Domiciliary Hospitalization in Health Insurance

What is Domiciliary Hospitalization?

Domiciliary hospitalization refers to hospital-like medical treatments and care provided to a patient at home, which would otherwise be available at a hospital. It is recommended in situations where the insured is in urgent need of hospitalization but cannot be shifted to a hospital. Domiciliary hospitalization in health insurance provides financial support to patients who are unable to get hospitalized due to a lack of hospital beds or the severity of their health condition.

When is Domiciliary Hospitalization Covered in Health Insurance?

Most health insurance plans in India come with domiciliary hospitalization cover. However, an insurance company will cover the domiciliary hospitalization costs only in the following cases:

• If the home hospitalization is for at least 72 hours
• If no beds are available in nearby hospitals
• If home hospitalization has been recommended by an MBBS doctor
• If the insured is in a critical condition and shifting to a hospital is dangerous

How Does Domiciliary Hospitalization Work?

Let's understand how domiciliary hospitalization works with the help of the following example -

Rajan is undergoing medical treatment for dementia but still finds it challenging to do his daily chores. One day at home, Rajan lost his balance and fell, hitting his head, spraining his neck and breaking his arm. He also fell unconscious. As he was alone at the time of the accident, the first aid and treatment were delayed, causing swelling and blood clots.

Since Rajan's condition was critical, the doctor decided not to move him to the hospital and recommended starting treatment at home. Once all necessary medical equipments were installed at his home and his broken arm was plastered, it took around five days after his treatment began for his swelling to reduce.

Meanwhile, Rajan's family raised a domiciliary claim under his mediclaim insurance policy of ₹15 lakh. Since his policy covered domiciliary hospitalization for up to 10% of the sum insured, his insurer paid ₹1.5 lakh, i.e. 10% of ₹15 lakh, as reimbursement for his domiciliary treatment.

Why Should You Choose Domiciliary Hospitalization Cover in Health Insurance?

Medical treatments are expensive today, whether you take them at a hospital or home. But if you bring the hospital home and create a hospital-like set-up at home, it can be very expensive. Therefore, having a health insurance policy with domiciliary hospitalization cover is essential.

If your medical insurance policy provides coverage for domiciliary hospitalization, your insurer will pay for your home treatment recommended by a qualified doctor as shifting to a hospital is not advisable. The insurer may compensate a percentage of the sum insured or up to the sum insured limit as specified in the policy.

Moreover, domiciliary hospitalization cover not only provides financial support to pay for the treatment but also save your family's money on travelling to the hospital.

What is Covered Under Domiciliary Hospitalization?

Domiciliary hospitalization in health insurance in India covers the following:

• Doctor consultation fees
• Cost of medical equipments
• Nursing charges
• Medicine bills
• Diagnostic tests

What is Not Covered Under Domiciliary Hospitalization?

Domiciliary hospitalization does not cover the following:

• Pre & post-hospitalization expenses
• Home treatment taken for less than 72 hours
• Treatment not recommended by an MBBS doctor
• Treatment for common cold, cough, hypertension, diabetes, asthma and arthritis
• Treatment taken for psychiatric illness, bronchitis, tonsillitis and upper respiratory tract infection
• Treatment for epilepsy, chronic nephritis, nephrotic syndrome, gout, rheumatism and pharyngitis

Difference Between Home Care Treatment and Domiciliary Treatment

Take a look at the key differences between a home care treatment and a domiciliary hospitalization:

How to Claim Domiciliary Hospitalization in Health Insurance?

Follow the steps given below to file a domiciliary claim under your health insurance policy:

1. Evaluation & Recommendation

   The doctor evaluates the severity of patient's medical condition and health requirements and recommends domiciliary hospitalization when deemed necessary.

2. Arrangement of Medical Facilities and Nurse

   The doctor arranges all the required medical equipments, such as oxygen cylinders, nebuliser, etc., for the patient at home. A nurse is also assigned to monitor the patient's condition at home.

3. Informing the Insurer

   The patient's family must notify the insurance provider about the domiciliary treatment and raise a claim. Submit any documents required by the insurer.

4. Claim Settlement

   The insurer will verify all the documents and pay the domiciliary claim amount to the policyholder.

7 Things to Know About Domiciliary Hospitalization Cover

Check out seven things that you must know about the domiciliary hospitalization cover:

1. Domiciliary hospitalization cover is not provided by all health insurance companies in India.
2. Domiciliary hospitalization is not always part of the base cover. The insurer may ask you to pay an additional premium amount to add this cover to your policy.
3. Unless the mandatory criteria for domiciliary hospitalization cover are met, the insurer will not pay for the cost of your home treatment. For eg: You will need to prove to your insurer that no hospital beds were empty in your neighbourhood and, thus, domiciliary hospitalization was essential.
4. While some health insurance plans cover domiciliary hospitalization expenses up to the sum insured, others may offer coverage up to a specified amount or percentage of the sum insured.
5. Some health policies only cover allopathic domiciliary treatment costs and not AYUSH treatments availed at home.
6. Corona Kavach health insurance plans also cover domiciliary treatment costs if the treatment is suggested by a medical practitioner.
7. In case you choose not to stay at the hospital and thus obtain treatment at home, your domiciliary claim will be denied by your insurer.

Bottom Line

No illness or accident comes with prior notice. All you can do is stay cautious and remain financially prepared. Domiciliary hospitalization helps you to avail medical coverage at home treatment if getting admitted to a hospital is not possible. Therefore, make sure to invest in a mediclaim insurance policy with the domiciliary hospitalization benefit. You can conveniently compare and buy health insurance online with the domiciliary benefit on websites like Policybazaar.com.