Domiciliary Hospitalisation in Health Insurance: All You Need to Know

Domiciliary hospitalisation is an important feature in health insurance that allows policyholders to receive medical treatment at home when hospital admission is medically necessary but not feasible. This coverage becomes valuable in situations such as non-availability of hospital beds, the patient’s critical condition, or specific treatment requirements.

Many health insurance policies in India include domiciliary hospitalisation benefits, subject to defined terms and conditions. Understanding how this domiciliary hospitalisation in health insurance works, along with its eligibility rules, inclusions, exclusions, and claim process, is essential for making informed decisions while choosing a health insurance policy.

What is Domiciliary Hospitalisation Meaning?

In simple terms, domiciliary hospitalisation refers to hospital-like medical treatments that are generally provided to a patient at home. In this situation, the patients are treated under the supervision of professional doctors and medical assistants. Additionally, they will also receive care from modern medical aids like oxygen concentrators, CPAP/BiPAP machines (for sleep apnea), ventilators, and nebulisers.

Since this facility can be included as both a standard coverage or a part of an add-on,  always check your health insurance policy documents carefully to understand its inclusions and conditions.

When Does Domiciliary Hospitalisation Apply?

Under most health cover plans, you can file a claim for domiciliary hospitalisation only under certain circumstances:

1. No Hospital Beds Available: During a medical emergency, if nearby hospitals are full out of beds and cannot admit new patients, you can opt for treatment at home.

2. Patient is Critically Ill: If the condition of the insured is so severe that moving them could worsen their situation, domiciliary treatment becomes essential.

3. Doctor’s Recommendation: Without the recommendation of an MBBS-certified doctor, domiciliary hospitalisation is not possible.

4. Minimum Duration: Treatment must continue for at least 72 hours to qualify for a claim.

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How Does Domiciliary Hospitalisation Work?

Domiciliary hospitalisation in health insurance generally works in the following steps:

1. Getting a Doctor’s Recommendation: For domiciliary hospitalisation, a policyholder must get a prescription from a certified doctor describing the reason they can’t move to the hospital.

2. Informing the Insurer: To initiate the claim, you first need to inform your insurer. You can contact them by using their telephone number or by directly raising a claim online via their official website. 

3. Arrangement of Treatment: Ensure having hospital-like facilities such as nursing care, oxygen cylinder, ventilators, or infusion pumps, to begin the treatment.

4. Documentation: Once starting the treatment, gather all the necessary documents, such as test reports, doctor's prescription, daily monitoring charts, and medical bills to file a claim.

5. Claim Filing: Submit these documents online or visit your insurer’s office to get the reimbursement of your medical bills.

6. Verification and Claim Initiation: If all documents are valid, reputable insurance companies like Bajaj General Insurance generally take less time to release the claim amount. 

Now that you know what a domiciliary claim means, let's see how it works in real-life situations with a practical example:

Mr Roy got sick with a severe infection requiring continuous intravenous (IV) antibiotics for 5 days. However, as no hospital beds are available in his city, a doctor prescribes home hospitalisation to get him treated as soon as possible.

This is why his family raised a domiciliary claim under his health insurance policy of ₹25 lakh. Under their domiciliary hospitalisation policy, only 10% of the sum insured is covered. Therefore, after verifying his documents, the insurer paid ₹2.5 lakh as reimbursement for his domiciliary treatment.

What is Covered Under Domiciliary Hospitalisation?

A well-structured health insurance for parents or any dependent should include the following benefits under domiciliary hospitalisation coverage:

1. Doctor consultation fees

2. Medical equipment (oxygen tanks, nebulisers, monitors, etc.)

3. Nurse charges

4. Cost of medicines

5. Expenses for Diagnostic tests (such as blood tests, ECG, etc.)

It’s equally important to know the limitations of your health cover plans. Typically,a policyholder can not claim the benefits of domiciliary hospitalisation for:

1. Pre and post-hospitalisation expenses.

2. Treatments shorter than 72 hours.

3. Cases where hospitalisation was possible but not opted for.

4. Expenses of home treatments that are taken without the recommendation of an MBBS doctor.

5. Common ailments like cold, asthma, arthritis, etc.

6. Treating psychiatric or psychosomatic conditions at home.

7. Treatments like epilepsy, gout, or bronchitis are not considered life-threatening.

Important Note: All the inclusions and exclusions under a domiciliary hospitalisation policy can vary across providers. This is why you should always read the insurance documents carefully to understand the insurance terms.

What are the Differences Between Domiciliary Hospitalisation and Home Care Treatment?

Although both home care treatment and domiciliary hospitalisation provide medical support at home, they have a fundamental difference in terms of urgency and necessity.

The table below highlights the key differences between these processes:

Under the policy documents of Bajaj General Insurance Limited, these distinctions are clearly laid out to help you make informed decisions.

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Why Should You Opt for Domiciliary Hospitalisation Cover?

Choosing a health insurance plan with domiciliary hospitalisation is a smart strategy.

Ensures Timely Treatment

This facility helps the patient to get timely treatment during any sudden medical emergency if they are unable to reach the hospital. In fact, since in the metro cities getting hospital beds is always a big hassle, this policy can help to save a lot of time and prevent further deterioration of health.

Critical Care at Home

While recovering from severe ailments and injuries, one’s mental health can significantly deteriorate. This is why, by receiving the necessary treatment in the comfort of home, patients can stay strong during a challenging recovery period. In fact, emotional well-being automatically quickens the healing process.

