Mediclaims for treatment at home

It is normal to make a claim to your insurer if you fall sick or if you have a surgical procedure and are admitted to the hospital.

But if you could not be taken to a hospital or a nursing home and instead had to be treated at home, you can still make a claim.

However, there are some important factors that you must note before taking up domiciliary treatment or hospitalisation at home.

You could be anywhere in India and fall sick. But at times, it may not be possible to move you to a hospital. Your doctor could have advised you not to strain by undertaking a journey to the hospital. Or sometimes, it may be because there aren’t rooms available at the insurance company’s network hospital near your place or even in a non-network nursing home. It may also be that the place where you have fallen sick is remote.

Insurance companies cite doctor advice and non-availability as important clauses in deciding on domiciliary treatment.

Companies such as United India Insurance, HDFC Ergo and Max Bupa allow claims made for domiciliary treatment, provided the conditions mentioned earlier are fulfilled. There are others such as ICICI Lombard that specifically exclude claims made for treatment taken at home.

Also, in case pre-hospitalisation and post-hospitalisation expenses are required, most insurance companies do not admit claims related to such costs in the case of domiciliary treatment. HDFC Ergo, though, allows claims for pre-hospitalisation expenses.

Making claim

You must also be aware of a couple of other conditions before making a claim. Some insurance companies specify the minimum number of days that treatment at home needs to be done for before a claim is made. This is usually 3 days in most cases. Many ailments are also specifically left out of the ambit of medical claims.

The list includes asthma, bronchitis, diarrhoea, influenza/cold/cough, hyper tension, epilepsy and arthritis, among a few others.

Besides, in case treatment is taken at home, there may not be a cashless settlement.

Instead you would be required to make a reimbursement claim to the insurance company providing all the relevant medical details and the reason for taking treatment at home. So, emergency cash must be kept ready.

Also you need to sound off the insurance company or third party administrator immediately or in case of an emergency, within 24 hours of starting domiciliary treatment.

You must also keep additional cash handy for post-hospitalisation expenses and maintain a complete record of doctor’s examination, tests, medical bills and fees.

You thus need to take policies that offer domiciliary treatment if you foresee a circumstance where you have to take treatment at home.

>venkatasubramanian.k@thehindu.co.in

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