Domiciliary Hospitalization in Health Insurance

What is Domiciliary Hospitalization?

Domiciliary hospitalization refers to home-based treatment where the insured gets hospital-like treatment and care at home. This benefit is recommended in a situation where the insured is in urgent need of hospitalization but cannot be shifted to a hospital. When the insured undergoes treatment & other hospital facilities at home, it is considered as domiciliary hospitalization.

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

Let's understand domiciliary hospitalization better with the help of an example -

Rajan is a clerk who is suffering from dementia. Even though Rajan is undergoing medical treatment, he finds it challenging to do his daily chores. One day while standing in the kitchen, Rajan lost his balance, fell, and broke his arm. He also bumped his head, sprained his neck and fell unconscious. He was alone at home at the time of the incident and therefore, the first aid and treatment got delayed causing swelling and blood clots.

Since Rajan’s condition was critical, the doctor figured that moving him to the hospital would be too difficult and he should undergo treatment at home. All the necessary medical equipments were installed at home and then the treatment was initiated to normalize his condition. It took around five days for his swelling to reduce and the plaster was put in place to stabilize his arm bone.

Once Rajan started feeling better, he decided to claim the medical expenses under his health insurance policy of Rs 15 lakh. Since his medical insurance policy covered domiciliary hospitalization for up to 10% of the sum insured, his insurer paid Rs 1.5 lakh i.e. 10% of Rs 15 lakh as compensation for his domiciliary treatment.

What is Not Covered Under Domiciliary Hospitalization?

The domiciliary hospitalization cover is not available under the following situations:

• 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

Importance of Domiciliary Hospitalization in Health Insurance

Medical treatments are expensive today, whether you take them at a hospital or at home. But if you bring the hospital home and create a hospital-like set-up at home, then you will have to shell out a lot of money. This is why paying for domiciliary treatment can be expensive and therefore, having a health insurance policy with domiciliary hospitalization cover is essential these days. If your health insurance policy offers coverage for domiciliary hospitalization, then your insurer will compensate you for the medical expenses incurred on the home treatment provided a qualified doctor has approved it and shifting to a hospital is not advisable. The insurer will compensate a percentage of the sum insured or up to the maximum capping as specified in the policy. It will not only provide you with financial support for the treatment but will also save your family’s money spent on travelling to the hospital.

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 every health insurance provider in India.
2. Domiciliary hospitalization is not always part of the base cover. Thus, 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 Ayurveda or homeopathic treatments availed at home
6. Corona Kavach health insurance plans also cover domiciliary treatment costs if the treatment is suggested by a medical practitioner. You can easily buy this health insurance plan online from our website.
7. An insurance company will offer coverage for domiciliary hospitalization only if you prove to them that hospitalization was not possible and you had no choice other than to take domiciliary treatment. In case you choose not to stay at the hospital and instead obtain treatment at home, then your claim can be denied.

4 Things to Remember when Availing Domiciliary Hospitalization Benefit

Here are a few things that you need to remember before availing a domiciliary hospitalization benefit:

1. Make sure to go through the mandatory criteria to check whether or not you are eligible to avail the domiciliary hospitalization benefit
2. Buy a health insurance plan with domiciliary hospitalization benefit if you feel you may need to avail this benefit in the future during an emergency
3. If your policy covers home treatment costs, remember to go through the policy inclusions and exclusions at the time of buying the policy so that you are well aware of the coverage offered
4. Make sure to provide all the necessary information when filing a claim for domiciliary hospitalization expenses

Bottom Line

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