Domiciliary Hospitalization In Health Insurance

We all know the importance of health in our lives. This coronavirus period has taught us the value of health and the importance of health insurance. We all have heard this adage, "Health is wealth", but are we taking this slogan as a priceless life lesson? 

What if you or your loved ones face an unexpected medical emergency and you cannot find a hospital bed at this critical moment? Also, you don't have enough money to pay for the necessary treatment? Isn't this a scary thought?

That's where health insurance comes into play. A health insurance policy provides various benefits that provide peace of mind in a medical emergency. A health plan covers hospitalization costs, daycare treatment, AYUSH treatment benefits, organ donor expenses, and mental health care. 

Another significant benefit that a health insurance plan offers is domiciliary hospitalization treatment. In some health policies, it is an in-built benefit, and some offer it as an add-on. Reading further, you will learn more about domiciliary hospitalization meaning, benefits, inclusions, exclusions, and other important details.

Domiciliary Hospitalization meaning

Domiciliary hospitalization or home hospitalization is one of the most important features of health insurance. It allows policyholders to get treatment at home if they cannot reach the hospital or find medical facilities for a specific treatment. 

Domiciliary hospitalization is required when a policyholder is unable to visit the hospital due to their medical condition or when beds in the hospital are not available. Also, there are some situations when the doctor advises the patient to take domiciliary treatment. In such cases, the health insurance companies will bear the total medical expenses of the policyholder's treatment under domiciliary hospitalization coverage.

Available coverage type under Domiciliary Hospitalization

There are 2 types of coverage offered under domiciliary hospitalization by health insurance companies. Customers should know about these coverage types before buying a health insurance plan in India:

• Offered as a coverage benefit in your health plan: Domiciliary hospitalization is offered as a coverage benefit in the health insurance plan by various health insurance companies.
• Offered as an add-on rider: Some insurance companies offered domiciliary hospitalization as an add-on rider at some additional premium.

Eligibility Criteria for Domiciliary Hospitalization

Below-mentioned are the conditions that you need to fulfill to get the benefits of domiciliary hospitalization:

• The treatment should last equal to or more than 3 days.
• The treatment should be related to diseases, injuries, and illnesses that generally require hospitalization.
• The patient should have an ongoing active health insurance policy.

Benefits of Domiciliary Hospitalization

Domiciliary Hospitalization offers various benefits to the policyholders. Read below to understand the benefits of domiciliary hospitalization in detail.

• Timely Treatment: Domiciliary hospitalization can be very beneficial when there is a lack of medical amenities for the patient because due to domiciliary hospitalization, patients can take medical treatment at their homes in case of medical emergencies. For example: As we all know, during the second wave of covid-19, India was facing a massive shortage of hospital beds and medical equipment, and patients were not getting timely medical attention. In such situations, home hospitalization can be very beneficial as it allows the policyholders to get timely medical treatment at home and reimburse the total expenses from the health insurance company.

• Offers Flexibility: Domiciliary hospitalization provides flexibility to receive treatment when the patient is unable to go to the hospital because of his medical condition. In such conditions, domiciliary hospitalization can be life-saving for them. For Instance: Rakesh has suffered severe injuries and his health condition has made it impossible to admit him to the hospital. This is where Domiciliary Hospitalization comes into play, as it will help Rakesh get timely medical treatment at his home so that his health does not deteriorate further.

• Boon for Senior Citizen or Physically Challenged: Domiciliary treatment can be very beneficial for senior citizens or physically challenged people who can't visit the hospital frequently. Domiciliary hospitalization is a boon for them as it allows them to get treated at home when continuous medical care is required. 

What is not Covered under Domiciliary Hospitalization?

Various things like pre and post-hospitalization in domiciliary hospitalization are not covered. Apart from it, the below-mentioned are the following treatment for diseases that are not covered under domiciliary hospitalization:

Domiciliary Hospitalization Claim Process

You can file a reimbursement claim for domiciliary hospitalization, which means you must first pay your bills before filing a claim for the expenses incurred during treatment.

• Intimate the Insurer

1. Intimate the insurer before going for domiciliary hospitalization.
2. File a reimbursement claim within 2 weeks after the treatment.

• Duly Signed Documents

1. Submit all the required documents for claim approval
2. The insurance company will verify the documents
3. After the verification is complete, the insurance companies start processing your reimbursement claim.

Required Documents for Reimbursement Claim

Below mentioned are the list of documents that are required to submit to the health insurance companies to file a reimbursement claim:

• Xerox copy of PAN and Aadhaar Card
• Original documents of Cash receipts and reports 
• Discharge Summary in original
• Other documents related to the treatment

How does Domiciliary Hospitalization in Health Insurance Work?

