Domiciliary Hospitilisation Cover

Health insurance policies offered by insurance providers these days include a wide variety of coverage for many different diseases and medical treatments. A lucrative insurance benefit that is available under some health plans is domiciliary hospitalisation or domiciliary treatment. Domiciliary hospitalisation enables the policyholder to seek treatment at home if they are unable to get a vacant bed or visit the hospital. The insurance company provides coverage for the treatment expenses incurred during home treatment. Let’s understand the concept of domiciliary hospitalisation with the help of an example:

In case a policyholder suffers from an accident at home, which makes it hard for them to be moved to a hospital, they will have to get treatment at home from doctors and medical professionals. Once the treatment process is over, the policyholder can then apply for an insurance claim for their domiciliary hospitalisation expenses.

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

Insurance claims for domiciliary hospitalisation are only accepted under certain conditions, which are mentioned below:

• The treatment is for any type of injury or medical condition that would require hospitalisation under normal circumstances.

• Home treatment has been prescribed by an authorised medical practitioner.

• Due to severe conditions, the patient cannot be transported to a hospital for treatment.

• If the insured patient has to seek treatment at home due to the unavailability of hospital beds in their area (For instance, when people were having trouble finding hospital beds during the peak of the second COVID wave).

• The duration of the treatment must be at least 3 days.

However, for the following aspects, the insurer will not cover any expenses under domiciliary hospitalisation:

• Any domiciliary treatment that lasts less than 72 hours.

• Pre and post hospitalisation are not covered under domiciliary hospitalisation.

• Some of the diseases that are not covered under domiciliary hospitalisation include; asthma, bronchitis, diabetes, epilepsy, nephritis, arthritis, gout, diarrhoea, dysentery, etc.

Domiciliary hospitalisation coverage is an important aspect of health insurance that must not be ignored. While the chances of requiring home treatment might be rare, if you or your family need to seek extended treatment at home, it can be quite expensive. Even in situations when the patient cannot be transported to the hospital due to their condition, home treatment from professional doctors and nurses can quickly deplete your life savings. To stay protected against these expenses and keep yourself and your family covered for all kinds of medical emergencies, such as home treatment, it is important to get a health insurance plan with domiciliary hospitalisation cover.

Here are some important things about domiciliary hospitalisation that you should be aware of:

• The domiciliary hospitalisation cover is only provided under a select few health insurance plans.

• Under some plans, this cover may not be available by default. You may have to buy domiciliary hospitalisation cover separately as an add-on.

• Under some health insurance plans, the maximum coverage for domiciliary hospitalisation may be limited to a certain percentage of the sum insured.

• It is the policyholder’s responsibility to prove to the insurance provider that the insured patient cannot be moved to a hospital due to a genuine reason and requires treatment at home.

Here are some important points you should keep in mind when looking for a health plan with domiciliary cover:

• Ensure to read the health insurance policy documents thoroughly to ensure that there is adequate coverage provided for domiciliary hospitalisation under your chosen plan.

• If there are no plans with this coverage available, you could buy domiciliary hospitalisation cover as an add-on, if available.

• Check the eligibility requirements under domiciliary hospitalisation cover to make sure you are eligible for domiciliary coverage.

• Understand the inclusions and exclusions of the domiciliary cover in your health insurance policy.

• While making a health insurance claim, make sure you submit the correct documents and paperwork to reduce the chances of your claim being rejected due to incorrect information.

The health insurance plans available at Bajaj Markets provides coverage for domiciliary hospitalisation. You can take a detailed look at the details of the policies with their premium quote in the table given below

Disclaimer: *Premium rates are indicative. The actual premium that you might have to pay may change depending on numerous factors.

While domiciliary hospitalisation may seem like a feature that you can easily skip in a health insurance plan, you may need coverage for home treatments in case of emergency situations. More and more insurers have started offering coverage for domiciliary hospitalisation under their health insurance, so it is recommended that you buy a health insurance plan that includes this coverage to future proof yourself against any home medical emergencies. The health insurance plans available on Bajaj Markets comes with the domiciliary hospitalisation cover, in case you are looking to buy a health plan.