What is Domiciliary Hospitalization: Meaning, Benefits, and How it Works

Imagine not being able to access a hospital bed during a health emergency because of a pandemic or full ICUs. Unfortunately, this isn’t rare, as India currently only has an average of 1.3 beds per 1000 individuals as of 2025. This is far below the standard requirement of 2 beds per 1000 people based on the National Health Policy’s recommendations. It means a majority of the population is still struggling to secure timely inpatient care.

This is where domiciliary hospitalization can help by offering hospital-grade treatment right at home. For this article, we’ve analysed 200+ health insurance policies, IRDAI Master Circulars, and real claim support cases to break down how domiciliary hospitalization works, what it covers, and how you can make the most of it.

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How Does Domiciliary Hospitalization Work?

Domiciliary hospitalization is hospital-grade treatment, which is brought home due to medical necessity or infrastructure limitations. This feature in health insurance skyrocketed in relevance during the COVID-19 pandemic, where many patients were treated at home with full medical supervision.

Let’s understand this better with a simple example:

A 75-year-old individual developed severe pneumonia during the pandemic. With no ICU beds available, he was treated at home with oxygen support, nursing, and daily medical monitoring. His expenses were reimbursed under domiciliary hospitalization benefits.

Under What Circumstances Can You Avail of Domiciliary Hospitalization?

To qualify for a domiciliary hospitalization claim:

• Treatment must normally require hospitalization.
• Must last more than three consecutive days.
• The doctor must certify the need for it in writing.
• Treatment must be prescribed and supervised by a qualified doctor.
• Costs should be reasonable and customary.
• All treatments should fall within the policy period.

Quick Note: Most insurers provide reimbursement only (not cashless) for domiciliary hospitalization.

What Are the Benefits of Domiciliary Hospitalization?

Domiciliary hospitalization is not an elective benefit that patients can opt for based on comfort or preference. It is only applicable in situations where hospital admission is not possible, either due to unavailability of beds or because the patient’s condition makes it unsafe or impractical to move them. 

In such cases, insurance coverage for domiciliary hospitalization ensures continuity of treatment at home and financial protection for necessary medical expenses, until hospital care becomes feasible.

Popular Health Insurers with Domiciliary Hospitalization That Make Ditto’s Cut

While most insurers in the market offer domiciliary coverage, the following plans stand out because of their overall performance metrics and comprehensive features:

P.S. All the plans discussed above cover domiciliary hospitalization up to the sum insured.

Treatments Covered and Not Covered Under Domiciliary Hospitalization

Like every other health insurance offering, domiciliary hospitalization has its share of inclusions and exclusions, as mentioned below. However, it is generally recommended to check the policy wording of the plan you choose, as the list may differ across policies.

Bottom Line: Treatments not covered under domiciliary hospitalization are often considered “manageable” on an outpatient basis and don’t meet the standard of inpatient-level care at home.

How to Claim Domiciliary Hospitalization in Health Insurance?

To claim domiciliary hospitalization under health insurance in India, follow these standard steps:

• Obtain Doctor’s Recommendation: The treating physician must certify in writing that domiciliary hospitalization is medically necessary, specifying the condition and need for in-patient-level care at home.
• Arrange Home Treatment: The doctor or hospital arranges for required medical equipment (e.g., oxygen, monitors) and nursing care at home. Treatment must last at least 72 hours as per most policy terms.
• Notify Insurer and Gather Documentation: Inform the insurance provider as soon as treatment begins. Collect necessary documents, which usually include:
  • Doctor’s certificate of hospitalization necessity
  • Detailed medical reports and treatment records
  • Itemised bills for medicines, equipment, nursing, and diagnostic tests
  • Proof of hospital bed unavailability or the patient’s severe condition (if applicable)
• Submit Claim Form and Documents: Complete the claim form provided by the insurer/third-party administrator (TPA). Attach all supporting documents (doctor’s certificate, bills, receipts, and reports).
• Claim Verification and Reimbursement: The insurer verifies submitted documents and processes reimbursement as per the policy sub-limits and exclusions. Most domiciliary hospitalization claims are settled on a reimbursement basis, not cashless.

Common Reasons for Domiciliary Hospitalization Claim Rejections

• Insufficient or Improper Documentation: Lack of a written doctor’s certificate certifying the need for domiciliary hospitalization, missing detailed treatment records, or incomplete billing information can lead to rejection.
• Treatment Duration Less Than Required: Most insurers require domiciliary hospitalization to last more than three consecutive days (usually 72 hours minimum); claims for shorter durations are often denied.
• Non-Qualifying Ailments: Claims related to excluded conditions, such as asthma, diabetes, hypertension, psychiatric disorders, or minor illnesses considered manageable on an outpatient basis, are generally rejected.
• Treatment Not Falling Under Policy Terms: If the treatment does not actually require hospitalization in normal circumstances or is not prescribed and monitored by a qualified medical practitioner, claims may be denied.
• Lack of Hospital Bed Unavailability Proof (if applicable): In cases where bed unavailability is claimed as the reason for home treatment, failure to provide supporting documents can cause claim denial.
• Attempted Cashless Claims: Most domiciliary hospitalization claims are reimbursed only; requests for cashless settlement may be rejected if not supported by the insurer’s rules.
• Policy Exclusions and Sub-Limits: Some policies have specific exclusions, sub-limits on domiciliary hospitalization coverage, or pre-authorization requirements that, if unmet, result in claim rejection.
  
  Remember: Ensuring thorough documentation, treatment eligibility, and adherence to policy terms greatly improves chances of claim acceptance.

Ditto’s Take on Domiciliary Hospitalization

Before relying on domiciliary coverage, ask your insurer:

• Is domiciliary hospitalization covered by default or via an add-on?
• What diseases are excluded?
• Is there a minimum duration for treatment?
• Are pre-/post-hospitalization expenses included?
• Are any sub-limits or caps applicable?

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What is Domiciliary Hospitalization: Final Thoughts

Domiciliary hospitalization offers critical flexibility in times of constrained resources or limited mobility. However, it’s often less understood and underutilized due to its stringent eligibility criteria and reimbursement-only model. Here’s why it matters in health insurance: 

• Essential during pandemics or bed shortages
• Helpful for elderly or terminally ill patients
• Can save lakhs in unexpected medical costs
• Requires proactive planning and paperwork

Still wondering if domiciliary hospitalization is the right choice for your insurance needs? Book a call or WhatsApp us to get expert guidance now. 

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