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SMC Insurance Brokers Pvt. Ltd.
Parsvnath Metro Mall, Near Pratap Nagar Metro Station, Pratap Nagar, New Delhi-110007
Registration No: 289, Registration Code No: IRDAI/DB-272/04/289, Valid till: 27/01/2026, License category: Direct Broker (Life & General), CIN: U66000DL1995PTC172311
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Health Insurance Benefits
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u/s 80 (D)
Cashless
Treatment
Free Annual
Health Check up
Health Insurance in 2 Mins
Health Insurance Benefits
Tax Benefits
u/s 80 (D)
Cashless
Treatment
Free Annual
Health Check up
Coverage Of Domiciliary And Home Care Hospitalisation Under Health Insurance
In certain situations, such as when your parents require hospitalisation for a medical condition or accidental injury and are too old to be taken to the hospital, you may choose to have them treated at home. Depending on the medical condition, your doctor may replicate the entire treatment regime at home under your watchful eye. Today, many hospitals offer such kinds of home treatment.
But, is home treatment covered by your health insurance policy? If yes, what are the conditions? Let’s see.
Home Treatment Coverage Under Health Insurance
Two benefits under health insurance that cover home treatment -
Domiciliary Hospitalisation Benefit
Home Care Treatment Benefit
We'll discuss each of the benefits, along with their associated conditions.
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Domiciliary Hospitalisation
Domiciliary hospitalisation allows you to obtain medical treatment at home if your medical condition prevents you from seeking treatmeant at a hospital or medical facility.
A domiciliary hospitalisation may be necessary for the following two situations
The severity of a medical condition/injury preventing you from being moved to a hospital
The lack of availability of hospital beds
Domiciliary Hospitalisation Coverage Under Health Insurance
Some health insurance policies cover domiciliary hospitalisation expenses. Domiciliary treatment won't be covered if it's not stated in your policy document.
If your policy covers these expenses, certain conditions must be met to be eligible for coverage.
These conditions may vary across insurers. Please read through your policy thoroughly before you go for this benefit.Specific Limit For Domiciliary HospitalisationHealth insurance policies have a limit for domiciliary hospitalisation expenses. You will be responsible for any extra expenses you incur.
For instance, Raghu has a health insurance policy with a sum insured of Rs 10 lakhs, and his policy stipulates a limit of Rs 1.2 lakhs for domiciliary hospitalisation expenses. Say he undergoes domiciliary treatment for his fractured arm and leg that costs him Rs 1.5 lakhs. His policy will cover Rs 1.2 lakhs of his domiciliary medical costs and he will be responsible for the remaining Rs 30,000.
Treatment Must Proceed For 3 Consecutive DaysA majority of the health insurance policies require you to undergo domiciliary hospitalisation for at least 3 consecutive days. Only then will the expenses be covered under the policy.
Some plans that do not have this condition -
IFFCO Tokio (Family Health Protector Plan)
IFFCO Tokio (Individual Health Protector Plan)
Liberty General (Health Connect Plan)
For example, Aditya fractured his hip bone and was advised surgery and a 2-week bed rest with constant monitoring. Since he couldn’t be moved to the hospital, the treatment was carried out at his home. The treatment period was more than 3 days, and hence, the costs will be covered by his health insurance policy.
Pre And Post-Hospitalization Expenses Are Not CoveredMost health insurance policies do not cover expenses you incur before or after your hospitalisation, such as diagnostic tests - X-rays, CT scans taken for monitoring purposes.
Nevertheless, some plans do cover expenses incurred for domiciliary treatment before and after hospitalisation. Here are a few of them:
Aditya Birla Health (Active Assure Plan)
Aditya Birla Health (Active Health Plan)
HDFC Ergo (Optima Restore Plan)
Let's recall Raghu's example. A month after the domiciliary treatment got over, the doctor advised him to undergo an X-ray and a CT scan to check his recovery. The costs for these diagnostic tests came to around Rs 5,000. Since his health insurance policy doesn't cover post-hospitalization expenses, he had to shoulder these expenses.
Some Treatments And Diseases Not CoveredSome insurance companies do not cover the domiciliary treatment of diabetes, diarrhoea, respiratory disorders, etc. and some insurance companies may not cover hospitalisation at home for infertility or maternity conditions. Also, there are some plans that don't cover domiciliary hospitalisation expenses for alternative treatments such as Ayurveda, Unani, Siddha, Homoeopathy, Naturopathy, etc.
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Home Care Treatments
Similar to domiciliary treatments, home care treatments are treatments for injuries and illnesses at home. As opposed to domiciliary treatment, where you undergo hospitalisation because of severe illness or injury and are unable to be moved to the hospital due to bed shortages, the home care treatment benefit does not have mandatory conditions.
Here are some policies offering home care treatment benefits
HDFC Ergo Optima Secure
Max Bupa Health Reassure
Aditya Birla Activ Health
Conditions Associated Home Care Treatments Coverage
These are some common conditions you should be aware of. These conditions may vary across insurers. Hence, you go through your policy wording before you choose this benefit.
Pre-Authorization Is CompulsoryYou need to get a pre-authorization in advance from your insurer. Pre-authorization is an initial approval of the treatment cost requested by the hospital from your insurer.
Specific Limit For The Home Care Treatment BenefitInsurance companies may cover the costs of such treatments up to the limit stated in the policy.
