What is Domiciliary Hospitalisation in Health Insurance?

Healthcare needs are evolving, and so are health insurance policies. With the rising costs of healthcare, insurance plans have become indispensable for securing your finances, as well as your health during medical emergencies.

One useful feature to have during such emergencies is the option for medical treatment to be performed at the convenience of your home. While this provides an additional layer of convenience, let us understand how this feature impacts your policy in other ways.

What is Domiciliary Cover in Health Insurance?

Medical treatment taken at home for a prolonged illness, which otherwise would require hospitalisation at a medical facility, is called Domiciliary Hospitalisation. It covers the medical expenses incurred by a policyholder who is not able to relocate to a medical facility due to medical conditions (as deemed by a doctor) or the unavailability of hospital beds.

But that does not mean all treatments at home are covered. To qualify for domiciliary treatment, the following criteria must be met:

• You must have a condition that prevents you from going to the hospital (or) you can’t find a bed in your town.
• The Doctor must confirm in writing that hospitalisation is necessary.
• All the costs must be just and reasonable.

What are the Best Policies with Domiciliary Coverage?

With that said, here are some of the top policies offering domiciliary coverage:

• Aditya Birla Activ One: Activ One has seven variants, all of which cover domiciliary treatment.  This policy offers a sum insured ranging from Rs. 5 lakh to Rs. 6 crore (with a 2x benefit) which is one of the highest in the industry. One of the most unique features of this policy is that some variants cover 7 chronic illnesses right from Day 1.

Apart from this, Activ One also offers comprehensive benefits such as daycare treatment, organ donor cover, etc. Several add-ons such as maternity cover, accident cover, critical illness cover, etc are offered by Aditya Birla to make this policy even more customisable as per your needs.

• TATA AIG Medicare Premier:  Medicare Premier is a really good policy from a reputed insurance company. Apart from the essentials, this policy also has a few extra bells and whistles like dental, OPD and international cover. This policy covers domiciliary treatment up to the sum insured. But one of the few downsides is that this is an expensive policy.
• Niva Bupa ReAssure 2.0: ReAssure 2.0 is one of the most unique policies in the industry. It covers all the basics – no copayment, no room rent restriction, and no disease-wise sub-limits. This policy covers domiciliary treatment up to the sum insured. However, Niva Bupa’s claim settlement ratio is on the lower end compared to other top insurers. Apart from this, ReAssure 2.0 also offers some industry-first features such as the age-lock feature, Booster+, etc, which makes it a more attractive proposition.
• HDFC ERGO Optima Secure: Optima Secure is one of the top health insurance policies in the market. It has no room rent restrictions, disease-wise sub-limits, and co-payment. This even has the Secure feature, where you get 2x coverage of the base sum assured from day 1. This policy covers domiciliary treatment up to the sum insured. However, one of the downsides of this plan is that you cannot customise it like the other plans. It also does not offer maternity and international coverage.
• Care Supreme: Similar to ReAssure 2.0, Care Supreme is also a very affordable policy. But, many of the features built into most popular policies are not available by default here. You get those only if you purchase add-ons. Nevertheless, this is a very affordable policy that covers domiciliary treatment from a good insurer.

Things to Remember Under Domiciliary Treatment

• Sublimits: In the case of top-notch policies, their domiciliary coverage is almost always up to the base sum insured. But in some policies, there may be a sublimit.
• Check for Specific Conditions: Domiciliary treatment comes into effect under very specific conditions, and it's important to understand these requirements. Always check with your insurer before availing this treatment.
• Waiting Periods: There might be waiting periods associated with domiciliary treatment coverage, which can affect when benefits become available.
• Alternative Medicine Cover: Keep in mind that domiciliary treatment may not always cover alternative systems of medicine like AYUSH.
• Scope of Coverage: The scope of coverage included in domiciliary treatment, such as medication, doctor consultations, and any other applicable medical services. Sometimes, certain policies leave out coverage for consumables or doctor consultations. This varies from plan to plan, and going through the policy wording will help you out a lot.
• Cashless vs. Reimbursement: Some policies may offer domiciliary coverage on a cashless basis, but some only offer coverage on a reimbursement basis. This greatly impacts convenience, and you must be aware of how it works under your policy.
• Inclusions: Take into account both inclusions and exclusions specified in each policy. This helps you fully understand the extent of domiciliary coverage offered.
• Pre and Post-Hospitalisation: More often than not, if you’ve undergone hospitalisation and need physiotherapy, it is covered under ‘pre and post-hospitalisation’ expenses. However, not all policies cover pre and post-hospitalisation expenses for domiciliary treatment.

Conclusion

Domiciliary hospitalisation covered by health insurance is a crucial perk for anyone with an insurance policy. However, you cannot choose a policy based on this feature alone. Rather, when choosing a policy, you must ensure that it also has no copayment, room rent restrictions or co-payment. Apart from this, if your policy offers domiciliary coverage (which most of the best health insurance policies in 2024 do), it must be one without any restrictions or conditions.

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