Know All About Domiciliary Hospitalization in Health Insurance

While searching for an ideal health insurance plan, did you encounter the term 'Domiciliary Hospitalization'? Are you confused with the term? 

We've got you and all other health insurance buyers who get confused between health insurance terms. Keep reading to learn more about domiciliary hospitalization in health insurance.

Domiciliary Hospitalisation Meaning in Health Insurance

A situation where the insured individual gets all the treatment and other hospital facilities at home is known as domiciliary hospitalisation in health insurance. 

An individual avails a home-based treatment for a critical disease, injury, or any other illness. On the good side, the treatment costs incurred are covered by the health insurance provider, but if only-

• The treatment is for an injury, illness, or disease for which hospitalization would be important in normal circumstances
• The condition of the insured patient doesn’t allow them to be shifted to a nursing home or hospital
• The insured patient had to avail treatment at home due to the unavailability of accommodation at the hospitalization
• The treatment lasted at least 3 days

Let’s understand domiciliary hospitalisation in depth with an example:

Anup Mishra, who runs a tuition center at home, is suffering from Episodic Vertigo illness. Although he is taking treatment, at times he gets panic attacks along with dizziness for a few minutes. 

One such day, while climbing the stairs, he got an attack, lost his balance, and fell down the stairs. In the whole situation, he injured his head, neck, and one of his legs, and then fell unconscious. Because of the absence of anyone at home during the whole accident, his treatment was delayed, resulting in swelling in his injured leg. Due to his serious condition, it was difficult to transfer him to a nearby hospital, so it was decided to continue his treatment at home. Then, various necessary equipment was delivered to his home, and the treatment was initiated.

When the treatment was finished and Anup began to feel better, he decided to file a claim with his health insurance company for the expenses. His health insurance provided coverage for in-home hospitalisation up to 8% of the sum insured. This means that if Anup had bought a health insurance plan for Rs 10 Lakh, the claim for his domiciliary hospitalisation would be around Rs 1 Lakh. Therefore, with this amount, Anup was capable enough of meeting the expenses for his treatment without burning his savings.

Domiciliary Hospitalization - What it Covers and Excludes?

Domiciliary hospitalization covers the treatment that justifies the conditions mentioned above. 

Also, read Benefits of Health Insurance Policy in India

However, note that there are two major conditions under which the treatment is not covered  - 

• Expenses for pre & post-hospitalization treatment.
• Any treatment that lasts for less than 72 hours or 3 days.
• Treatment includes bronchitis, epilepsy, hypertension, asthma, chronic nephritis, cough, cold and influenza, arthritis, gout, diabetes mellitus and insipidus, rheumatism, upper respiratory tract infection, chronic nephritis, nephrotic syndrome, tonsillitis, pharyngitis, and psychiatric disorder.

Importance of Domiciliary Hospitalization Cover in Health Insurance 

Many health insurance policyholders value the domiciliary hospitalisation feature. After all, the benefit allows them to be treated at home if they are unable to travel to the hospital or find accommodation in a hospital for a specific treatment. The best part is that this benefit saves the insured patient's family members at the time of emergency. 

Moreover, the benefit of home hospitalisation saves the insured or their family members a tonne of money that would otherwise be spent on frequent hospital visits. 

Things to Know About Domiciliary Hospitalization Cover

The important things to know about the Domiciliary Hospitalisation cover are listed below:

1. It is not provided by every health insurance company. 
2. It is not a default cover. You may be asked to pay an additional premium amount based on the condition of the cover.
3. While some policies cover domiciliary hospitalization up to the sum insured, others come with restricted coverage.
4. There are certain criteria for the treatment type availed at home and the illness for which treatment is availed at home.
5. There are a few health insurance providers that cover only specific expenses incurred on allopathic treatment. Homeopathic or Ayurvedic treatment availed at home for illness may not be covered by them.
6. To make the most of domiciliary hospitalisation benefits, you need to prove to the insurance provider that it is impossible for you to be admitted to a hospital and have no choice except for domiciliary hospitalisation. Remember that your expenses will only be reimbursed if the insurer is satisfied with your explanation. If you are in a position to go to the hospital but choose not to, your insurer will not pay for the treatment.

Things to Remember About Domiciliary Hospitalisation

1. If you think it would be important for you to have domiciliary hospitalization covered by your side during an emergency, find a health insurance plan that offers the benefit in the first place.
2. Remember to go through the requirements given to check whether or not you are eligible to avail of domiciliary hospitalization benefit.
3. If your policy offers the cover, make sure you go through the inclusions as well as exclusions well in advance to avoid last-minute disappointments.
4. Do remember to provide the necessary information when claiming domiciliary hospitalization.

Top 5 Health Insurance Policies That Cover Domiciliary Hospitalization

You must have a good understanding of all domiciliary hospitalisation by this point, including how it benefits the policyholder. Refer to the table of health insurance plans that include the feature of domiciliary hospitalisation and get ready to make a quick purchase.

Before you go ahead, please note that the ranking of the health insurance companies has been done based on the claim settlement ratio since when it comes to policy purchase, CSR is a key factor to be considered. 

(CSR According to the IBAI’s General Insurance Claim Insights Handbook For Policyholders - 4th Edition)

It is important to note that the detailed cover under domiciliary hospitalization feature may depend on the health insurance company. In other words, while you may enjoy cover for domiciliary expenses up to the sum insured amount in one plan by a health insurance company, another plan from another health insurance company may offer you cover for domiciliary expenses up to a specific percent of the sum insured amount.

As a result, when purchasing a health insurance policy with domiciliary hospitalisation coverage, you must be very careful to confirm your requirements. To ensure a worthwhile purchase, carefully read the policy vocabulary and other policy documents.

Also Read

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Health Insurance Policies for Business Owners

Conclusion 

Hope, you have understood all about domiciliary hospitalisation. Though this benefit is of great advantage, in case of an emergency, you should always try to visit a hospital. A treatment at the hospital will let you have access to all the tools and medical equipment without any delay. 

If looking forward to availing multiple benefits of health insurance with domiciliary hospitalization, choose a policy with this feature at first.

Rest assured, the feature of domiciliary hospitalization, even when available at an additional cost, will help you be at physical and financial ease. 

Those willing to learn more about health insurance in India or buy health insurance online, give us a call at our toll-free 1800-1205-698.