What Does Health Insurance Cover For Domiciliary Treatment?
Published On May 31, 2022
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Domiciliary hospitalization is a benefit in many health insurance plans wherein the policyholder is considered as hospitalized even when they are getting treatment at home. Since a health insurance covers hospitalization, the insurer is bound to pay for medical treatment in such a scenario.
However, not all instances of domiciliary hospitalization are covered by a health insurance plan that include the benefit. Certain conditions have to be met for your insurer to pay for treatment during domiciliary hospitalisation.
What Is Covered Under Domiciliary Hospitalization?
- The patient must be suffering from a disease, ailment, or injury where a certified medical practitioner or doctor has advised hospitalisation.
- The patient must have an ongoing health policy that is active.
- The treatment duration must be equal to or greater than 3 days.
- The patient cannot be relocated to a hospital due to the severity of injury. For example, if the patient is suffering from paralysis or major leg injury, it is usually not advisable for them to be relocated to a hospital.
- There is a non-availability of accommodation at hospitals and the patient has no other option but to initiate their treatment at home.
What Is Not Covered Under Domiciliary Hospitalization?
Pre- and post-hospitalization expenses are not covered under domiciliary hospitalisation.
Any home treatment that lasts less than 72 hours or 3 days is not considered under domiciliary hospitalisation.
In addition to the above, the following diseases are not covered under Domiciliary hospitalisation.
- Cough, cold or influenza
- Diabetes Mellitus or Insipidus
- Pyrexia of unknown origin
- Chronic Nephritis
- Psychiatric or Psychosomatic Disorders
- Diarrhoea, dysentery and gastro-enteritis
- Arthritis, Gout, or Rheumatism
- Tonsillitis and Upper Respiratory Tract Infection, Laryngitis, Pharyngitis
The benefit of domiciliary hospitalisation is offered only when certain conditions are met or there is no bed availability in hospitals. Your reimbursement claim for domiciliary hospitalisation may not be approved if you chose home treatment despite being fit to approach a hospital or not looking for accommodation in a different hospital if the one you approached was full.
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