Are You Covered for the Home Treatment Cost Under Your Health Insurance Policy?

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Are You Covered for the Home Treatment Cost Under Your Health Insurance Policy?

Health insurance policy includes a benefit called domiciliary hospitalization, which allows the policyholder to be treated at home. Click here to know more.

  • Feb 16, 2022

Due to a shortage of hospital wards during the second wave of the COVID-19 epidemic, many seriously ill people were compelled to remain at home and treat symptoms there. To assist such patients, several hospitals established COVID home care packages that included medical consultations, medications, and occasional home care for a set fee.

Some health insurance policies in India, particularly those issued in the last 4-5 years, offer the provision of domiciliary hospitalization as one of the health insurance benefits, that covers the expense of therapy at home as part of their health insurance coverage.

Medical insurance policy includes a benefit called domiciliary hospitalization, which allows the policyholder to be treated at home while still being considered hospitalized. Because hospitalization is taken care of by health insurance cover, the insurance provider is obligated to pay for medical treatment in this situation.

Conditions for Domiciliary Hospitalization In Health Insurance Coverage

The insured must fulfil the following requirements and criteria in order to claim health insurance benefits for domiciliary hospitalization:

  • A trained medical expert or doctor must advise the patient to get admitted to the hospital due to disease, ailment, or an accident.
  • The patient cannot be moved to a hospital due to the magnitude of the injuries.
  • The therapy should last for at least three days.
  • The patient has no choice but to begin their therapy at home due to a scarcity of available beds in hospitals.
  • The patient must be covered by a valid and ongoing health insurance cover.

Domiciliary Hospitalization In Medical Insurance Policy & It’s Covered Costs

All hospital expenditures, including drug prices, doctor consultation fees, and hospital equipment rentals such as oxygen cylinders, will indeed be reimbursed in domiciliary hospitalization.

Limits to Domiciliary Hospitalization Costs

If the medical insurance policy has a sub-limit, the total cost is not covered even though it is acceptable. The reason being, a small percentage of your cover is allocated for domiciliary hospitalization. Some insurance providers offer domiciliary care up to a specified fraction of the covered amount, while others only cover it as an addition.

Let us help you understand the concept without using jargons. Let’s say, you have a health care policy with a ₹10 Lakh cover and it covers domiciliary hospitalization up to 10% of the total cover. In this case, you will be eligible to claim up to ₹1 Lakh out of the total cover.

Reimbursement for Domiciliary Hospitalization In Healthcare Policy

Because the reimbursement procedure is based on paperwork, one must save all essential documents in order to have a smooth claim experience.

The insured must provide documentation that hospitalization was necessary. A doctor could have even prescribed hospitalization. All inquiry findings, including scans and other testing, would be needed. All receipts for expenses would have to be submitted for reimbursement.

In conclusion, health insurance policy in India progressively expanded their coverage and demand, particularly after the second wave of COVID, when individuals realized the need of looking for policies that provide domiciliary hospitalization. As a result, it is recommended that before purchasing a healthcare plan, one must thoroughly research the various benefits and optional riders available.

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Ref. No. KLI/22-23/E-BB/492


- A Consumer Education Initiative series by Kotak Life

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