Know All About Domiciliary Hospitalization in Health Insurance

While searching for an ideal health insurance plan, did you encounter the term 'Domiciliary Hospitalization'? Are you confused with the term? 

We've got you and all other health insurance buyers who get confused between health insurance terms. Keep reading to learn more about domiciliary hospitalization in health insurance.

What is Domiciliary Hospitalisation Meaning in Health Insurance?

The term Domiciliary Hospitalisation denotes all medical treatments and health care services received by a patient within their residential premises. Since, the person who is insured receives home based medical treatment and support services, he/she is considered hospitalised under the health insurance policy and thus, is accorded medical coverage under the terms and conditions of policy. However, it is interesting to know that the insured person must meet certain criteria or clauses for the health insurer (health insurance company) to provide him/her the coverage benefits. 

Below are the conditions for providing domiciliary hospitalisation to a patient offered by health insurance plans:

• Patient is suffering from a medical illness/disease that necessitates hospitalisation, advised by a licensed practitioner 
• Patient needs to be an ‘insured’ meaning one having an active health insurance policy 
• Though the patient needs hospitalisation, he/she cannot be relocated due to the severity of the condition or injury. For eg- severe limb injury or a case of paralysis
• Minimum period of duration of the treatment/medical services given to insured patient should be at least 3 days
• Unforeseen circumstances that make the hospitalisation difficult for a patient such as shortage of bed or other medical facilities

Domiciliary Hospitalization - What it Covers and Excludes?

Following are the medical conditions and support treatments that are provided cover under the purview of Domiciliary Hospitalisation:

• Bills of the prescribed medications 
• Diagnostic services- lab tests, reports, x rays etc
• Expenses of supporting medical staff like nurses, technicians, and therapists etc
• Visit charges of the doctor

Below mentioned are few general conditions that are excluded from Domiciliary Hospitalisation:

• Any treatment that does not exceed a period of 3 days; pre and post hospitalisation charges are not covered under domiciliary hospitalisation 
• Any prescribed treatment/service that does not recommend hospitalisation for a patient
• Cost incurred on dietary or health supplements like vitamin, protein powders which are not part of the treatment plan

Below mentioned is a list of medical diseases which are excluded from Domiciliary Hospitalisation:

• Diabetes Mellitus and Diabetes Insipidus
• Injury afflicted on self due to suicidal attempt
• Miscarriage or Infertility Treatments
• AYUSH Treatment 
• Epilepsy
• Bronchitis
• Asthma
• Fever/Pyrexia of unknown cause
• Influenza, Cold or Cough
• Psychiatric Illnesses/Disorders
• Diarrhoea or Gastroenteritis
• Blood Pressure/Hypertension
• Nephritis/Chronic Kidney Infection
• Arthritis/Rheumatic Diseases
• Tonsillitis/Pharyngitis/Laryngitis and other Respiratory Tract Infections

Importance of Domiciliary Hospitalization Cover in Health Insurance 

It is easily understandable that the ever growing economic inflation has shown its whooping impact on the medical and healthcare sector too. Expensive treatment of domiciliary care has forced the common man to become more aware about the significance of a well covered health insurance plan without compromising on the efficiency of the medical treatment and services received at home. 

Following listed points highlight the importance and benefits offered by domiciliary hospitalisation cover provided in a health insurance plan:

• If the patient is not insured, they will have to shell out large amount of sum from their hard earned income on domiciliary treatment, whereas in contrast, a well covered health insurance plan will ensure that they get necessary medical coverage under the same
• A health insurance plan providing domiciliary treatment cover becomes more essential especially when the insured patient and/or his family get domiciliary hospitalisation for a long duration
• A great boon for patients whose limbs have been critically injured and are in an immobile state but require hospitalisation at home 
• Important to highlight here is the great relief that domiciliary coverage offers for old and immobile senior patients who can avail the best of medical care and attention conveniently at home with reduced risk of infection
• Insured person can settle his/her claim process in a smooth way with comprehensive domiciliary coverage under a health insurance plan
• Your health insurance plan’s domiciliary cover will ensure adequate reimbursement of the doctor’s visitation charge, fees of nurse and other medical medical staff while you receive the best of personalised healthcare at home

Top 5 Health Insurance Policies That Cover Domiciliary Hospitalization

Before purchasing a health insurance policy for domiciliary hospitalisation and treatment, it is advised that you judiciously research, analyse and compare the ranking given to the health insurance companies. One of the pivotal parameters indicating their ranking is the Claim Settlement Ratio (CSR) which simply is the ratio between the number of claims resolved and the total number of claims a health insurance provider receives in a financial year. It determines whether the insurer can settle the claims of its customers.

