Domiciliary hospitalization is a part of the health insurance lexicon. It is a benefit wherein the insured person getting treatment at home instead of a hospital is still considered hospitalized by the insurance company and the health insurance policy covers the expenses.
All insurance companies do not provide domiciliary hospitalization benefits. The insurers who provide this benefit have set certain conditions, and there are many exclusions. A detailed understanding of domiciliary hospitalization is thus needed to understand this better and which has been explained below.
Conditions for Domiciliary Hospitalization
Even if the health insurance policy of the insured person includes domiciliary hospitalization, certain conditions must be fulfilled for the insurer to cover the expenses. These are –
- The insured person is suffering from a disease, ailment, or injury for which a certified medical practitioner has advised hospitalization
- The severity of the disease or injury prevents the insured person from relocating to a hospital. A certified doctor must attest to the inability of the patient to get admitted to a hospital
- Lack of beds in the hospital or required medical equipment necessitating treatment at home
- The duration of the treatment is equal to or more than 3 days.
Features of Domiciliary Hospitalization
Domiciliary hospitalization can be a part of the regular health insurance plan offered by the health insurance company. However, many insurers do not offer domiciliary hospitalization by default. They provide this benefit as an add-on carrying a certain price. The customers can select domiciliary hospitalization by paying the extra premium amount.
Coverage under domiciliary hospitalization is the same as for conventional hospitalization. Most insurance companies cover the domiciliary hospitalization expenses up to the sum insured. However, the domiciliary hospitalization expenses provided by some insurers are less than the sum insured. In such a case, the specific limit for domiciliary hospitalization expenses is mentioned in the policy document.
Expenses such as nursing expenses, doctor’s fees, oxygen supply, surgical equipment, diagnostic tests, anesthesia, medicines, pacemaker, artificial limbs, and other general expenses similar to general hospitalization are covered.
Domiciliary hospitalization usually comes with a waiting period. The domiciliary hospitalization cover becomes active after the termination of the waiting period. The insured cannot file claims for domiciliary hospitalization during the waiting period.
Usually, all kinds of treatments are covered under domiciliary hospitalization. However, treatments that are not covered are mentioned in the policy document. It varies from one insurer to another.
Senior citizen health insurance plans usually include domiciliary hospitalization. Some insurers offer domiciliary hospitalization benefits for senior citizens only.
COVID-19 specific health insurance plans also provide domiciliary hospitalization cover if a qualified doctor mandates home treatment.
Exclusions of Domiciliary Hospitalization
Pre and post-hospitalization expenses are not covered under domiciliary hospitalization. The coverage is only for the expenses incurred during the course of treatment of the patient at home.
A claim cannot be made under domiciliary hospitalization if the treatment at home lasted for less than 72 hours. This is because the insurers require at least 3 days of treatment at home to consider it domiciliary hospitalization.
The insurer may cover only allopathic treatment under domiciliary hospitalization. This means such a policy won’t cover the expenses incurred on ayurvedic or homeopathic treatment at home.
Certain pathological conditions are not included in domiciliary hospitalization. This means the expenses incurred on the treatments of such conditions at home cannot be claimed under domiciliary hospitalization. The diseases excluded are as follows.
- Chronic nephritis
- Cough, cold, and influenza
- Pyrexia of unknown origin
- Diabetes mellitus or Diabetes insipidus
- Psychiatric and psychosomatic disorders
- Diarrhea, dysentery, and gastro-enteritis
- Tonsilitis and Upper Respiratory Tract Infection
Insurers can also include other diseases in the exclusion list, apart from the above-mentioned diseases. Thus, it is prudent to carefully read the list of exclusions mentioned in the policy document.
Domiciliary hospitalization does not provide a cashless treatment facility. This is because cashless treatment can be availed only at a network hospital of the insurer. Since domiciliary hospitalization means treatment at home, there is no hospital involvement. Thus, domiciliary hospitalization is based on reimbursement only. The insured person needs to settle the bill from his/her resources and then file a claim to get reimbursement.
The claim needs to be filed within 7-14 days from the end of the treatment. Documents such as doctor’s prescriptions, original test reports, documents pertaining to the specific treatment, discharge summary, cash receipts, and other documents asked for by the insurer need to be submitted. Reimbursement is approved if the conditions of domiciliary hospitalization are met, and the documents are in order.
Benefits of Domiciliary Hospitalization
Domiciliary hospitalization is highly beneficial in an emergency when the patient needs immediate treatment but is unable to get admitted to a hospital either due to lack of beds or required amenities or lack of hospitals in the vicinity. In such a case, treatment at home saves the patient’s life while the domiciliary hospitalization cover reimburses the cost of treatment at home.
Due to high-risk factors, physically challenged persons and senior citizens in grave medical conditions often cannot be shifted to hospitals. Domiciliary hospitalization ensures that such patients get the best possible medical treatment at home without losing their health insurance cover.
Patients often recover faster in their familiar home environments. Domiciliary hospitalization coverage ensures that the patient avails the benefits of home treatment without being burdened with the treatment cost.
Points to Remember
It is necessary to check whether the insurer is providing domiciliary hospitalization by default or as an add-on benefit. If it is an add-on benefit, decide whether or not the extra cost of domiciliary hospitalization fits your budget.
The list of inclusions and exclusions in the domiciliary hospitalization clause of the health insurance policy must be scrutinized to avoid confusion about what all are covered or not.
Opting for domiciliary hospitalization is an individual choice. However, senior citizens should include domiciliary hospitalization in their health insurance policies.