What is the Meaning of Domiciliary Hospitalization in Health Insurance?

Although the awareness about health insurance in India isn’t very high, the recent outbreak of the COVID-19 epidemic has made people care extra for their health during these crisis times. With the help of a health policy, the medical insurance company will take care of the costs incurred when you seek any medical attention for illnesses that require hospitalization or costly procedures. But with the availability of claims for domiciliary treatment, it has become even more beneficial for people who are unable to get treatment at hospitals.

Pavithra Shetty, a 28-year old interior designer, was diagnosed with COVID-19 at the airport while on way to Mumbai. Due to the shortage of beds in the hospital, she was advised for home treatment by the doctor. She immediately rushed back to her home, isolated herself, and started following the treatment while consulting her doctor over a video call. After 14 days, she had completely recovered and was normal but had to continue with a few medications. She knew that her health insurance policy provided coverage for domiciliary hospitalization and hence filed for claim with the necessary documents. In a week’s time, her claim request was successful, and her insurer had paid back the expenses towards her COVID-19 treatment.

Let us acquaint you with domiciliary meaning and how has this term become the most talked-about term in health insurance these days?

What is Domiciliary Hospitalization?

Domiciliary Hospitalization is referred to as home hospitalization, wherein a person undergoes treatment for an illness or disease at their home instead of a hospital. This type of situation happens when the patient is unable to move or cannot be transported to the nearest hospital or if there is no availability of a bed in the hospital. In such cases, the insured person can claim for the medical expenses from the insurance company, even if there was no hospitalization involved.

This is among the most considerable benefits offered by Health Insurers, as it allows those who have to be treated at home to claim for medical expenses. It also helps reduce the total amount spent on the treatment taken at the hospital. But first, let us understand the type of coverage that is offered through domiciliary hospitalization:

Insurance companies provide two types of coverage for domiciliary expenses, which are:

1. Coverage Included in Health Insurance Plan: The benefit of domiciliary hospitalization coverage is provided with the health insurance policy. 
2. Coverage Purchased Separately: Some insurance companies provide domiciliary hospitalization as an additional cover for an extra cost. 

In both the cases mentioned above, the health insurance company will reimburse the medical costs that were spent on home hospitalization and treatment for a specific amount, which could be part of the sum insured or a percentage of it, depending on the policy’s terms and conditions.

Terms and Conditions to Opt for Domiciliary Hospitalization 

Home hospitalization is not always available or prescribed. There are specific requirements that you need to fulfill in order to avail of a Domiciliary Hospitalization facility with a health insurance policy. While the eligibility conditions might differ, the standard conditions are as follows: 

• The patient has an illness or a medical condition, or an injury that requires treatment in a hospital
• A board-certified medical professional must recommend hospitalization at home
• The health insurance policy should be active, with all dues cleared
• The duration of treatment has to be no more than three days
• The patient is not in a position to visit the hospital for treatment due to certain injuries, paralysis, etc
• Unavailability of rooms, wards, or beds in hospitals

For a detailed list of criteria, it is strongly recommended that you refer to the terms and conditions of the health policy for better understanding.

3 Benefits of Domiciliary Hospitalization

The recent COVID-19 pandemic led to a shortage of hospital beds forcing many to travel long-distance in order to secure admission to a hospital for treatment. So, there are plenty of advantages for a policyholder to make use of domiciliary hospitalization, especially during unforeseen circumstances. Some of them are: 

• Convenient for the patient as well as for the doctor to extend medical services from one place, saving time and money.
• Can undertake the treatment from the comfort and safety of home, thereby eliminating any chance of infection or spread of illness or disease inside the hospital. 
• It can save massive amounts of time for the patient, especially those who reside away from the hospital, by helping them get prompt medical treatment at home.

Exclusions Under Domiciliary Hospitalization

Not all treatments are covered by the insurer under Domiciliary Hospitalization. Below is the list of medical conditions that are not covered for home treatment claims:

• Asthma
• Bronchitis
• Tonsillitis
• Cough and cold
• Influenza
• Arthritis
• Gout and Rheumatism
• Chronic Nephritis
• Nephritic Syndrome
• Diarrhea
• Upper Respiratory Tract Infection, including Laryngitis as well as Pharyngitis
• All types of Dysenteries such as Gastroenteritis and Diabetic Mellitus as well as Insipidus, Epilepsy, Hypertension, Psychiatric or Psychosomatic Disorders of all sorts, Pyrexia of unknown origin.

Since each health insurance policy has a list of inclusions and exclusions, it is better that you refer to it for a clear idea of your eligibility before you file any claim for domiciliary hospitalization.

Documents Required to file claims for Domiciliary Hospitalization

For successful processing of a claim for domiciliary hospitalization, the insured person needs to provide relevant documents to the insurer or TPA for approval. They are: 

• Copy of diagnostic report, bills, receipts, etc., issued by the lab, doctor, and pharmacy for treatment of sickness, illness, or disease. 
• A prescription from a board-certified doctor recommends the treatment of home treatment.

After contacting the health insurance company, forward the above to their claim processing department or the respective third-party administrator for claims approval.

Take Away

It is difficult to predict any ailment or illness in advance. Therefore, the only thing that you can do in your capacity is to remain alert, stay financially secure, and have a comprehensive health insurance policy that provides maximum coverage.