What is Domiciliary Hospitalisation in Health Insurance?

Imagine falling critically ill and learning that no hospital beds are available.

Or, your aged parents falling sick.

Or getting a fatal illness that affects your mobility significantly.

Would you want to get hospitalized? Will that still be an option? Wouldn’t you want to be in the comfort of your home while you can still look after your child and be with your family?

After all, when Jane Austen said, “There is nothing like staying at home for real comfort,” she echoed what we all feel - drawing strength from our family to fight the worst from the comfort of our homes!

However, while you can arrange for the medical attention you need at home, the hurdle here is how you fund all related expenses.

You are easily looking at a substantial budget - including the medical specialists, the round-the-clock nurses, tests, medicines, medical equipment, and more. All of this would undoubtedly put a dent in your savings, thereby leading you to either

• Compromise on the medical care that you avail to save expenses or
• Have access to exceptional medical care while compromising the financial stability of your family members.

-because, to your knowledge, your health insurance plan spreads its financial security net only if you have been hospitalised. But what if your plan had a feature to help you out even when you haven’t been hospitalised? That would cater to your medical requirements well, right?

In that case, all you need to do is avail of the domiciliary hospitalisation feature! So, what exactly does the inclusion of this feature into your insurance plan mean? How can you avail of this? Should you avail this at all? What are the benefits of availing of this?

Here’s a blog on everything you need to know about domiciliary hospitalisation across the health insurance sector -

What is the meaning of domiciliary hospitalisation in health insurance?

Domiciliary hospitalisation, as the name suggests, is a condition in which an individual is significantly ill and is being treated at home because -

1. His/Her mobility is considerably affected by the illness, preventing them from being transported to the hospital.
2. He/She is in immediate requirement of hospitalisation, but no hospital beds are available.

Under such circumstances, where a doctor advises and agrees with the patient’s wishes to continue their treatment in the comfort of their home, your insurance policy (one that comprises the domiciliary hospitalisation coverage) ensures the complete funding of all medical requirements.

From the ease of treatment at home to ready access to premium healthcare, it seems domiciliary hospitalisation covers it all for policyholders in cases of urgent medical requirements. However, the feature doesn’t come without some downsides of its own.

Hence, we suggest you weigh out the pros and cons of this home hospitalisation feature before you get all set to avail of this feature in your health insurance plan.

What are the pros and cons of domiciliary hospitalisation?

PROS

• Availability of quality healthcare services:

Despite being in a home setting, under domiciliary hospitalisation, patients have access to premium healthcare services, personnel, tests, and medical equipment. This ensures that one does not have to compromise on the quality of healthcare one receives, irrespective of the fact that they are in a non-professional medical environment.

• Exceptional for time-sensitive treatments:

Home hospitalisation ensures that a patient does not lose out on precious time usually consumed during transportation to hospitals. In addition, this ensures the possibility of better outcomes as premium health care is immediately offered to the patient.

• Affordable in comparison to hospitalisation:

When hospitalising a patient, multiple charges (like room rent) contribute to the sky-high price of the bill; however, when one opts for home hospitalisation, these factors are no longer a concern for the patient, thereby reducing the financial burden on the patient.

• Greater control in choosing healthcare givers:

Now, let’s be honest, even when you have caught a bad cough and cold and have a slightly high temperature, the discomfort is unsettling.

While in the case of commonly acquired ailments, this is a temporary discomfort, in the case of long-term and/or fatal and critical illnesses, the hardship is long and much more permanent.

Under such circumstances, it is logical that the patient is kept as comfortable as possible and that he/she has the power to choose the healthcare options they find the most comfortable. With home hospitalisation, the patient can choose their caregivers, the schedule for their treatment, and the routine for their recovery path.

This gives them some peace amidst the chaos of their illness.

• Familiar environment:

How often have we heard that the body heals via a healed mind? Well, it is true. In a familiar and comfortable environment, stress is mitigated, and the patient has a better chance of a positive outcome over speedy recovery.

CONS

• Restricted access to medical equipment

While it is true that in domiciliary hospitalisation, patients can enjoy the perks of premium healthcare services, patients cannot access certain advanced medical equipment that is only available across hospitals and other medical facilities. This might compromise the quality of medical care being provided to the patient.

• Exclusions across domiciliary hospitalisation coverage

While some of the best insurance providers across the country offer this domiciliary advantage for patients, this perk is not available for all ailments. Therefore, it is important that you look into the exclusions for this perk prior to availing of a health insurance policy that offers this feature. In addition, ensure that the policy you avail of with the domiciliary feature caters to your medical requirements.

• Lack of professional environment

In some cases where the patient has a critical ailment, he/she might not feel comfortable in a non-professional environment sans the expected medical setup, structure, and support.

Take a close look at the pros and cons of the domiciliary hospitalisation feature. You can see that an individual’s requirements and preferences largely decide the cons of the feature. And hence, the pros often weigh out the cons of this feature.

Subsequently, potential policyholders now seek insurance plans that include this feature. They approach the best insurance providers across India (you can get a list of these in our blog - Best Health Insurance Companies in India )

And seek out plans that best suit their financial and medical requirements. In case you have similar plans, here is how you can avail of such insurance plans with the domiciliary hospitalisation feature -

How to avail of domiciliary hospitalisation in a health insurance plan?

STEP 1: Contact your insurance provider.

If you have an existing health insurance plan and are unsure whether domiciliary hospitalisation is included in your plan, reach out to your insurer or Book a call with our experts and enquire about the same. (P.S. in case you don’t know and your current insurer is reluctant to offer you the same, you can always go for Health Insurance portability )

If you are obtaining a new health insurance plan, ask your agent/advisor/insurance provider regarding the coverage for the same. Make sure to also look into the inclusions, exclusions, additional charges, and waiting period.

Considering that you have already availed of a health insurance plan with the home hospitalisation feature and completed the waiting period, you can now enjoy the perks of this feature.

STEP 2: Obtain a referral for an expert medical practitioner.

Request your assigned doctor or medical expert for a referral regarding the home hospitalisation option. This would be instrumental in applying for the filing of the claim under the domiciliary feature.

STEP 3: Contact a home health care agency.

After reaching out to your insurance provider, they will provide you with a list of home healthcare agencies functional in your locality. So reach out to one as per your preference to avail of their services.

Inform the agency regarding the ailment you seek care for and all details they demand.

STEP 4: Schedule an assessment with the home health care agency.

The chosen healthcare agency will schedule a house call to determine if your home is suitable for the kind of home care treatment that you seek. Then, based on their analysis, they will offer you a treatment plan that is best suited.

STEP 5: Start with the home hospitalisation and treatment.

Having chosen the plan, now the home treatment process begins. First, the home healthcare agency will provide the required medical equipment, practitioners, medical staff, and medicines to recover from the injury or illness.

While the steps to avail of the domiciliary hospitalisation treatment are now over, you must stay updated with the claim filing option. Staying informed beforehand helps you stay prepared with the required documentation, making the entire process hassle-free.

How to claim domiciliary treatment in your insurance plan?

Peter is an eminent football player. Unfortunately, during one of his training sessions, he succumbs to a critical injury requiring immediate medical attention. Since the injury affects his mobility significantly, he takes up the domiciliary hospitalisation process.

While he and his family work with the details of his treatment plan, his brother deals with the process of the claim settlement or reimbursement process. He now has two options to face -

• Cashless

If the insurance provider offers a cashless option on the domiciliary hospitalisation treatment process, he would have to inform the insurance company before starting treatment. In case he had opted for the copayment feature (read to know the pros and cons of copayment )

-he will need to pay only the pre-decided % of the treatment charges or the entire amount will be paid off by the insurer themselves after reaching out to the healthcare agency and cross-checking the charges with the claim made by the insured individual.

Please note: Not all insurers offer a cashless option on this feature. Please clarify this before you avail of the health insurance plan with this feature.

