What Is Domiciliary Hospitalization In Health Insurance

Do you know that a health insurance policy can also cover those expenses which have been incurred if you were treated at your home? Yes, this is very much possible with one of the major benefits of “domiciliary hospitalization” which is generally present in your health insurance policy as per the certain conditions imposed by health insurers.

Let’s dig deeper to know about domiciliary hospitalization in health insurance and how this cover helps you to save a big chunk of money.

Meaning of Domiciliary Hospitalization

Domiciliary hospitalization is a kind of benefit or coverage which is a part of the health insurance policy. This simply means, when an individual receives hospital–like treatment at the ease and comfort of their own home. This benefit ensures insurance coverage to the policyholder if they are getting treatment at home, considered to be “hospitalized” by the insurance company. For instance, due to a severe medical condition, you may not be able to get hospitalized, in such a case, the costs related to the treatment taken at home gets covered under your health insurance policy.

However, this cover is not that simple how it looks, as the coverage is dependent on several terms and conditions. Domiciliary hospitalization can happen majorly due to most common reasons. 

First, if the patient is in such a condition, it becomes impossible for them to transfer to the hospital. Secondly, if there is a lack of proper medical infrastructure at the chosen hospital, such as non-availability of hospital beds or any specific medical equipment. Or, thirdly, domiciliary hospitalization can happen if continuous hospitalization is not possible.

Terms & Conditions

In India, most of the health insurance companies do not cover domiciliary hospitalization. And, the insurance companies who offer domiciliary hospitalization, benefit have certain limits and conditions. The most common conditions of domiciliary hospitalization occurs when: 

• The disease or bodily injury must be certified by a doctor or any medical practitioner.
• Home treatment is for at least for three days or 72 hours or more than three days.
• Insured’s condition is critical and it becomes impossible to transfer the patient to any hospital.
• Non-availability of hospital rooms and thus patients have no other option but to receive hospital like treatment at home.

It is to be noted that not all the conditions and circumstances of domiciliary hospitalization are covered in a health insurance policy, thus it is very crucial to read the inclusions and exclusions of a health insurance plan before selecting it.

How Domiciliary Hospitalization Works in Health Insurance?

Let’s look at the steps which generally take place in the process of domiciliary hospitalization:

Step 1: The patient goes to meet a doctor and get advice which requires medical treatment. Now, the doctor evaluates and analyses if the patient would require a domiciliary hospitalization or has to be admitted in hospital based on the severity of the condition.

Step 2: If the doctor advises for domiciliary hospitalization, then they certify the whole process and prepare a medical treatment plan for how it needs to be conducted and also prescribe the duration of treatment at home. For instance, at this stage, the doctor might advise the patient to have a dedicated nurse for any extra medical interventions, if needed.

Step 3: Once the doctor has prepared a proper treatment plan of domiciliary hospitalization, then the insured will notify their insurance company about the process and duration of the domiciliary hospitalization to seek insurance coverage. At this stage the insurance company might ask for more details in the form of documentation and will provide the coverage as per the terms and conditions of the chosen health insurance policy.  

Step 4: Insurance coverage is available only if “Domiciliary Hospitalization Benefit” is either included in your basic policy or available as an add-on cover at extra charges. However, the coverage for domiciliary hospitalization is either up to sum insured amount means 100% insurance coverage or up to a specific limit of the sum insured.

For instance, if someone has a health insurance policy of INR 20 lakh and their health policy covers domiciliary hospitalization benefit for up to 10% as sub-limit of the total sum insured. Then, their domiciliary expense coverage will be around INR 2 lakh.

What is Covered and Not Covered in Domiciliary Hospitalization Benefit?

Covered:

• You can only raise a claim if your treatment lasts for more than three days.
• Covers all kinds of hospitalization costs.
• Covers doctor consultation fees, nursing charges, the cost of medical equipment, and medication costs.
• Policyholders get coverage for the expenses incurred during the policy period on the advice of a doctor.

Not Covered: 

• Pre-and post-hospitalization costs.
• Any medical condition which pre-existed before purchasing the insurance policy.
• Any home treatment that lasts less than 72 hours.
• Diseases such as asthma, epilepsy, cold, cough, diabetes, diarrhea, high blood pressure.
• Injuries caused deliberately by the policyholder.
• Coverage for addiction treatment.
• Treatment costs for mental illness
• Treatment costs incurred for alternative therapies, such as ayurveda, yoga, acupuncture, naturopathy, homeopathy.

