Essentials of Domiciliary Hospitalisation: What You Should Know

• Written by Nidhi Goyal

  Reviewed by Munmi Sharma

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“No beds available, please go back.”- The hospital corridors echoed.

She was shattered on listening to this as his father’s condition worsened. There was no time to wait for a hospital bed, so the doctor advised Ananya to undergo domiciliary hospitalisation. She set up a domiciliary plan, a mini hospital room in her living room, with IV drips, oxygen, and 24*7 nursing. 

But Ananya’s heart still cried, “How will I bear this cost?” 

“Will all our savings be wiped out in a few days?” “Will our family floater plan cover the domiciliary expenses?”

Did you know that your health insurance policy can also cover medical expenses incurred if you were treated 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 opt for a plan that includes domiciliary treatment or purchase an add-on cover 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 the Meaning of Domiciliary Hospitalisation?

Domiciliary hospitalisation is when a patient gets hospital-like treatment in the comfort of their home on a doctor’s recommendation. The insurer covers the expenses of such treatment when the insured cannot get the required treatment at a hospital. Simply put, the insured patient gets coverage for treatment at home rather than at the hospital. As per this clause, Ananya could arrange elderly care at home for her father without financial stress.

Eligibility and Requirements for Coverage of Domiciliary Hospitalisation

Availing of this coverage benefit requires you to meet some conditions. You will get the coverage for the sum insured 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:

• The treatment at home is medically required and is prescribed by an authorised physician.
• The treatment should last at least 3 days, i.e., 72 hours.
• The patient’s condition is very critical due to comorbidities and/ or old age. They are unable to move around. 
• Due to severe illness or injury, the patient can not be shifted to the hospital. 
• The doctors may advise domiciliary hospitalisation if the patient’s continuous hospitalisation is vital for extended periods.
• Sometimes, the doctors recommend a patient’s domiciliary hospitalisation due to the unavailability of beds and the paucity of specific medical facilities or staff. For example, this situation most frequently emerged during the pandemic. 
• The medical expenses of a few diseases are not covered, such as asthma, bronchitis, epilepsy, hypertension, influenza, cold, pyrexia of unknown origin, diabetes mellitus, diabetes insipidus, diarrhoea, all psychiatric or psychosomatic disorders, arthritis, gout and rheumatism, tonsillitis, and upper respiratory tract infection, including Larynitis, and Pharyngitis, etc.

Benefits of Domiciliary Hospitalisation

The medical inflation is whooping. It is always beyond the capacity of an ordinary man 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 aware of domiciliary hospitalisation coverage in your health insurance.

Understand how domiciliary insurance cover is important:

• 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 extended long hospitalisation is vital.
• A great advantage for insured individuals who have lost mobility due to illness or injury.

How does Domiciliary Hospitalisation Work?

Domiciliary medical reimbursement follows a procedure for successful claim settlement. Make sure you follow it without fail.

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

Step 1: Doctor’s Assessment:

A qualified physician evaluates the patient's condition and recommends domiciliary treatment when traditional hospitalisation isn't feasible due to factors like the patient's inability to be moved, bed unavailability, or the need for prolonged care.

Step 2:  Medical Arrangements

The doctor provides the patient with hospital-equivalent medical equipment and services at home that he could get in the hospital. Furthermore, a nurse is assigned to the house to monitor the hospitalised patient’s condition.

Step 3: Informing the Insurer & Documentation

The policyholder or a family member  must notify the insurance company. Furthermore, the company can ask for more details about the insured patient’s hospitalisation, such as medical reports, medical expenses bill/receipts, and a certificate of domiciliary treatment signed by the doctor.

Step 4: Claim Review and Reimbursement

The policy covers hospitalisation domiciliary expenses as per policy terms and conditions. The insurance provider reviews the claim and submits documents for verification. Once approved, the reimbursement amount is processed and transferred to the patient's bank account, assuming the treatment is covered under the policy and within applicable limits.

Note: There is often a capping on 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%, you will only get up to INR 1,00,000 after applying for claim settlement. This can vary depending on the clauses of different insurers. Hence, don’t forget to review the wording of your policy’s brochure before buying any policy.

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

5 Factors to Keep in Mind While Considering Domiciliary Hospitalisation

Domiciliary hospitalisation coverage can be a significant advantage for any policyholder. It can be a great option, especially if you have elderly members in the family. If you are planning for domiciliary hospitalisation, you should keep in mind a few aspects. Domiciliary treatment gives support not only to the patient but also 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.
• Remember to read the policy’s fine print to learn about its eligibility criteria, waiting period, sum insured amount percentage, inclusions, and exclusions.
• While the basics remain the same, insurers may have other coverage terms. Make sure you understand the details of your policy correctly. 
• 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 avail of the hospital at home services and have a smooth experience. This will prevent the misplacement of essential documents and the claim's failure.

>> Also Read: Types of health insurance policies

Take Away!

Getting a domiciliary hospitalisation in health insurance coverage is always recommended. It makes hospital-at-home stay for your old parents convenient and hassle-free. So, make a smart and wise decision for the welfare of your family and add home hospitalisation or 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. Get quality medical services at home without any financial worries.

>> Also Read: 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.