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How Does Domiciliary Hospitalization Work in Health Insurance Policies?

Updated On May 01, 2021

The term domiciliary hospitalization refers to all health care expenses that the policyholder makes when he is undergoing treatment for a medical illness at his home. But the ailment should be certified by the doctor and he should prescribe hospitalization at home to seek health insurance claims. Health insurance policies that cover domiciliary expenses will meet day-care treatment expenses, home nursing expenses, costs of medicines, doctor fees, etc.

How Does Domiciliary Hospitalization Work in Health Insurance Policies?

How Does Domiciliary Hospitalization Cover Work?

Some health insurance policies offer domiciliary hospitalization as an add-on cover to the policy, at an additional cost. This benefit can only be availed if a minimum of one-day hospitalization did not occur, or was not possible for a medical ailment. Generally, health insurance policies will not pay for treatment that didn’t last for more than a day, and this rule applies to domiciliary hospitalization as well.

At times, the general health condition of the insured will not allow them to be shifted to a hospital, or the hospital will not have beds to accommodate the insured. In such instances, people with domiciliary hospitalization cover can get treatment in their home under medical supervision. This is an add-on to be bought with the insurance policy for an additional premium. If all the conditions are satisfied, the insurer will pay the compensation for the treatment of the health condition.

Inclusions and Exclusions of Domiciliary Hospitalization

The following are the inclusion and exclusion criteria for domiciliary hospitalization in health insurance policies. The expenses for domiciliary hospitalization will be met under the health insurance plan if,

  • The insured is suffering from a terminal illness where the medical professional has prescribed hospitalization at home for them.
  • The duration of the treatment will last for three days or more.
  • The injury is quite severe that the individual is not able to be shifted to the hospital in the current state such as injury in the leg, paralysis, etc.
  • The insured is forced to seek treatment at home, owing to the non-availability of beds in the hospital.
  • This cover is available only for an allopathic stream of medicine

The following are not included in the health insurance policy for domiciliary hospitalization.

  • The expenses for pre and post hospitalization will not be covered under the scheme
  • Any treatment that lasts for less than 3 days will not be counted as domiciliary hospitalization.
  • Domiciliary hospitalization will not be covered under the health insurance plan of the employer.
  • The following diseases will not be covered under domiciliary hospitalization
    Respiratory illness – Bronchitis, Asthma
    Neurotic disorders - Epilepsy
    Metabolic diseases - Diabetes mellitus, hypertension
    URI – tonsillitis, and laryngitis
    Psychiatric disorders
    Diarrhea and dysentery

Domiciliary expenses in health insurance are not available in all policies. Adding this cover to the insurance policy comes at an additional premium cost. It might be required to submit all pertaining bills to file claims.

Bottom Line

The cost of medical treatment is escalating to skyrocketing costs and normal people are not able to handle the rising costs of healthcare. Thus, it is beneficial to have a health insurance policy with flexible riders and add-ons to cover all medical risks to lead a stress-free life.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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