Note that not all health insurance policies offer domiciliary hospitalization by default. Depending on your and your family's medical requirements, you can add a domiciliary treatment benefit by paying an extra cost.  

If your health insurance policy covers domiciliary hospitalization benefits, your insurer will reimburse the expenses incurred for the domiciliary treatment the same way it would for regular hospitalization. 

Generally, the below process is followed to gain the benefits of domiciliary hospitalization coverage:

• The patient visits the doctor for a medical consultation. The doctor evaluates the conditions and, depending on the severity of the medical condition, refers the patient for domiciliary hospitalization or admission to the hospital. 
• In case of domiciliary hospitalization, the doctor prepares a treatment plan that includes the medication and duration of domiciliary treatment required. 
• Once the plan is prepared, the insured notifies the health insurance company to seek domiciliary hospitalization coverage. At this stage, the insurer may ask for further details. 
• Depending on the policy terms and conditions, the health insurance company will reimburse the eligible amount as per the domiciliary hospitalization limit. 

What is Covered Under Domiciliary Hospitalization?

Below are some of the inclusions under domiciliary hospitalization coverage:

• Annual health check-ups
• Caretaker/ Nurse fee
• Medication cost
• Lab test expenses
• Advanced technology treatment
• Medical expenses incurred for at least 3 days of home treatment
• E-consultations

* We suggest you go through the policy documents carefully to learn about the inclusions under domiciliary hospitalization, as coverage can differ from plan to plan. 

Things to Consider About Domiciliary Hospitalization

Domiciliary hospitalization cover helps patients get the best possible medical care from the comfort of their homes. Following are the key points that you can consider to avail of domiciliary hospitalization benefits: 

• Domiciliary hospitalization should be for at least 3 days. 
• Go through the policy documents to learn about the domiciliary hospitalization limit. You cannot claim an amount exceeding the sum insured limit. 
• No cashless facility is available.
• You must serve the waiting period before claiming domiciliary hospitalization.
• Keep all the treatment-related documents, including consultations, bills, etc., to make the domiciliary hospitalization claim process efficient.
• Unless all the mandatory criteria under domiciliary hospitalization are met, the insurer will not reimburse the cost of home treatment. 

Conclusion

Domiciliary hospitalization is an excellent feature of health insurance as it covers a wide range of treatments, except the ones mentioned above. It is very beneficial for the policyholders, and it provides the right medical aid at home during medical emergencies. So, Always buy a comprehensive health insurance plan that covers all your medical insurance needs in a sudden medical emergency. Choose Well and Stay Healthy.

Disclaimer: The information published in this article is for the reader′s reference only. The content of this information is to provide an overview of your health insurance needs and should not be relied upon for personal, medical, legal, or financial decisions; you should consult an appropriate professional for specific advice. The Company makes no representations about the suitability, reliability, timeliness, and accuracy of the information, services, or any other items mentioned on this subject for any purpose whatsoever.

*Standard Plans Terms and Conditions apply.

FAQs

Q. Is the cost of hiring a nurse covered under domiciliary hospitalization?
A. Yes. The total cost of home hospitalization including the cost of hiring nurses is covered under domiciliary hospitalization.

Q. Do I have to wait to take the benefit of domiciliary hospitalization?
A. No. There is no waiting period for domiciliary hospitalization.

Q. Are the AYUSH treatments covered under domiciliary hospitalization?
A. No, alternative treatments such as AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy are not covered under domiciliary hospitalization.

Q. Is the cost of ICU beds covered under domiciliary hospitalization?
A. yes, the cost of ICU beds is covered under domiciliary hospitalization.

Q. Is the cost of medicine covered under domiciliary hospitalization?
A. Yes, the cost of medicines is also covered under domiciliary hospitalization.

Q. Is there any waiting period for domiciliary hospitalization?

A.Yes, some of the illnesses and diseases may apply a waiting period for domiciliary hospitalization and the policyholder can avail of the benefits once the waiting period is over. 

Q. Do all health insurance policies offer domiciliary treatment benefits?

A.No, not all health insurance plans offer in-built domiciliary hospitalization coverage. Other policies may offer it as an add-on benefit, which the policyholder can avail of by paying an extra cost. 

Q. What is the domiciliary hospitalization limit?

A.Depending on the policy terms and conditions, the domiciliary hospitalization limit may range from 10% to 100% of the sum insured.