• Reimbursement

If the insurer only offers a reimbursement option, the insured individual will need to gather the medical papers, invoice, referral paper from the medical expert and invoice documents.

Initially, the policyholder will have to pay the treatment charges from their pocket, which the insurance provider will later reimburse. Then, the insurer will tally the charges of the home healthcare provider with the offered documents before reimbursing the claimed amount.

In case you have opted for a health insurance plan from the top insurers across the nation, this claim settlement process (to get a better idea on this, you can go through our article on the claim settlement process)

-becomes hassle-free and smooth. However, prior to availing of this feature, there are a few questions that you need to ask your agent/advisor/insurer. This will help you make an informed decision.

What should you remember when availing of domiciliary coverage?

• Waiting period on the domiciliary hospitalisation feature
• Inclusions and exclusions on the feature (these have been listed below)
• Added charges for the feature (if any)
• List of specific documents to avail of this feature
• The domiciliary hospitalisation claim procedure
• The sum insured towards this feature
• The eligibility criteria to avail of this perk in your health insurance plan

What are the best health insurance plans for domiciliary hospitalisation feature?

While this perk can be extremely beneficial for policyholders, not all insurance providers include this in their plans. Among the ones available in the market, here is a quick look at some of the best plans available that offer coverage of up to the entire sum insured -

Along with the specific feature in the discussion, the above-mentioned plans also offer some other lucrative perks that make them a favourite with policyholders. However, each plan also comes with certain drawbacks. So, the best way forward would be tallying the policies on our Comparison tool [subtext: link to our comparison tool on our website] and opting for the plan that best suits your comprehensive medical requirements.

Frequently Asked Questions:

1. What are the eligibility criteria mandatory for Domiciliary Hospitalisation?

1. The illness or injury sustained has to be hospital-level critical but can still be treated at home instead of a medical facility or hospital.
2. Obtain prior authorisation from your insurance provider regarding the home treatment process.
3. Referral documentation from your appointed doctor stating your treatment can be completed from your home under the domiciliary treatment process.
4. Your current health insurance plan must include the domiciliary hospitalisation feature.
5. Your insurance provider might include some other criteria in your plan. Please enquire before availing of the policy.

2. How to claim domiciliary hospitalisation?

   If Cashless

Inform your insurance provider that you have chosen a home healthcare agency from the list of tie-up agencies (provided by the insurer). Let your insurer contact the agency about the total charges involved in the home treatment, which includes the equipment, medicine, and charges of the medical specialists appointed.

If you have a copayment feature, get ready to pay a pre-decided % of the total bill. Else, your insurer has you covered financially for the treatment. Then, you can concentrate solely on the treatment and healing process.

  If Reimbursement

Reach out to your insurance provider. Keep the treatment invoice, bills, and doctor referral papers ready. The health insurance company will reach out to you with demands for the same papers. Then, the company contacts your home healthcare provider to tally the charges.

While you pay off the entire charge initially after the treatment process is over, your insurance provider reimburses the costs later.

3. What is the difference between domiciliary treatment care and residential care?

The main difference between domiciliary treatment & residential care is that the former is advised by the doctor and happens under the formal supervision of a doctor with a hospital like environment, whereas residential care is more open, broad and free in terms of choices.

4. Can AYUSH treatments be availed of under domiciliary hospitalisation?

AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homoeopathy) treatments are usually covered by insurers extending the domiciliary hospitalisation benefits in their health insurance policy. However, this varies from one insurance provider to the other.

Here are a few insurance providers that offer AYUSH treatments under their health insurance plan -

• HDFC Ergo myHealth Suraksha Silver
• Care - Care Plus Complete
• NIVA BUPA (MAX BUPA) ReAssure
• Star Health Comprehensive

In case you have already availed of a policy (or about to avail of one), you can also check out if this plan offers coverage for the AYUSH treatments, we suggest you -

1. Visit - Understand your Health Insurance Policy
2. Choose the name of your insurer from the drop-down and the health policy that you plan to avail of or have availed of.
3. In the FAQ section of the policy, you can check out if the plan offers coverage for AYUSH treatments.