Must Be Medically NecessaryThe expenses of home care treatment will only be covered under your health insurance if the treatment is deemed 'medically necessary.
The treatment must meet certain conditions in order to be covered -
Necessary for the medical management of the illness or injury.
Must not exceed the level of care necessary to provide safe, adequate, and appropriate medical care in scope, duration, or intensity.
A medical practitioner who is not related to you must recommend the treatment.
Must meet the professional standards generally accepted by the Indian medical community or international medical practice.
Treatment Must Be Prescribed In WritingA health insurer will only pay for your home care treatment if the treating doctor prescribes the treatment in question in writing.
Authorised Home Health Care Provider Is MandatoryGetting home care treatment from a registered home health care provider is mandatory.
The Treatment Should Otherwise Call For Inpatient CareIn order to qualify for home care, your condition should otherwise necessitate inpatient care at the hospital, which means, a continuous hospital stay for 24 hours or more is mandatory. Your claim must also be approved under inpatient hospitalisation.
For example, Lalit was diagnosed with dengue and was advised hospitalisation. He requested his doctor to carry out the treatment at home. His health insurance will cover all of his treatment expenses.
Records Must Be MaintainedIt will be necessary to keep records of the treatment administered every day of the home care treatment. The treating physician must sign the records.
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A Quick Comparison: Domiciliary Treatments Vs Home Care Treatments
Domiciliary Treatment Home care Treatment Coverage Condition The treatment should be carried out at home because you are severely ill/ injured and can’t be moved to the hospital or because of the unavailability of beds at the hospital. The doctor must prescribe the treatment in writing and it must be medically necessary. Pre-authorization from the insurer may also be required for the said treatment. Claim Option There is a cashless option as well as a reimbursement option available for this benefit. Most policies allow you to claim this benefit on a cashless basis. However, certain exceptions may apply. Number of treatments covered If the policy's conditions are met, you may use this benefit for treatments of all injuries and illnesses. Some insurers may limit the treatments for which you can use this benefit. Many insurers may only offer this benefit for conditions like dialysis, chemotherapy, dengue, and hepatitis.Your policy document will clearly list all such treatments - ensure you go through the list before opting for the benefit. Treatment Location As far as the location of the domiciliary treatment is concerned, there are no limitations. Certain insurers might only cover the costs of treatment if it is administered in a metropolitan area.
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Summing Up!
Choosing a health insurance plan that covers domiciliary hospitalisation and home health care treatment is necessary for mitigating health expenses. Since the future is uncertain and medical emergencies are unpredictable, such coverage may prove to be valuable in times of need. Read through your policy to ensure you are aware of the conditions and scope of this coverage.
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Our Customers' Stories
Sharing the experience of happy and satisfied customers with you.
Sameer Yadav
I was searching for investment plan but I couldn't find it, then I got the call from SMC insurance and they aligned a call with Ishita Sharma as point of contact (POC) for all my queries and she explain me very well. Ishita explain me all investment plan with advantage and disadvantage, I really appreciate her. Ishita always enthusiast towords work and ready to answer all my questions .I have taken two policies ( HDFC click to invest) plan with 15k premium per month. I always recommend SMC insurance to all, for better life and happy retirement with huge health and wealth. Thank You SMC insurance for your best service. Special thanks to Ishita for E2E help and endless support, you did fabulous work. Show More
Dheeraj Bhatia
I am associated with SMC insurance since 2011 and found them to be most ethical, trustworthy and highly responsive. Some of my precious policies done thru other agencies are still running on SMC’s advice. That is a strong testimony to their customer-centric approach. I am glad to be associated with SMC and strongly recommend their services to all concerned. Wishing the very best to Team SMC !Show More
Jyoti Sharma
We were fortunate enough to have selected SMC as our Health Insurance Broker for they have been very helpful in resolving our queries related to health insurance. I would like to cite two examples where SMC's role has been very crucial. One was when payment for cashless hospitalization was not coming through as the insurance company was taking undue longer time to approve the Hospital Bill. It was then I talked to Neha and it was she who through her contacts in the Insurance co. facilitated and expedited the approval for payment of hospital bill. Second was very recently when the Insurance co. had proposed a top up "Enhancer" policy for our existing policy. When I talked to Neha she immediately told me not to take this policy being offered without any medical test as it will not be beneficial to us and may create problem later on account of recent hospitalization. If I had I not consulted Neha, I would have into a big trouble with the insurance co. These two instances speak very high of sincere advice and timely help rendered by the SMC Staff, Ms. Neha Khanna which helped us a lot in time of need.Show More
Sumit Khanna
Hi, I am Sumit here, purchasing insurance policies from SMC for almost 8 years. Would like to recommend this company to other customers because they are taking care of my insurance broking services in a fabulous way. I would like to extend my gratitude and thanks to policy servicing and also insurance claim backend services. They have rendered fantabulous services for me and would like you guys to definitely go and rely on them for all your insurance needs.Show More
Kishor Kumar Bijlani
My experience with SMC Brokers is excellent. They provide support from the beginning till end i.e from issuance of insurance policies till settlement of claims. They explain very nicely various provisions relating to Insurance Policy also facilitate settlement of claims with Insurance Companies. Show More
Megha Singhal
I have purchased HDFC policy from SMC Insurance with the help of Harsh Sharma. I have got the satisfactory services from SMC Insurance. Thank you SMC Insurance.Show More
