What is Domicilary Hospitalisation: Coverage, Exclusions and How to Claim
The word ‘domiciliary’ originates from the word “domicile” which means home. Domiciliary hospitalisation is simply hospitalisation at home. Generally, health insurance policies require the holder to visit a hospital & get admitted to avail the policy benefits. But, domiciliary hospitalisation policy covers the treatment of the patient at home without hospitalisation.
Opting for domiciliary hospitalisation will allow medical treatment at home. But before you purchase a domicilary hospitalisation policy, understand how it works, what it covers and excludes, how to claim it and documents required. Read on!
What is Domiciliary Hospitalisation in Health Insurance?
Domiciliary hospitalisation in health insurance means that the insured can undergo treatment at home. They do not need to be hospitalised to claim health insurance coverage. This is in special cases where the doctor will advise home treatment if a person is unable to receive hospital treatment due to an illness, disease or injury.
Example:
An individual owns a health insurance policy with a domiciliary hospitalisation facility. He/she contacted COVID-19 & could not find accommodation in any hospital. He/she started his/her treatment at home.
The insurance policy covered his/her medical expenses while being treated at home without hospitalisation. This was possible because he/she had this special facility in his/her policy.
Is it always available in all health policies? In general, it is not a common policy term. To get its benefit you need to find out about health insurance policies that offer this special feature.
How does Domiciliary Hospitalisation Work in Health Insurance?
Domiciliary hospitalisation is an add-on that has to be purchased at an additional cost with the health insurance plan. The insurer will check the medical records and reports before settling a domiciliary hospitalisation insurance claim. The treatment must last for more than a day to claim domiciliary hospitalisation health insurance.
What is Covered in Domiciliary Hospitalisation?
It covers all general expenses related to the hospitalisation including boarding expenses, room charges, and nursing expenses. It also covers:
- Surgeon, Medical Practitioner, Anaesthetist, Consultants, Specialist Fees.
- Anaesthesia, Operation Theatre Charges, blood, Oxygen, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-Ray, Dialysis, Radiotherapy, Cost of Pacemaker, Chemotherapy, Artificial Limbs and similar expenses.
Broadly, domiciliary hospitalisation is treated as general hospitalisation. All conditions are similar to general hospitalisation. However, certain necessary conditions need to be satisfied before availing of domiciliary hospitalisation. These conditions are discussed below.
Required Conditions to Claim Domiciliary Hospitalisation Health Insurance
It is not always available. You need to fulfil certain conditions to use this special facility provided in the insurance policies. These conditions may differ from policy to policy.
The general conditions are:
- The patient has a disease, illness, or injury which needs hospital care.
- A certified medical professional must advise hospitalisation.
- The health policy should be active.
- The duration of treatment must be 3 days or more.
- The patient is unable to go to the hospital due to conditions such as paralysis, injury, etc.
- Hospital accommodation is not available.
Note: Please refer to the specific policy document to understand all the conditions in detail.
Benefits of Domiciliary hospitalisation During COVID-19 Pandemic
COVID-19 pandemic flooded Indian hospitals. Many people could not secure beds in hospitals due to shortage & unavailability. In such situations, domiciliary hospitalisation facilities in health insurance policies are life-saving.
Advantages:
- Provides treatment from the comfort of your home without out-of-pocket expense.
- Convenient, both for the patient as well as the caretaker.
- For people living away from hospitals, it saves critical time by providing immediate treatment at home.
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Domicilary Hospitalisation Exclusions
Several illnesses and diseases are excluded from domiciliary hospitalisation health insurance coverage. They are:
- Epilepsy
- Bronchitis
- Asthma
- Hypertension
- Diarrhea
- Dyentry
- Diabetes type I and type II
- Cold and cough
- Pharyngitis and laryngitis
- Tonsilitis
- Influenza
- Upper respiratory tract infection
- Arthritis
- Rheumatism
- Gout
- Psychiatric disorders
- Chronic nephritis
- Pyrexia for less than 10 days
- Homeopathic or Ayurvedic treatment at home
- Other exclusions depend on the insurer
- Pre & post-hospitalisation expenses are not covered
Note: Read the policy document carefully to understand which diseases are covered & which are not.
How To Claim Domiciliary Hospitalisation Health Insurance?
To claim domiciliary hospitalisation health insurance, you first need to wait until the waiting period is over. Your home treatment must also last for at least more than a day. At the time of claiming this health insurance, you need to submit the following documents:
- Treating doctor’s letter stating the reason for domiciliary hospitalisation.
- All expense bills and reports.
Also Read
Points to Remember
- Not all health insurance policies offer domiciliary hospitalisation. Find the policies which offer this facility and read the policy document carefully.
- The price or premium of the policy can increase with this facility. Worried about high premium payment? You can manage it by paying the premium on a monthly basis. Read this guide to know should you buy health insurance on EMI?
- Check the necessary conditions for using this facility in the policy document.
- Know the exceptions given in the policy document.
- Keep all the necessary documents ready to avoid any last-minute rush.
FAQs
Ans: The domiciliary hospitalisation limit is up to 10% of the sum insured. If the sum insured amount is Rs. 7 lakh. Then you can claim up to Rs.70,000 for domiciliary hospitalisation.
Ans: Not necessarily. Before buying any policy please confirm about this facility.
Ans: Extra premium or high premium can be charged for this facility. One must check the policy document and payment options carefully to understand all the details.
Ans: Yes, many insurance companies offer to convert any policy into a domiciliary hospitalisation policy on the payment of a little extra premium. Please check with the concerned insurance company for details.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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