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 Hospitalisation
Health 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 Days
A 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 Covered
Most 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 Covered
Some 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.