List of Diseases Not Covered in Domiciliary Hospitalization

• Hypertension or High Blood Pressure.
• Asthma
• Influenza or Cold and Cough.
• Diarrhea or Dysentery Related Issues.
• Tonsillitis and Respiratory Related Infections.
• Bronchitis
• Epilepsy
• Diabetes, Mellitus or Insipidus
• Arthritis
• Psychiatric Disorder

List of Diseases Covered in Domiciliary Hospitalization

• Cancer
• Leukemia
• Tuberculosis
• Paralysis
• Kidney Ailment
• Malaria
• Typhoid
• Cerebral Palsy
• Polio
• Hemorrhages Caused by Accidents
• Osteoporosis
• Chronic Pulmonary Disease
• Accidents of Serious Nature

*Coverage of diseases under domiciliary hospitalization clause depends upon policy to policy. Always check the inclusions before buying the health insurance policy.

Things to Keep in Mind While Evaluating Domiciliary Hospitalization for Health Insurance

Check whether “domiciliary hospitalization” is included in your health insurance policy or not.

If not included, then you can buy the add-on cover at extra premium cost.

Check the waiting period associated with domiciliary treatment.

Look out for the coverage options included for domiciliary hospitalization, either it can be up to the full sum insured amount or any sub-limits where the coverage is up to a certain amount.

Read the inclusions and exclusions very well, as you must be aware what kind of medical treatments can fall under domiciliary hospitalization under the health insurance plan.

Also gather the information regarding submission of documents which have to be given to the insurance provider at the time of seeking claim against expenses related to domiciliary hospitalization.

Certain health insurance plans such as senior citizen health insurance plans or health insurance policies related to Covid-19, have built-in domiciliary hospitalization coverage, where all the medical treatment related to any injury or illness is done at home, which would have been done at hospital premises otherwise.

Domiciliary Hospitalization and Covid-19

Covid-19 was such illness or ailment which required hospitalization at home in most of the cases, due to the non-availability and shortage of hospital beds and due to the nature of the disease which was quite contiguous. It is also termed as “home quarantine”, where the whole treatment was given at home instead of the hospital.  

This coverage of domiciliary hospitalization of the Covid-19 based health insurance plans proved to be extremely beneficial as one could receive the right kind of medical treatment at home under this benefit. It also provides the coverage against the full expenses related to the home treatment of Covid-19 infection.

Apart from the condition that the treatment lasts for at least three days, that is 72 hours, there are two more main conditions which must be met for availing domiciliary hospitalization in case of Covid-19. Similarly, like the basic conditions of domiciliary hospitalization, the patient suffering from Covid-19 also has to be serious and critical enough to visit a hospital. Plus , they can only avail this facility if there is non-availability of rooms in the hospital premises. 

Only in such conditions, a Covid-19 patient can receive the benefit of the domiciliary hospitalization at the comfort and ease of their home.

Advantages of Choosing Domiciliary Hospitalization in Health Insurance

• Allows to receive personalized care and thus promotes patient satisfaction.
• Promotes a better and conducive environment which helps in speedy recovery.
• Reduces the chances of catching hospital-based infections and thus creates a safer environment for patients.
• Cost-effective for the insurance providers as well as for the insured, as there are less expenses related to prolonged hospital stay, nursing charges and other such related charges.

Domiciliary Hospitalization Claim Settlement Process

Domiciliary Hospitalization is mostly covered under the reimbursement process, let’s have a look how one can file for the claim which has to be made under domiciliary hospitalization:

• The insured has to notify their insurance company immediately about the kind of treatment which they are going to avail under domiciliary hospitalization and make them understand the need of such hospitalization by providing them with all the required information about illness or doctor’s certification. 
• Then, it is important for them to submit other important documents such as medical and diagnostic reports. 
• As a next step, the insurance provider analyzes all the submitted documents and might ask for more documents or related information if needed.
• As a last step, if the insurance provider approves all the submitted documents, then will immediately initiate the payment process and will settle your claim.