Domiciliary hospitalisation: All you need to know

Health insurance is an antidote for any kind of medical emergency that arises out of nowhere. While one usually needs insurance to aid for hospital expenses as a result of such emergencies, often there are situations when health services are required beyond the hospital stay. This is when the concept of domiciliary hospitalisation comes into the picture.

“Domiciliary hospitalisation means medical treatment for an illness/disease/injury which in the normal course would require care and treatment at a hospital but is actually taken while confined at home under any of the following circumstances – the condition of the patient is such that he/she cannot be shifted to a hospital, or the patient takes treatment at home on account of non-availability of room in a hospital,” said T A Ramalingam, chief technical officer at Bajaj Allianz General Insurance.

During Covid 2.0, the sudden load of patients literally shook the medical infrastructure in the country. Severe scarcity of ICU beds and oxygen cylinders made the situation worst. During this time, many people were forced to opt for home treatment as hospital accommodation wasn’t available. This is a primary example where domiciliary hospitalisation becomes effective.

Looking at the disproportionate health facilities available for citizens, insurers had to accept claims for home treatment. The cost of oxygen cylinders peaked during May-June, thus forcing people to file claims for their health insurance to compensate for the unplanned expenditure. Since home treatment isn’t a raging facility in the insurance sector yet, only a few of them include the option of domiciliary hospitalisation in their policies. Meanwhile, some insurance companies allow utilising this benefit as an additional rider for a separate sum insured.

The insurance provider covers the medical expenses incurred while the patient is away from the hospital due to certain reasons. However, there are certain prerequisites that must be met by the patient in order to get the claim amount. This majorly includes a verified doctor’s written recommendation as well as a minimum of three days of continued illness.

Domiciliary hospitalisation prevents the hassles of hospital attendance when patient movement is simply not feasible. Sometimes, the family is forced to shift the insured patient to a hospital only to get an insurance claim for the medical bills. But, in genuine cases, the facility of domiciliary hospitalisation can help you with quality healthcare even at home.

Similarly, if the hospital beds are not available then one can take the treatment at home but then the onus lies on the policyholder to prove the unavailability of hospital beds. In addition, a continuous line of treatment along with a daily monitoring chart duly signed by the treating doctor needs to be maintained.

Taking a lesson from the disastrous impact of Covid-19, policyholders must get a comprehensive cover for as many medical needs as foreseeable. However, it’s equally critical to know that not all health conditions can be treated at home. Common ailments like asthma, hypertension, epilepsy, diabetes, diarrhoea and others are not covered under domiciliary hospitalisation.

While it surely has a limited scope, domiciliary hospitalisation can still prove to be extremely useful in certain situations like the pandemic itself. As a policy buyer, it’s important for you to read the inclusion and exclusions of your policy rather carefully. Effective planning is half work done.