Understanding Domiciliary Hospitalisation in Health Insurance

Introduction

Health insurance has evolved significantly over the past few years in the competitive market. Now, health insurers are offering multiple features to ensure policyholders receive the best possible care. One such feature is domiciliary hospitalisation – it allows patients to receive hospital-like treatment at home and the insurer covers the cost. Of course, it comes with certain conditions. For all policyholders, it is crucial to understand how domiciliary hospitalisation works and how it can provide financial relief with uninterrupted medical care, and that too when the patient is hospitalised at home.

What is Domiciliary Hospitalisation?

Domiciliary hospitalisation (Treatment like hospital at home) is a new concept which gained popularity during Covid-19 pandemic, when hospitals were running out-of-beds due to huge inflow of patients. Under the domiciliary hospitalisation, the patient is hospitalised at home and medical treatment is administered under the supervision of a medical practitioner. The insurance company covers the cost of medical expenses during domiciliary hospitalisation provided some conditions are met. One, when a patient cannot be moved to a hospital due to their medical condition, two, if hospital beds are unavailable. This feature is particularly useful in scenarios like pandemics, chronic illnesses, and severe mobility restrictions.

When Does Domiciliary Hospitalisation Apply?

Policyholders are eligible for domiciliary hospitalisation cover if any of these two conditions apply:

1. Patient’s Condition:  In a condition where a doctor certifies that the patient’s condition is so critical that shifting them to a hospital immediately for treatment is not advisable. In that case, they can avail the benefit of domiciliary hospitalisation.
2. Non-availability of Hospital Beds: Many of us must remember the situation, where hospital beds were not available during the Covid-19 pandemic. In such disasters, where the hospital beds are unavailable, insurers may approve domiciliary treatment for eligible policyholders.

Key Features of Domiciliary Hospitalisation

• Doctor’s Prescription is Mandatory: Since the hospitalisation is done at home, it is mandatorily to be done under the supervision of a medical practitioner. The medical practitioner has to certify that the patient’s critical condition does not allow him to be shifted to a hospital immediately.
• Duration of Treatment: In general, most insurers require the domiciliary care to last for at least 3 consecutive days to be valid for coverage under the policy.
• Coverage Includes Medical Expenses: Expenses such as doctor consultations, nursing charges, medical tests, and medicines are covered.
• Policy-Specific Inclusions and Exclusions: In domiciliary hospitalisation, all medical conditions may not be covered. So, policyholders need to check their policy details in advance. 

Note: On an average, it takes a person nearly 4 hours to read & analyse an insurance policy, and approximately 1 day or more to compare different insurance plans and make a decision.

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Which conditions are covered under Domiciliary Hospitalisation?

Usually an insurance provider will not cover all diseases under this category. But, here’s a quick checklist of conditions which can be treated at home, such as:

Which conditions are NOT covered (Excluded) under Domiciliary Hospitalisation?

Not all medical conditions qualify for domiciliary hospitalisation. Some common exclusions are listed below;

• Chronic illnesses like diabetes and hypertension.
• Treatment of psychiatric conditions at home are excluded.
• Physiotherapy and rehabilitation therapy.
• Non-medical expenses such as home assistance, food, or general living expenses.
• Treatments that do not require active medical supervision.

What are the Benefits of Domiciliary Hospitalisation Coverage?

What are the challenges in availing Domiciliary Hospitalisation?

Domiciliary hospitalisation can be quite beneficial for patients who cannot be shifted to a hospital due to their critical medical condition. But policyholders face many challenges to avail this cover from a health insurer. Some of the challenges are listed here:

• Pre-approval Requirements: Some insurers require pre-authorisation before approving home-based hospitalisation claims.
• Documentation: Insurers may require detailed documentation from the policyholder such as doctor’s prescription & medical reports to support the need of domiciliary hospitalisation which will delay the treatment.
• Limited Coverage: Health insurance policies often impose a cap on domiciliary expenses which can restrict the reimbursement amount to a specified limit.
• Availability of Medical Personnel and Equipment: Not all home settings are equipped to handle complex medical instruments and care. This makes it challenging for patients to receive proper treatment.

Comparative Analysis Health Cover under India’s Top 4 Health Insurance Plans 

Conclusion

Domiciliary hospitalisation in health insurance is a feature which ensures that the medical care is accessible, even when hospitalisation is not possible. Everyone must understand its inclusions, exclusions, benefits, and the claim process as it helps to make an informed decision while selecting a health insurance plan. Before buying a health insurance plan, do compare different insurers and their domiciliary hospitalisation coverage amount as it can lead to better financial protection and peace of mind in times of medical emergencies.