What is Domiciliary Hospitalization?

According to the IRDAI Master Circular, domiciliary hospitalization means medical treatment for an illness, disease, or injury, which in the normal course would require care and treatment at a hospital. However, it is actually taken while confined at home, either because the patient’s condition makes hospital transfer unsafe, or because no hospital room is available at the time.

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.

It takes an average person up to 5 hours to read & analyse a policy, and 10 hours or more to compare different plans and make a decision. This is why we propose a better alternative - taking a 30-minute FREE consultation with Ditto’s certified advisors. We have a spam-free guarantee, and we’ll never push you to buy a plan. Don’t delay this - we have limited slots every day, so book a quick call here before they run out.

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.

Before we discuss the list, here’s how we decide what plans to feature.
At Ditto, every health plan goes through our six-point evaluation framework. It doesn’t mean these are the only good plans, but that they stand out after being scored across all six pillars.

You can learn more about how we evaluate health insurance plans here.

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

Plan Name Restoration Renewal Bonus Network Hospitals CSR ICR
HDFC ERGO Optima Secure 100% of base SI, once/year (addon: unlimited) 50% pa, up to 100% (irrespective of claims) 13k+ 97% 86%
Care Supreme Up to base SI, unlimited times 50% pa, up to 100% (addon: 100% p.a up to 500% or unlimited accumulation) 11.4k+ 93% 59%
Aditya Birla Activ One Max 100% of base SI, unlimited times 100% pa, up to 500% (irrespective of claims) 12k+ 96% 68%
Niva Bupa Aspire Titanium+ Unlimited restoration after the first claim Booster+: Carry forward unused cover up to 10x 10k+ 92% 58%
ICICI Elevate Unlimited restoration of base cover 20% pa up to 100% (Addon: 100% p.a up to unlimited accumulation) 10.2k+ 85% 83%

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.

Covered Under Domiciliary Hospitalization Not Covered Under Domiciliary Hospitalization
Doctor consultation fees
Nursing charges
Cost of medicines and medical equipment
Diagnostic tests
Pre- and post-hospitalization expenses (if mentioned in the policy)		 Asthma
Bronchitis
Chronic nephritis / Nephritic syndrome
Diarrhoea and dysentery
Diabetes mellitus / insipidus
Epilepsy
Hypertension
Influenza, cough, or cold
Psychiatric or psychosomatic disorders
Pyrexia of unknown origin
Tonsillitis/Upper respiratory tract infections
Arthritis, gout, and rheumatism

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.
CTA

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?

Why Choose Ditto for Health Insurance

At Ditto, we’ve assisted over 7,00,000 customers with choosing the right insurance policy. Why customers like Arun love us:

Domiciliary Hospitalisation

✅No-Spam & No Salesmen

✅Rated 4.9/5 on Google Reviews by 12,000+ happy customers

✅Backed by Zerodha

✅Dedicated Claim Support Team

✅100% Free Consultation

You can book a FREE consultation. Slots are running out, so make sure you book a call now!

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. 

Frequently Asked Questions (FAQs)

What is the difference between home care treatment and domiciliary hospitalization?

Home care treatment is for situations where a patient could have been hospitalised but chooses home treatment for comfort, recovery, or continuity of care. Domiciliary hospitalization, on the other hand, covers hospital-level care at home because an actual hospital stay is not possible. It's usually a substitute for hospitalization.

What is the limit of domiciliary hospitalization?

The limit of a domiciliary hospitalization cover depends on the policy terms and often varies by insurer. Some policies provide this coverage up to the sum insured, and a few others, like Care Freedom, provide domiciliary hospitalization cover only up to 10% of the sum insured.

Can I combine domiciliary hospitalization with regular hospitalization coverage in my health insurance plan?

Yes, domiciliary hospitalization is often part of the overall health insurance sum insured. Expenses incurred during domiciliary treatment are usually deducted from your total hospitalization cover limit. However, domiciliary hospitalization has separate conditions and sub-limits, so always check if your plan has any caps on domiciliary claims or specific requirements for combining these benefits.

Last updated on: