Domiciliary Hospitalization in Health Insurance – Know Meaning, Exclusions, Eligibility and Advantages

Health insurance claims are normally released by the insurer after the policyholder is hospitalized for treatment of ailment or illness. But with the introduction of domiciliary hospitalization claims, insurance companies are now approving claims for those who choose to receive treatment at home instead of a hospital.

What is domiciliary hospitalization?

Domiciliary Hospitalization is also known as home treatment or hospitalization at home, which means a patient opts to receive treatment for an illness or condition at home instead of getting admitted to a hospital. This kind of scenario occurs whenever the individual is not able to move around or cannot be taken into any nearest hospital when there isn’t the availability of a bed or ward. In these cases, the insured is able to claim for medical expenses to the insurance company even if there was no hospitalization.

One of the greatest advantages offered by health insurance companies through domiciliary treatment is that the policyholder who requires treatment at home is eligible to claim medical costs that are incurred during his period of treatment at home. It assists in reducing the overall treatment cost that may happen in the hospital. Before moving further, it is important to know in detail about the types of domiciliary hospitalization that are offered by Insurance companies:

1. Coverage offered within the health insurance policy: The benefit of domiciliary hospitalization insurance comes preloaded with the health insurance plan.
2. Domiciliary coverage purchased separately: You may purchase domiciliary hospitalization as extra protection for an additional cost from the insurer.

In both of the scenarios mentioned above, the health insurance company shall be covering the medical expenses incurred through home hospitalization upto a certain amount. This could be an amount that is part of the insurance cover or a portion of it, based on the terms and conditions of the chosen policy.

Exclusions from domiciliary hospitalization

While talking about Domiciliary Hospitalization, you must understand that not all treatments are covered by this facility. The following are the list of conditions that are not covered:

• Asthma
• Cold and cough
• Bronchitis
• Tonsillitis
• Influenza
• Arthritis
• Gout and Rheumatism
• Chronic Nephritis
• Nephritic Syndrome
• Diarrhea
• Infections in the upper respiratory tract which includes Laryngitis and Pharyngitis
• Gastroenteritis, Diabetic Mellitus and Insipidus, Epilepsy, Hypertension, Psychiatric or Psychosomatic Disorders of all kinds, Pyrexia of unknown origin.

As every health insurance policy has an individual list of inclusions and exclusions, it’s best to refer them to get a clear understanding of your eligibility prior to deciding whether you should submit any claim for hospitalization that may be taken at home.

Eligibility conditions for choosing Domiciliary Hospitalization

There are specific requirements that you must satisfy for you to qualify and utilize the Domiciliary Hospitalization facilities offered by a health insurance policy. While eligibility criteria may vary for each and every insurance policy, the common requirements can be explained as the following:

• The health insurance policy must be in active state, with all the dues paid.
• The patient needs to be suffering from an illness, medical issue, or an accident that can be treated at home.
• The treatment is certified by the doctor suggesting home hospitalization.
• The patient isn’t in a position to visit the hospital for medical treatment on account of some injuries, paralysis, or other physical conditions.
• The duration of treatment shouldn’t be more than 3 days.
• Rooms, wards or beds are not available in hospitals for the policyholder to get admitted.

For a full set of guidelines that you must meet, we strongly recommend you to refer to the policy document which governs the policies on Domiciliary Hospitalization for a much better understanding.

Advantages of Domiciliary hospitalization 

The recent COVID-19 epidemic led to a shortfall of hospital beds, pushing many people to travel long distances to gain admission to hospitals for treatment. There are many advantages for an insurance policyholder to take advantage of domiciliary hospitalization, particularly in unforeseeable situations. A few of them are listed below:

• Patients can receive treatment from the safety and comfort of home, thus reducing any risk of infection or spreading of illness or disease that may be present in the hospital that could compromise their existing condition.
• The patient and the doctor can stay at each other’s respective locations while choosing to get treated in one location, thereby saving time and money.
• It will save huge amounts of time for patients, particularly for those who live outside of the city, where hospital accessibility is difficult.

Documents for filing claim: 

For the successful processing of a claim for domiciliary hospitalization, the insured policyholder needs to submit these documents to the insurance company or TPA for approval. They are:

1.) A copy of the bills, receipts, diagnosis report, prescriptions, scan reports etc., these are given by the laboratory, doctor and pharmacy to treat the illness, sickness, or the onset of a disease at home.

2.) A letter of recommendation or prescription by the doctor recommending home treatment for the insured person.

3) After you have contacted the health insurance provider, forward the above information to their claim processing department or to the appropriate third-party administrator for processing of domiciliary hospitalization.

It’s hard to know the outcome of the severity of any illness or ailment before it is treated, but it is certainly possible for you to be aware and also be financially secure to have an insurance plan that provides comprehensive health coverage.

PayBima helps you in finding the right health insurance plan that includes domiciliary hospitalization from a wide range of insurance providers. You also get to shortlist policies according to your requirements, goals and premium paying capacity. Not only this, but their customer support team is also available to help you get answers to your doubts and questions related to insurance policies.