Health Insurance 1070 views February 19, 2021

If you are new to health insurance, you might not be aware of terminologies such as Domiciliary Hospitalization and could thus miss out on the benefits and worsen your health unknowingly. It’s a type of hospitalization where treatment happens at home and not at a hospital or any other healthcare unit. But how can this be valid? What are the conditions you should meet to get a cover for such treatment? Can you have it on a cashless basis or will you need to spend first and get it reimbursed from the health insurer later? You will know all these here. Let’s begin!

Health Insurance

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When Will the Health Insurer Admit a Domiciliary Hospitalization Claim?

The health insurance company will admit the domiciliary hospitalization claim only when you cannot be shifted to a hospital due to poor health conditions. Sometimes domiciliary hospitalization is granted also when there are no hospital beds available. But the cover will be given only when the treatment lasts for at least 3 days. All that would, however, need a certification from a qualified healthcare professional in writing.

Which of the Two – Cashless or Reimbursement Claim – is Admissible Upon Domiciliary Hospitalization?

Most health insurance companies admit reimbursement claims only upon domiciliary hospitalization. But some could admit cashless claims too. For cashless claims, the treatment  needs to be carried out by healthcare professionals of network hospitals only. A network hospital means the healthcare unit with whom the health insurer has a tie-up. So, check the policies carefully and see the claim process of each before deciding the one to go with.

But Will the Domiciliary Hospitalization Cover Apply to All Diseases/Conditions?

No, the cover won’t apply to all diseases or conditions. There are some illnesses for which the domiciliary hospitalization cover won’t come into play. These include –

  1. Asthma
  2. Bronchitis
  3. Diabetes mellitus and insipidus
  4. Hypertension
  5. Diarrhea
  6. Arthritis
  7. Gout
  8. Cough, cold and influenza
  9. Psychiatric disorder
  10. Rheumatism
  11. Upper Respiratory Tract Infection
  12. Tonsillitis

But here again, it depends on specific health insurance plans; some may have a domiciliary hospitalization cover for a few of these illnesses. So, go through the fineprint carefully and get clarity on what’s covered and what’s not.

Will the Domiciliary Treatment Cover Apply to COVID?

With the COVID-19 cases surging in India, hospital beds are not lying vacant, forcing many to go for home hospitalization. But people are asking whether domiciliary treatment cover is available for COVID. Usually, the cover is not given under normal health insurance plans for COVID-related home hospitalization. But as the healthcare infrastructure has collapsed due to the COVID-19 pandemic, the Insurance Regulatory Authority of India (IRDAI) is considering the inclusion of domiciliary hospitalization cover for COVID too. However, Corona Kavach Policy, an indemnity-based health insurance plan for COVID, covers mandatory home quarantine for 14 days and related costs if the standard protocols are met.

Domiciliary Hospitalization Cover of Top Health Insurance Plans

Let’s check out below the domiciliary hospitalization offers of top health insurance plans.

Top Health Insurance PlansDomiciliary Hospitalization Coverage Details
HDFC ERGO Health Optima RestoreUp to the sum insured ranging from INR 3-50 Lakh
ICICI Lombard Health Booster PlanUp to the sum insured ranging from INR 5-50 lakh
Niva Bupa Health Companion PlanUp to the sum insured ranging from INR 2 lakh-1 crore
Care Health InsuranceUp to 10% of the sum insured ranging from INR 5 lakh-6 crore
Aditya Birla Active Care PlanUp to the limits as specified in the policy

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