron cases rising, there is an argument for the insurance regulator to facilitate a treat-at-home policy in lieu of hospitalisation, subject to checks and safeguards. It will reduce the out-of-pocket medical expenses of the insured and bring down claims outgo of insurance companies.

Offering domiciliary treatment as an add-on cover could work for insurers but that would increase the premium. Some insurance policies cover outpatient treatments, with policyholders paying additional premium. There are insurance products that cover home care treatment, but the extent of coverage is defined. An individual Covid Standard Health Policy is available that covers pre- and post-hospitalisation, home care treatment as well as concurrent treatment of comorbidities. The terms of the contract are binding on the insurer. It merits a review given the exceptional circumstances.

To reach those not covered by Ayushman Bharat, the government could part-fund the insurance premium, for people below a suitable income threshold. The need is also to have better-designed health insurance products that cover all eventualities, including the treatment costs of patients as the long-term toll of the disease emerges. Proper actuarial calculations will hold down costs.


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