Insurance companies, which would only settle hospitalisation claims so far, may soon extend the benefits for homecare expenses not only for Covid-19 treatment but also other ailments.

The medical insurance or the indemnity policy issued by insurance companies in India primarily covered claims arising out of hospitalisation. Any outpatient visits or diagnostic tests were usually left out of the purview of the indemnity policy or had to be bought as an add-on cover at an additional premium.

However, in the wake of Covid-19 pandemic and the shortage of beds and unavailability of medical staff across the top cities posing a challenge in ensuring treatment, a number of insurance companies have extended the cover for home-based care.

Technology platforms

According to Dr S Prakash, Managing Director, Star Health and Allied Insurance, homecare is a good initiative and has to be fundamentally encouraged not only during Covid-19, but even after the pandemic. One of the biggest problems for the insurance industry is the “unnecessary conversion of outpatient into inpatient”, and this can be avoided by providing homecare through properly assisted technology platforms.

The move will help bring down the claims in value terms for insurance companies. The average claim for Covid-19-related hospitalisation, for instance, has been in the range of ₹1.09 lakh to ₹1.12 lakh, which is more than three times the claim outgo incurred by insurers for viral diseases such as dengue. When compared to this, a 14-day homecare package offered by most hospitals and service providers works out to close to ₹15,000, excluding medicines.

When asked if the insurance industry was prepared to bring in changes in its coverage norms, he said: “We have to break the rule so that we can create one. You cannot break the rule during normal circumstances; it is during times like this that you can experiment and innovate something new. This is a very good idea, which will help the customer, hospitals, and insurance companies as well.”

Bajaj Allianz General Insurance, which started giving claims for home-based care on a case-to-case basis from May, subsequently rolled out the service for all of its indemnity customers. A wide scale replication of the service for other treatments may call for some tweaking in pricing as well as terms and conditions of the policy, said Bhaskar Nerurkar, Head-Health Claims, Bajaj Allianz.

“It (having cover for home-based treatments) may come, but it will involve some process of working on the terms and conditions. We will have to follow the market data, and the actuaries will have to appropriately price it and put some terms and conditions to ensure that there is no abuse of that cover,” he pointed out.

Extending scope

ICICI Lombard General Insurance and HDFC Ergo, for instance, have extended coverage for homecare expenses for non-Covid treatment. HDFC Ergo has included gastroenteritis, bronchopneumonia, respiratory tract infection, chemotherapy, pancreatitis, dengue, COPD management, hepatitis and fever management under home care.

“We have the regulator’s approval for extending the coverage for some non-Covid home-based care, and we have tied up with specific service providers for the same,” said Bhargav Dasgupta, MD and CEO, ICICI Lombard. The insurer is also considering accepting claim for certain OPD procedures as well for claim actualisation.

According to Ravi Vishwanath, President - Accident and Health, HDFC Ergo, homecare may bring some stability in the cost of treatments.

“Apart from convenience, such a trend may also help in containing a widespread outbreak of infectious diseases in the future. Moreover, it may also establish stability in cost of treatments, given there will be lesser burden on healthcare institutions and medical staff,” he said.

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