What is Domiciliary Hospitalisation?

The last few years have made most of us realise that health insurance schemes are essential at every age to cover hefty medical expenses. As you discover more and more benefits of health coverage, you may have also come across the term domiciliary hospitalisation. As the name suggests, domiciliary hospitalisation is when you are hospitalised at home. 

Yes, you read that right. Hospital-at-home or domiciliary hospitalisation can be a part of your health insurance policy. When you buy a health insurance rider, you can either opt for a plan that includes domiciliary treatment, or you can buy an add-on cover for the same by paying an extra premium. Let’s dig deeper to understand how you can become entitled to get a reimbursement claim against the domiciliary hospitalisation expenses. So, continue reading the article to make the most of this benefit. 

What is Domiciliary Hospitalisation?

Domiciliary hospitalisation is when a patient gets hospital-like treatment in the comfort of his home. The expenses of such a treatment are covered by the insurer when the insured is unable to get the required treatment at a hospital. Simply put, the insured patient gets coverage for the treatment being received at home rather than at the hospital. 

However, availing of this coverage benefit requires you to meet some conditions. You will get the coverage for the sum insured that is allocated as per the domiciliary hospitalisation cover under your policy. Furthermore, your claim for domiciliary hospitalisation will be acceptable in case of the following reasons: 

1. The treatment at home is medically required and is prescribed by an authorised physician.
2. The treatment should last for a minimum of 3 days, i.e., 72 hours.
3. The patient’s condition is very critical due to comorbidities and/ or old age. They are unable to move around. 
4. Due to severe illness or injury, the patient can not be transported to the hospital. 
5. In case the patient’s continuous hospitalisation is vital for a longer period, the doctors may advise domiciliary hospitalisation.
6. Sometimes, the doctors recommend a patient’s domiciliary hospitalisation due to the non-availability of beds and the paucity of specific medical facilities or staff. This situation most frequently emerged during the pandemic. 

How does Domiciliary Hospitalisation work? 

Let’s understand how domiciliary hospitalisation works through the following simple and easy steps:

Step 1: Based on the severity of the illness and health requirements, the doctor recommends domiciliary treatment or traditional hospitalisation to the patient. Usually, the doctor recommends home hospitalisation when the patient’s admission to the hospital completely is not favourable. 

Step 2: The doctor provides the patient with all kinds of medical facilities at home that he could get in the hospital. Furthermore, a nurse is assigned to the home to monitor the hospitalised patient’s condition. 

Step 3: Once the doctor recommends domiciliary hospitalisation, the policyholder or a family member should inform the insurance company about it. Furthermore, the company can ask for more details about the insured patient’s hospitalisation. You have to submit the medical reports, medical expenses cash receipts, a certificate of domiciliary treatment signed by the doctor, and a cancelled cheque or NEFT details. 

Step 4: Your health insurance company will review your claim application. Once the claim settlement team verifies all your documents and claim form, it will send its approval report to the concerned authorities for the claim settlement. The concerned authority will process the reimbursement amount to your bank account. 

Note: There is often a capping over the claim settlement of domiciliary hospitalisation. For instance, if your policy’s sum insured is INR 10,00,000 and your domiciliary expenses benefit is only 10% of that sum insured, you will only get up to INR 1,00,000 after applying for claim settlement. This can be varied as per the clauses of different insurers. Hence, don’t forget to go through the wording of your policy’s brochure before you buy any policy. 

Did you know that Care Supreme Health Insurance covers domiciliary hospitalisation expenses up to the sum insured? 

Benefits of Domiciliary Hospitalisation

The medical inflation is whooping. It is always beyond the capacity of an ordinary businessman or serviceman to procure expensive medical treatments in hospitals or at home. But, the funds can be easily arranged if the right health insurance policy is chosen. You should be cautious about domiciliary hospitalisation coverage in your health insurance. This becomes vital on many occasions. Continue reading to understand how domiciliary hospitalisation benefits your health insurance:

• Reduces your financial burden in the unanticipated future; otherwise, you may have to bear the burden of domiciliary hospitalisation expenses from your pocket
• Helps you arrange the best medical care at home for your old parents
• A convenient option for the insured patient and his family members when the long hospitalisation is vital 
• A great advantage for insured individuals who have lost their mobility due to illness or injury
• Easy claim settlement process.

What's usually Covered under Domiciliary Hospitalisation?

You should know the inclusions of the domiciliary hospitalisation before applying for a claim settlement. Look at the following points to know what is covered under domiciliary hospitalisation:

1. Outpatient treatment
2. Lab tests
3. Medication
4. Doctor consultation
5. The following diseases are usually included:

• Cancer
• Malaria
• Polio
• Paralysis
• Tuberculosis
• Kidney ailments. 

What's usually Not Covered under Domiciliary Hospitalisation?

Incomplete information about domiciliary hospitalisation can be heavy on the pocket. Check out the following pointers to know what is not covered under domiciliary hospitalisation:

1. In most cases, pre and post-hospitalisation in the hospital might not be included.
2. Pre-existing ailments unless specifically mentioned in the policy document and/ or within the waiting period
3. Home hospitalisation more than 72 hours
4. Any treatment related to de-addiction 
5. Self-injuries treatment
6. AYUSH treatment
7. The following diseases are usually excluded:

• Hypertension
• Epilepsy
• Diabetes mellitus
• Diabetes insipidus
• Diarrhea
• Asthma 
• Upper respiratory tract infections
• Gout
• Arthritis
• Rheumatism
• Mental disorder

5 Factors to Keep in Mind while Considering Domiciliary Hospitalisation

Domiciliary hospitalisation coverage can be a big advantage for any policyholder. It can be a great option, especially if you have elderly members in the family. Just keep in mind the following factors before buying a health insurance plan:

• Health insurers may not include domiciliary hospitalisation by default. You should find out whether this is an in-built feature in your policy. If not, you have to buy an add-on cover with an extra premium. 
• Don’t forget to read the wording of the policy’s fine print to know about its eligibility criteria, waiting period, sum insured amount percentage, inclusion, and exclusions.
• While the basics remain the same, it may be possible that different insurers have different coverage terms. Make sure you understand the details of your policy properly. 
• Some health insurance schemes designed for COVID-19 and senior citizen health coverage have the built-in feature of domiciliary hospitalisation. You can opt for any of them as you won’t have to pay an extra premium for home treatment. 
• You should gather the pre-information regarding the documentation requirements to settle the domiciliary hospitalisation. This will save you from essential document misplacement and claim failure.

Take Away!

In a nutshell, getting a domiciliary hospitalisation in health insurance coverage is always recommended. This will make you get a convenient and hassle-free hospital-at-home for your old parents. So, make a smart and wise decision for the welfare of your family and add domiciliary hospitalisation to your health insurance plan. The extra premium that you will pay for it right now will help you save big chunks of money in the future. 

Care Health Insurance understands your concern towards your and your family’s well-being. We know that domiciliary hospitalisation in a health insurance plan can prove to be a significant advantage. It is a unique advantage that allows policyholders to receive necessary medical care at home, sparing them from hospital stays when feasible. Through our various plans we try to provide our valued customers with quality medical services while enjoying the comfort of their homes. 

>> Also Read: Health Insurance Benefits for Domiciliary Hospitalisation

Disclaimers: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.