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Know Exactly What Is Domiciliary Hospitalisation In A Health Insurance Plan

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Health Insurance is just a base to create a financial backing for you and your family. Domiciliary Hospitalization is just another add on to take care of you in times when you need medical care at your home. The term ‘Domiciliary Hospitalization’ means that the medical expenses of the policyholder will be taken care of when he/she is already undergoing treatment for any disease or injury at home in India. 

Following conditions need to be followed-

The patient is suffering from a disease where the doctor has prescribed hospitalisation for him/her, and he/she has a valid ongoing base health policy.

  1. The patient cannot be shifted to any nearby hospital because that may pose a risk towards the current state of a patient. For example, a person who has a fractured leg or injury in the hips may find it steep until the initial recovery period is over to avoid further dislocation. The patient didn’t find accommodation in a nearby hospital that has enough facilities for the proper treatment.
  2. The domiciliary hospitalisation cover shall be available to treatments taken only under the Allopathic Mode of Treatment.

Where can Domiciliary Benefit be availed

The domiciliary hospitalisation benefit can be availed in the case where the minimum 24-hour hospitalisation is not possible or does not happen. Generally, a health insurance claim is provided only when the insured is hospitalised for a minimum 24-hour period. It is for this reason that most health insurance policies do not pay for treatments that do not result in hospitalisation. For instance, a fracture of the knee, resulting in a minor surgery that does not require any admission will not be covered under the health insurance policy.

However, in certain circumstances, it can be challenging to meet the criteria. There is a situation where the insured patient’s condition does not let them move to a hospital, or if the hospital is unable to accommodate them due to unavailability of space. In such cases, the patient has to be treated at home and kept under medical attention. Such situations come under domiciliary hospitalisation, where the insurer will pay out the compensation related to the health conditions under such a position under the domiciliary hospitalisation benefit in exceptional cases. There are some conditions imposed by health insurers when extending this cover, such as the duration of the treatment under such circumstances cannot surpass three days. Furthermore, as per data released by IRDAI, cases like bronchitis and diabetes are not covered under this policy as well.

The costs of medical care are rising drastically; on the other hand, the income of the common man has no relative growth. Thus, it is prudent to have health insurance covering all medical risks. As diseases come uninvited, financially backing yourselves up is a must.

There are insurance company that offers different health plans, which include various benefits including domiciliary hospitalisation. Health Insurance plans which covers domiciliary expenses with day-care treatment expenses, hospital cash allowance, home nursing, hospitalisation expenses and many more.

However, choosing the most suitable plan depends on your age, family size, your assets and liabilities. Domiciliary expenses are not covered in every health insurance policy, whether group health insurance or individual health insurance. It is crucial to analyse all your requirements before getting health insurance. You should be aware of the add-ons available and the premium for each.

You may have to pay an additional premium depending on the requirements above for availing this cover. Also, other conditions, like the type of treatment availed, will apply. Insurance companies generally, only cover the expenses incurred on Allopathic medicine.

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