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What is Domiciliary Hospitalization in Health Insurance?

Published On Dec 30, 2020

Domiciliary hospitalization or home health care is a treatment option where the individuals take medical treatment at home, as their general condition prevents them from shifting to the hospital. Taking treatment at home due to lack of admission beds in a hospital can also be covered under domiciliary hospitalization and the condition also is accepted by insurance companies. It is not covered by every health insurance plan and is indeed acquired as a rider by paying an additional premium amount on specific plans. Also, the plan will not provide for alternative streams of medicine such as Ayurveda or homeopathy. It covers only specific expenses in allopathic treatment. 

What is Domiciliary Hospitalization in Health Insurance?

Purpose of Domiciliary Hospitalization

The main purpose of domiciliary care is to offer convenience for individuals to get treated at home, at times of difficult situations. Insurance providers who offer this additional cover also have certain illnesses, as their exclusion criteria for which coverage is not provided. Conditions for availing domiciliary hospitalization are as follows:
The inclusion criteria for domiciliary hospitalization are as follows:

  • Treatment that lasts more than three days.
  • The patient is not able to relocate to a health care facility owing to the severity of the disease e.g., paralysis, fracture, etc.
  • Patients who undergo home care due to non-availability of hospital beds. 

Following are excluded in Domiciliary Hospitalization

  • Treatments that last less than 72 hours.
  • Expenses for pre and post-hospital treatment.
  • Respiratory illnesses, diabetes, epilepsy, hypertension, dysentery, upper respiratory tract infections, etc.,
    Pros and Cons of Domiciliary Hospitalization
Basis Domiciliary Hospitalization Pros Domiciliary Hospitalization Cons
Beneficiaries  Domiciliary hospitalization cover will be of tremendous help in seeking medical aid for the elderly and in people where mobility is compromised. Domiciliary hospitalization is not offered by every health insurance provider. It is not a default cover. It is required to pay an additional premium to the existing policy. 
Convenience  Their cover helps them to take advanced medical care at the convenience of their home. There are set criteria to avail treatment at home and some insurance providers can offer only a restricted coverage.
Ease of claim It also saves the time and effort of the caretakers, as they have to visit the patient every time in the hospital.  It is important to prove to the insurance provider that it was not possible to get admitted to the hospital.

Points to Remember While Choosing Domiciliary Hospitalization Cover

Some important points to remember while choosing the domiciliary hospitalization cover are:

  • It is important to choose a plan that offers this benefit, as it is not offered by all insurance companies.
  • To avail of the benefit, the individual should satisfy the inclusions and exclusions criteria.
  • It is important to substantiate the claim for getting treated at home and only if the insurer is satisfied, he will pay the expenses for the treatment. 

Final Words

People seeking health insurance at an older age and those who take family health insurance with seniors at home can include a domiciliary hospitalization rider in their plan. But seeking treatment in a hospital is always beneficial as the facility will have all the latest equipment to handle any medical emergency. 

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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