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When Gurgaon-based Shanti Kumari (name changed), 60, tested positive for Covid-19, she decided to take a home -care package for speedy recovery. The package included home care, consultation by doctors, psychologists, physicians with daily routine check-ups, among other things. The package helped her in monitoring the situation from home without getting hospitalised.

Meanwhile, she thought that she could recover the cost of the package later from her insurance company. But to her surprise, the insurance company denied her claim stating “a home care package is not covered under the policy. It covers the treatment if the person gets hospitalised.”

There are many like Shanti Devi who have preferred home care in the absence of availability of beds in hospitals. But when they submit the claim to the insurer, it is rejected. “Tele-consultations are covered if the person has an OPD plan under the health insurance policy,” said Amit Chhabria, business head at PolicyBazaar.com. He added that in a basic health insurance policy, Covid treatment gets covered only if the person gets hospitalised or the patient is moved to a make-shift hospital on the advice of a doctor.

Girish Rao, chairman and MD of Vidal Health said that it varies from insurer to insurer and on case-by-case basis. “In many cases, the insurance companies have stepped up and are permitting the claim. But again, these are based on clinical protocols and what is the level of Covid infection. Clearly, in some policies, home care is not permitted. But given the scenario, a lot of insurers are now, especially the public sector companies, are waiving some of these  conditions and approving the home care, too. The cost of medicines even when the patient is sitting at home is significant. So, it’s not as simple as the hospitalisation but surely there is merit in applying for reimbursement. And in some cases, especially where the patient is admitted in a non-hospital environment, they are being considered.”

Currently, as directed by the regulator, no insurer can deny Covid-19 claims under a health insurance policy. The Insurance Regulatory and Development Authority (IRDAI) also asked all insurers last year to offer standard Covid-19 specific policies — Corona Kavach and Corona Rakshak.

Corona Kavach policy specifically covers hospitalisation expenses for the treatment of Covid-19. Corona Rakshak is a benefit policy which means a lump sum benefit is payable on a positive diagnosis of Covid-19. But remember, the payment is made only after 72 hours of hospitalisation. These corona-specific policies pay for consultation and also cost of home treatment for up to 14 days per incident.