What is Domiciliary Hospitalisation in Health Insurance?

A health insurance policy offers a host of benefits and keeps your mind at peace during medical emergencies. Apart from taking care of your hospitalization expenses, a health plan also covers day-care treatments, organ donor expenses, AYUSH benefits and mental healthcare. One more important benefit that a health insurance policy offers is domiciliary hospitalization.

Imagine that a family member has suffered a serious leg injury and it is not possible to transfer them to the hospital. In such a situation, the doctor may advise home treatment or domiciliary hospitalization. If the patient’s health insurance plan covers domiciliary hospitalization expenses, the insurer will take care of his treatment bills.

If you are buying a health insurance policy online for the elderly, it is especially important that it covers domiciliary hospitalization. There may be times when it is not possible to shift an elderly person to a healthcare facility due to certain pre-existing conditions or injuries. In such cases, a health insurance policy covering domiciliary hospitalization expenses will come in handy. Even, in some cases, a critical illness insurance also includes domiciliary hospitalization cover. To know more what is domiciliary hospitalization, read on.

What is domiciliary hospitalization under mediclaim insurance?

Domiciliary hospitalization or home-based treatment is a situation in which a person suffering from a disease, illness or injury receives hospital-like treatment at home. Here are some situations when the treating medical practitioner may advise domiciliary hospitalization for patients:

• The patient’s physical condition is such that it is impossible to shift them to the hospital.

• When a patient can be shifted to the hospital but is advised domiciliary treatment due to non-availability of rooms in the hospital.

However, remember that the insurer will cover domiciliary hospitalization expenses only if the patient has an active health plan and receives treatment for 3 or more days.

What type of coverage is available under domiciliary hospitalization?

Insurance companies offer two types of coverage under domiciliary hospitalization, which you should know before buying a health insurance policy online. These are:

1. Domiciliary hospitalization included in your health plan:

Many insurance companies include domiciliary hospitalization benefits in the regular health plans they offer.

2. Domiciliary hospitalization as an add-on cover:

Some insurance companies offer domiciliary hospitalization as an add-on cover and at an additional premium.

In both cases, insurance companies usually cover domiciliary hospitalization expenses up to the sum insured. However, some insurers may cover only up to a specific amount mentioned under policy terms and conditions.

What are the benefits of domiciliary hospitalization?

1. Helps one avail timely treatment:

If you or a loved one has suffered a serious injury or your health condition makes it impossible to shift you to the hospital, domiciliary hospitalization cover can help. Timely home-based treatment will prevent your health from deteriorating further.

2. Ideal for uncertain situations:

In case beds are not available in the hospital or it is risky to shift the patient to a healthcare facility, domiciliary hospitalization is the only option.

3. Familiar atmosphere:

Patients tend to recover sooner when they receive treatment in the comfort of their homes.

Domiciliary hospitalization – What it covers and excludes under HDFC ERGO’s health insurance?

Inclusions:

If you have bought HDFC ERGO health insurance policy online or offline, it will cover domiciliary hospitalization expenses in the following cases:

• It is prescribed by a certified healthcare practitioner

• It is not possible to move the patient to the hospital due to their poor health condition

• The treating medical practitioner advises treatment at home when rooms are not available in the hospital

Exclusions:

HDFC ERGO does not cover expenses for the following treatments under domiciliary hospitalization:

• Asthma, tonsillitis, upper respiratory tract infection, and bronchitis

• Gout, arthritis, and rheumatism

• Diabetes mellitus and diabetes insipidus

• Diarrhea, gastroenteritis, and all other types of dysenteries

• Hypertension, epilepsy

• Pyrexia of unknown origin

• Psychiatric or psychosomatic disorders

• Post hospitalization expenses

5 things to know about domiciliary hospitalization cover

1. Domiciliary hospitalization cover is not offered by all insurance companies.

2. Some insurance companies may ask you to pay additional premium to cover domiciliary hospitalization.

3. While some insurers cover domiciliary hospitalization expenses up to the sum insured, others may offer a restricted coverage.

4. Domiciliary hospitalization cover has a waiting period, so you can file a claim only if the waiting period is over.

5. To avail the benefit, you must submit necessary documents and the treating doctor’s letter to the insurance company, stating the reason for domiciliary hospitalization.

Conclusion

Domiciliary hospitalization covers a range of treatments, except for those mentioned under policy terms and conditions. Also, your insurer will not cover home treatment if you are fit enough to go to the hospital. However, whether you are taking a health insurance policy online or through an agent, especially for the elderly members of your family, make sure you choose a plan with domiciliary hospitalization. Also, go through the inclusions and exclusions carefully to avoid any disappointments later.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.