Ideal for Elderly Parents

Elderly patients are highly susceptible to secondary infections in hospitals. In fact, according to the news of India Today, around 10% to 20% of patients acquire severe infections in hospitals. However, with this domiciliary care, this risk can be significantly reduced, allowing for a safer and more familiar environment.

Reduced Financial Burden

According to news from CNBC, the medical inflation rate in India is rising at an alarming rate of 12% to 14% per year. This is the reason that getting any medical facilities at home can also create a huge financial burden on your savings. However, with a domiciliary hospitalisation in health insurance, you can easily disburse the treatment amount based on the policy terms.

7 Things to Know Before Choosing Domiciliary Hospitalisation Cover

Before you rush to add this benefit to your policy, here are seven quick facts to keep in mind:

1. Not All Plans Include It: Choose a policy that offers domiciliary hospitalisation in its base plan or as an add-on.

2. It May Come at an Extra Cost: The cost can be high, but it’s worth it—especially if your parents or dependents are prone to health complications.

3. Proof of Necessity is Required: You must prove hospitalisation was not an option.

4. Partial or Full Coverage: Some plans cover up to a limit; others cover up to the full sum insured.

5. Limited to Certain Treatments:Although allopathic treatment is commonly covered under this plan, there might be an exclusion for AYUSH policy, which includes ayurvedic, yoga, unani, siddha and homoeopathic treatment.

6. Does Not Cover Voluntary Home Treatment: Choosing to stay home despite hospital availability disqualifies the claim.

7. Sum Insured Amount Utilised Differently: In India, numerous health insurance plans cover domiciliary hospitalisation expenses up to the sum insured. Simultaneously, some insurers also offer coverage up to a specified amount or percentage of the sum insured.

8. Analyse the Policy Limits: Review your policy for specific sub-limits on domiciliary care, as many insurance providers may not cover the full sum insured.

Also Read: Difference Between Sum Insured vs. Sum Assured

How to Claim for Domiciliary Hospitalisation Under Bajaj General Insurance Limited’s Health Insurance?

To claim domiciliary hospitalisation with Bajaj General Insurance, there are certain criteria you have to keep in mind:

1. Meet the Timeline: The treatment has to be medically necessary for at least 3 consecutive days.

2. Proper Doctor Evaluation: We will immediately reject your claim if any certified medical practitioner (MBBS) does not approve the necessity of the home treatment.

3. Understand the Coverage Restrictions: Chronic conditions like asthma, bronchitis, diabetes, hypertension, and rheumatism generally fall under pre-existing disease. This is why our health insurance plan would not provide domiciliary treatment for these conditions.

4. Gather Necessary Documents: Before filing a claim for domiciliary hospitalisation, keep documents, including the doctor's prescription, treatment records, and medical equipment, handy. Remember, one wrong document can lead to immediate claim rejection.

Why Choose Bajaj General Insurance Limited for Domiciliary Hospitalisation Coverage?

Bajaj General Insurance Limited is a trusted name when it comes to health insurance in India. Here's what makes it stand out:

Customisable Plans

You will get the flexibility to choose your plan as per your medical needs under our multiple policies with domiciliary care benefits for individuals, families, and seniors. In fact, while purchasing health insurance online from our website, you can receive instant quotes depending on your healthcare preferences.

Transparent Policies

Simply read your health insurance policy documents to understand the domiciliary hospitalisation clauses. However, if you face any issue or have any queries, our all-around customer care assistance will always be there at your service.

Additional Benefits

Apart from the domiciliary hospitalisation care, you would receive the comprehensive benefits for your other healthcare needs under our policy. For instance, you will receive the benefits of preventative healthcare check-ups, ambulance costs covered, as well as coverage for maternity and newborn expenses.

Wide Network of Cashless Hospitals

Along with domiciliary treatment, at our network of over 18,000+ cashless hospitals, you can get quality treatment without the hassle of upfront payment and focus fully on recovery.

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The Bottom Line

While purchasing health insurance, it is essential to look for the domiciliary hospitalisation coverage. Especially if you have ageing parents or family members who may require long-term or home-based care. However, before choosing a plan, read the policy terms clearly to choose the healthcare plan that perfectly suits your needs.

To secure your family’s future, purchase comprehensive health insurance online from Bajaj General Insurance now! With our easy claim and renewal process, you can ensure a complete peace of mind at every stage of your life.

Frequently Asked Questions

Do I have to serve a waiting period for domiciliary hospitalisation?

Yes, you generally have to serve a waiting period for domiciliary hospitalisation as it is a part of standard health insurance claims. This usually includes an initial waiting period of 30 days and specific waiting periods of at least 36 months for pre-existing diseases.

Can I claim a cashless benefit under domiciliary hospitalisation?

Yes, you can claim a cashless facility under domiciliary hospitalisation from insurers like Bajaj General Insurance if the medically necessary stay lasts at least 72 hours. However, this clause can vary across different providers.

Is the cost of medicines covered under a domiciliary hospitalisation policy?

Yes, under the domiciliary hospitalisation policy, the cost of prescribed medications to manage the condition is covered.

Is there any age limit to get a domiciliary care policy?

No, there is generally no specific age limit to receive treatment with domiciliary care. However, since it depends on medical necessity, the patient has to be covered under an active health insurance policy to get this facility.

Can I apply for an offline claim for a domiciliary treatment policy?

Yes, you can apply for an offline claim for a domiciliary treatment policy. To initiate this process, you need to submit the hard copies of the required documents, such as medical reports and bills, to the insurer or third-party administrator.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.