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How does domiciliary hospitalization work in health insurance

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Health insurance is a crucial investment that one must make in his lifetime. It financially covers you from health hazards. However, how much benefit you can reap from your insurance depends on the plan that you opt for. Therefore, it is crucial that you choose a plan that suits your needs the most.

Choosing the right kind of plan requires some level of research:

  1. You should be very clear about the conditions and benefits medical insurances come with.
  2. Know your priorities and keep in mind the health complications and age of the insured.
  3. Familiarise yourself with the terms and look for maximum benefits.

Domiciliary hospitalization is one of the benefits that most people look for these days. It allows the policyholder to claim for a hospitalization fee even when he is being treated at home. It comes with certain conditions and has several benefits. Since one cannot foresee the nature of a medical emergency that might befall, it is best to prepare for the worst and cover all that you can in your insurance.

If you are still lost upon domiciliary hospitalization and how it works, read on to clear your doubts. We have unravelled all the confusion around this benefit.

What is Domiciliary Hospitalization in Health Insurance?

Domiciliary hospitalization in health insurance is a benefit that allows the policyholder to be considere hospitaliz even when he receives treatment at home. This home-based treatment, however, will only be considered legit in certain conditions, like when it is not possible for the patient to visit the hospital. Let us go through the conditions one by one to understand them better. The expenses will be covered only if-

  • The treatment requires hospitalization in normal circumstances. If policyholder A is getting treatment for flu or mild dengue at home, the policy will not cover those expenses as the condition did not require him to get admitted to a hospital.
  • The condition of the patient is not suitable to be transported to a hospital.
  • There are no beds available in the hospital.
  • The treatment lasted for 3 days or more.

Let us take an example. Policyholder A, aged 62, who suffers from hypertension, falls down a flight of stairs and breaks his leg. There is no one at home, and thus he does not get the benefit of emergency treatment and hospitalization. In the meantime, he has suffered blood clots in the legs, and by the time he gets help, it becomes difficult and risky to move him to a treatment facility (but at the same time advisable). The only option he is left with is treatment at home. In such a case, he will get his money reimbursed.

Only if it is risky for a patient to move to a hospital, the insurer gets the cover.

When are Domiciliary Expenses Not Covered

A policy will not cover your expenses if:

  • You are fit to get hospitalized, and the hospital has beds.
  • If the treatment did not require hospitalization in normal circumstances.

Let us turn to another example for easy understanding. Policyholder B detects symptoms of food poisoning and gets certain tests done prescribed by a physician. When the reports arrive, he is diagnosed with diarrhoea, and the physician advises him to get admitted to a hospital as soon as possible. However, he decides to get his treatment at home instead of the hospital (despite the availability of beds). His expenses will not be covered as he chose to get treated at home despite having the option of getting admitted to a hospital.

Besides the above mentioned two broad conditions, most insurances do not cover certain diseases under domiciliary hospitalization like:

  • Bronchitis
  • Epilepsy
  • Asthma
  • Chronic nephritis
  • Diarrhoea, dysentery, and gastroenteritis
  • Hypertension
  • Arthritis or Rheumatism

Therefore, it is clear that domiciliary hospitalization is given to only those who really need it, and these conditions prevent people from taking undue advantage of their policy.

More Things to Know About Domiciliary Hospitalization in Medical Insurance

Besides knowing what conditions will allow you to avail of the benefit, there are other important aspects of this term that you should know about.

  • To begin with, not every insurance company will provide you with domiciliary hospitalization.
  • It is not a default cover and does not come as one of the obvious benefits of a policy. It is up to you to ask for it, which will require you to pay an additional premium amount.
  • It is covered up to a certain percentage of the sum insured.
  • Homeopathy treatments are not covered by most policies.
  • You must prove to your insurer that home treatment was the only option for you as it is impossible for you to move to a facility. And only when your insurer is satisfied can you get the benefits.

Domiciliary hospitalization is indeed important. It is true that the chances of requiring the benefits are thin, but imagine the catastrophe that would fall upon you if you do face such a situation. It would drain all your money, and your insurance premiums would render useless as the policy will not cover your expenses.

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