Following is a table providing a list of domiciliary plans of top 5 health insurance companies having high CSR, as per 2022-2023 data.

Health Insurance Company	Policy Name	CSR
ACKO Health Insurance	ACKO Group Medical Health Insurance	97.68
Aditya Birla Health Insurance	Aditya Birla Activ- Health Platinum, Assure Diamond for individuals & Family; Aditya Birla Activ- Care Classic, Assure Diamond Topup & Platinum Essential for Seniors	99.01
Bajaj Allianz General Insurance	Bajaj Allianz Health Guard Plan	93.54
Care Health Insurance	Care Senior Citizen Plan, Care for 45+ for Seniors and Care Heart Plan	100
Cholamandalam MS General Insurance	Cholamandalam Super Top-Up Plan and Chola Flexi Health Supreme Plan for Individuals and Family	93.63

Things to Know About Domiciliary Hospitalization Cover

The important things to know about the Domiciliary Hospitalisation cover are listed below:

1. It is not provided by every health insurance company. 
2. It is not a default cover. You may be asked to pay an additional premium amount based on the condition of the cover.
3. While some policies cover domiciliary hospitalization up to the sum insured, others come with restricted coverage.
4. There are certain criteria for the treatment type availed at home and the illness for which treatment is availed at home.
5. There are a few health insurance providers that cover only specific expenses incurred on allopathic treatment. Homeopathic or Ayurvedic treatment availed at home for illness may not be covered by them.
6. To make the most of domiciliary hospitalisation benefits, you need to prove to the insurance provider that it is impossible for you to be admitted to a hospital and have no choice except for domiciliary hospitalisation. Remember that your expenses will only be reimbursed if the insurer is satisfied with your explanation. If you are in a position to go to the hospital but choose not to, your insurer will not pay for the treatment.

Things to Remember About Domiciliary Hospitalisation

1. If you think it would be important for you to have domiciliary hospitalization covered by your side during an emergency, find a health insurance plan that offers the benefit in the first place.
2. Remember to go through the requirements given to check whether or not you are eligible to avail of domiciliary hospitalization benefit.
3. If your policy offers the cover, make sure you go through the inclusions as well as exclusions well in advance to avoid last-minute disappointments.
4. Do remember to provide the necessary information when claiming domiciliary hospitalization.

Customer Support For Health Insurance

For any questions or doubts related to domiciliary hospitalisation cover plans, please connect with our policy guides who’re available 24*7. You may browse our web portal:

www.insurancedekho.com | Dial our toll - free number 7551196989 | Just drop an Email at support@insurancedekho.com

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Conclusion 

Summarising briefly the insurance coverage benefits for domiciliary care, an insured person must provide all essential documents pertaining to doctor’s certifications, diagnostic reports and prescriptions to the health insurance company before filing the claim. While careful observation about the claim benefits, clauses, and exclusion etc have to be made before buying your best domiciliary insurance policy, InsuranceDekho is always at your service for all queries regarding domiciliary health insurance.

FAQs Related To Domiciliary Hospitalisation

Q1. What are the few points to check before buying a domiciliary insurance plan?

Ans.  Following points should be considered before opting in domiciliary hospitalisation:

• The patient should be under domiciliary supportive treatment for minimum of 3 days
• You cannot apply for claim reimbursement if the amount exceeds the sum insured amount for domiciliary hospitalisation
• Reimbursement on the claim does not include cashless transaction facility in domiciliary hospitalisation
• Waiting period in case of domiciliary care coverage differs on account of pre existing diseases and illnesses

Q2. Are AYUSH treatments covered under domiciliary insurance policy?

Ans. Few health insurance companies do offer coverage options for AYUSH therapies and treatments but generally, insurance for the same is not provided under domiciliary hospitalisation.

Q3. Is the cost incurred on hiring a nurse covered under domiciliary hospitalisation?

Ans. All expenses related to the cost of hiring ancillary medical staff such as nurses or attendants are insured under domiciliary hospitalisation.