Lack of data no excuse for homecare hospital cover

Chennai: Two decades after opening up the insurance sector in India on the promise of innovative products, industry officials complain on lack of data for domiciliary hospitalisation cover suggested by their sectoral regulator.

The Indian insurance regulator IRDAI has allowed non-life insurers to offer "homecare/domiciliary treatment" or treatment at home as an add on cover afresh or to their existing policies.

In a circular to all non-life insurers including standalone health insurers, the Insurance Regulatory and Development Authority of India (IRDAI) has said companies have to file their products with it, if home treatment is offered as an add-on cover.

According to IRDAI, homecare treatment is one taken at home for an ailment that normally needs hospitalisation provided that a medical practitioner advises the insured home treatment; there is a continuous active line of treatment with the health status of the insured monitored daily by a medical practitioner during the duration of home treatment; and that records of daily monitoring of the insured patient and the treatment given are recorded and signed by a medical practitioner.

Norms for settlement of claims should be mentioned in the policy document and prospectus, it said. IRDAI said that insurers can offer the cover to their existing policyholders by charging an additional premium for the residual period of time.

However industry officials complained about the absence of data for offering the cover. Curiously, homecare or domiciliary hospitalisation cover was introduced by the government owned non-life insurers in the 1980s. "Since domiciliary hospitalisation cover has been in vogue for quite some time, data on that should be available with the companies. In any case, lack of data is never a restraining factor in innovation. The recent example of Covid-19 specific covers is a case in point," K.K. Srinivasan, former Member (Non-Life) IRDAI told IANS.

A glance at various claims reports of Insurance Information Bureau of India (IIB) does not show the term 'domiciliary hospitalisation' though there is data on Out Patient Policy which is entirely different. "If the regulator directs to collect data on domiciliary hospitalisation then we can collect the same from the insurers," Kunnel Prem, CEO, IIB told IANS.

"Majority of the insurers stayed away from homecare insurance for reimbursement or cashless treatment. Insurers have some minimal cover," said Meena Ganesh, Managing Director & CEO, Healthvista India that offers homecare services under the brand Portea Medical. Continuing further Ganesh said: "The IRDAI circular doesn't mandate the insurers to offer homecare treatment cover. It is only a recommendatory circular - if you want to offer, you can offer."

According to her, only a small portion of her customers get domiciliary hospitalisation cover reimbursement. Industry officials state the IRDAI's circular has come due to the massive Covid-19 pandemic second wave and many patients were not able to get a bed in hospital. Welcoming IRDAI's move, Liberty General Insurance Ltd's CEO and Whole Time Director Roopam Asthana had told IANS that the "add-on cover has to be priced right taking into account the data and possible scenarios".

The insurers will save on huge daily hospital room charges, though the doctor and nurse fee may be on slightly on the higher side then what a hospital charges. "For the past one year, we have offered our policyholders suffering from Covid-19 homecare facility. The expense incurred by a patient at home is 80 per cent less than what is spent in a hospital," S. Prakash, Managing Director, Star Health and Allied Insurance Company Ltd told IANS.

According to him, the homecare treatment insurance cover is several decades old overseas and one should not wait long for data to offer the same to Indian policyholders. Prakash said insurers should tie up with hospitals with telemedicine facilities which in turn would further reduce the doctor visit charges. "I see this segment to have a great future. We will soon come out with a homecare policy," Prakash added. On their part the third party administrators (TPA) or the healthcare claims processing agencies say the domiciliary cover as an add-on cover will not impact them.

"For us, a claim is a claim. When this cover becomes mainstream, then the industry should educate the policyholders on the documents that need to be submitted for a claim," Nikhil Chopra, Chief Business Officer, Medi Assist Insurance TPA told IANS. He said this cover is provided in some group health insurance policies by some insurers.

"If this product picks up, we will need to scale up and train our processors and doctors for such claims and pre-authorisations," Girish Rao, Chairman & Managing Director, Vidal Health Insurance TPA Pvt Ltd told IANS.

Source: The Economic Times