What Is Domiciliary Hospitalization in Health Insurance And How It Works

Domiciliary Hospitalization: What is it?

Nobody likes getting admitted to a hospital, but it’s unavoidable when you need treatment. However, it’s not an option for many due to various factors. This is where domiciliary hospitalization comes into the picture. It refers to a type of medical treatment where a patient is hospitalised at home instead of in a traditional hospital setting. It allows a patient to receive medical care and treatment while he/she is at home. It is recommended for patients who are unable to be admitted to a hospital but still require medical treatment, care, or observation. This type of hospitalization is often used for patients with chronic or long-term illnesses, elderly patients, or patients with mobility-related issues.
Your insurer will only cover all the treatment expenses if you have an active health insurance policy and the benefit is included in the plan or if you have taken domiciliary hospitalization cover as an add-on. However, remember the treatment for domiciliary hospitalization should be for more than 3 days.

How Domiciliary hospitalization In Health Insurance Works

Domiciliary treatment expenses are covered only if the benefit is included in your base health insurance plan. While some insurance providers include domiciliary hospitalization benefits in the regular healthcare plan, some offer it as an add-on coverage for which you have to pay an additional premium. So, while buying a medical insurance policy, check if the feature is included in the plan; otherwise, you have to get domiciliary hospitalization cover added to your regular plan. However, since there’s an additional premium for it, purchase it if there’s a need. To claim domiciliary hospitalization expenses, you have to file a domiciliary claim with your insurance provider.

Inclusions & Exclusions

Inclusions

Domiciliary hospitalization provides coverage under the following conditions:

If the duration of treatment is more than 72 hours or 3 days.
If the home treatment is prescribed by a certified medical practitioner.
If the treatment is for any illness or injury that would require hospitalization under normal circumstances.
If the patient cannot be shifted to a hospital due to any severe health condition, such as paralysis or fractures.
If there is non-availability of hospital beds with adequate treatment facilities.

Exclusions

The following conditions are excluded from domiciliary hospitalization meaning:

Any treatment that requires less than 72 hours or 3 days is excluded from the scope.
Pre- and post-hospitalization expenses are not covered. .
Diseases not covered under domiciliary hospitalization are diabetes mellitus, hypertension, asthma, bronchitis, tonsillitis, upper respiratory tract infection, arthritis, gout, nephritis, diarrhoea, dysentery, epilepsy, and psychiatric or psychosomatic disorders.

When Domiciliary hospitalization Is Necessary and Permissible in Health Insurance

Domiciliary hospitalization is necessary and permissible under the following circumstances:

When the patient cannot be moved to a hospital due to a medical condition, such as fractures or paralysis.
If there are no rooms at the hospital with the required medical infrastructure.
The duration of treatment is more than 3 days or 72 hours.

However, there are some exceptional situations when domiciliary hospitalization is permissible. For instance, your minor child gets hospitalised for an extended period, and you may not be comfortable letting the child stay in the hospital without you or other family members. Similarly, if your parents need hospitalisation due to an accidental injury or medical condition which can be treated at home, they will prefer to be at home among family members instead of in a hospital.
An important point to keep in mind is that your claim for domiciliary hospitalization can get rejected if the domiciliary hospitalization is voluntary.
Voluntary domiciliary hospitalization meaning is when a person seeks home treatment when he/she can be shifted to a hospital and when hospital rooms are available with the necessary treatment facilities.
So, check the terms and conditions of the health insurance plan before buying it.

Importance of domiciliary hospitalization

Domiciliary hospitalization cover has many benefits. When you are buying health insurance, ensure it is part of the base policy or add it to your healthcare plan:

First and foremost, domiciliary hospitalization offers peace of mind. There’s no better place than your home, where you can receive hospital-like treatment for any disease, ailment or injury. Being with family during an illness makes you relaxed and comfortable.
It is cost-effective as the miscellaneous expenses incurred during hospitalization are almost nil.
Covers all treatment-related costs if the patient cannot be moved to a hospital or there is no accommodation in the hospital for specific treatment.
You can avail of professional medical care and treatment at home
If the health insurance policy covers only hospitalization expenses, domiciliary hospitalization cover can reduce your financial burden to a large extent
Apart from providing financial protection for the treatment, it will also save your family’s finances spent on hospital visits

Things to know about domiciliary hospitalization

When availing domiciliary hospitalization cover, there are certain things that should be kept in mind:

You can claim domiciliary hospitalization benefits only if they are included in your health insurance policy or if you have opted for domiciliary hospitalization cover by paying an additional premium.
The insurer will only pay for the home treatment expenses if you have met the criteria for domiciliary hospitalization. For instance, you have to submit proof that your medical condition did not allow you to shift to a hospital or there was no hospital room available for your treatment.
The treating doctor has to recommend home treatment; otherwise, your claim for domiciliary hospitalization can get denied.
Only allopathic treatments are covered. Ayurvedic or homoeopathy treatments cannot be claimed under domiciliary hospitalization expenses.
The duration of treatment required must be at least 3 days.

Things to remember when availing domiciliary hospitalization benefit

When availing domiciliary hospitalization cover, there are certain things that should be kept in mind:

All insurance companies do not provide domiciliary hospitalisation cover by default.
Some insurance providers offer to cover domiciliary hospitalization benefits at an additional premium.
While some insurers cover domiciliary hospitalization expenses up to the sum insured, others have limited coverage.
You must know the inclusions and exclusions of domiciliary cover.
Check whether the treatment that you will undergo at home is included in domiciliary hospitalisation cover.
Your claim for domiciliary hospitalization will be approved only if the insurance company is convinced with your reason for domiciliary hospitalization, i.e., your health condition was such that you could not be shifted to a hospital or due to the unavailability of hospital beds and proper treatment facilities.
Submit necessary documents and the treating doctor’s recommendation letter while filing an insurance claim for domiciliary hospitalization expenses.

Conclusion

Wouldn’t we all like to skip staying in the hospital if the option of getting treated from home is available? The treatment provided during domiciliary hospitalization is similar to that provided in a hospital but is done from home. This cost-effective and patient-centred alternative is getting popular for the constant medical supervision it provides to a patient. When you sit down and assess your health insurance needs, remember to consider adding domiciliary hospitalization to the policy, as it has many benefits that can make your life easier during medical emergencies. We hope you have found answers to your questions about domiciliary hospitalization meaning and what is domiciliary hospitalization under Mediclaim insurance and would now make an informed choice.