Domiciliary
Hospitalization
  • Availability Under Health Plan
  • Coverage under Domiciliary Hospitalization
  • Required Documents for Claim Settlement
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Domiciliary Hospitalization

Domiciliary Hospitalization is commonly known as Home Hospitalization. It is one of the important features of Health Insurance as it allows the policyholders to get treated at home if he/she is not able to reach the hospital or not able to find medical amenities for a particular treatment. It also helps the Insured in saving a lot of money that can be incurred on frequent visits to the hospital. The Insurance Company reimburses medical expenses to the policyholder during the policy term as per the advice of the doctor.

Coverage under Health Plan

Eligibility Criteria

To get the benefit of Domiciliary Hospitalization, you must fulfill certain conditions:

  • The treatment should last equal to or more than 72 hours.
  • The treatment should be related to diseases, illnesses, or injuries which would normally require hospitalization.

Benefits of Domiciliary Hospitalization

To know about the Benefits of Domiciliary Hospitalization in detail, read below:

Always Ready for Emergency/ Uncertain Situations

Domiciliary Hospitalization proves to be necessary for an unfortunate situation when there is a lack of medical treatment or medical amenities.

For instance- During the second wave of Covid 19, there was a huge crisis in the country and the citizens were unable to get medical aid due to the non-availability of beds and medical equipment, as a result of which they were advised to get treatment at home. Alongside, the soaring expenses made it difficult for people to get aid. In such a case, Domiciliary Hospitalization helps you get the right treatment at home & get reimbursement for the same, thereby not burdening the pockets.

Flexibility of Treatment

Domiciliary Hospitalization can be a lifesaver and becomes necessary for people who are physically challenged and cannot move to the hospital for getting treated.

For instance- Pradeep was climbing the stairs and unfortunately, he injured his leg and fell unconscious. As there was no one around, his treatment got delayed. Since his condition was critical, it was difficult to move him to the hospital. Thereafter, it was decided to treat him at home. All the equipment was installed at the house, and the treatment started to normalize the condition of his leg. With the help of Domiciliary Hospitalization, Pradeep was given the right kind of aid at the right time.

Domiciliary Hospitalization provides you the flexibility of getting appropriate medical treatment at home.

Convenience for Senior Citizens/ Physically Challenged

It is a very beneficial feature for Senior Citizens and for those who are Physically Challenged as they cannot visit hospitals frequently. Domiciliary Hospitalization allows them to get the treatment at their homes for which they can also file a claim & get Reimbursement for the Medical expenses.

Diseases not Covered under Domiciliary Hospitalization

Diseases Not Covered under Home Hospitalization
Hypertension Bronchitis
Asthma Epilepsy
Cough, cold, or influenza Chronic Nephritis
Pyrexia of unknown origin Diabetes Mellitus or Insipidus
Diarrhea, dysentery & gastro-enteritis Arthritis, Gout, or Rheumatism
Tonsillitis and Upper Respiratory Tract Infection Psychiatric or Psychosomatic Disorders
Laryngitis Pharyngitis

Claim Procedure for Domiciliary Hospitalization

Domiciliary Hospitalization claims can be done only on a reimbursement basis, which means that you have to primarily settle the bills on your own & then file a claim for the expenses incurred during the treatment.

Inform the Insurer

Inform the Insurer

You need to intimate the Health Insurance Company before opting for Domiciliary Hospitalization. Once the treatment is completed, you need to file the Reimbursement Claim within 7 to 14 days after the treatment.

Duly Signed Documents

After the treatment, you must collect all the original documents that the Insurer might require for approving the Reimbursement Claim. If the insurer ask for additional documents, you must submit them for smooth Claim Process.

Health Insurance Companies

Required Documents for Claim Settlement

  • Copy of PAN, and Aadhaar Card
  • Cash receipts and reports for tests done in original
  • Discharge Summary
  • Cash receipts from the hospital
  • Other documents specific to the treatment
  • Any other document, if asked for, by the company

Conclusion

Domiciliary Hospitalization is a great feature that can help the policyholder to receive the right medical treatment at home particularly during emergencies. Domiciliary Hospitalization is a very unique feature as it helps you get Reimbursement for the right medical aid, when there is a lack of basic medical facilities.

Health Insurance Articles

Frequently Asked Questions (FAQs)

1. Is there any waiting period for Domiciliary Hospitalization?

No, there is no waiting period for Domiciliary Hospitalization.

2. Is the cost of hiring a nurse at home covered?

Yes, the total expenses of the treatment at home including the cost of hiring a nurse are covered.

3. Is the cost of Medicines covered under Domiciliary Hospitalization?

Yes, the cost of medicines is covered under the Domiciliary Hospitalization.

4. Is AYUSH treatment covered under Domiciliary Hospitalization?

No, AYUSH treatments i.e. Ayurvedic, Yoga, Unani, Siddha & Homeopathy are not covered under Domiciliary Hospitalization.

5. Is the cost of ICU beds covered under Domiciliary Hospitalization?

Yes, the cost of ICU beds is covered under Domiciliary Hospitalization, if its cost of ICU beds comes under the total coverage amount of the policy.

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Reviewed By: Naval Goel

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.