Home Is Where The Healing Happens – Domiciliary Hospitalization Explained

The path to recovery can sometimes be long and tedious and a simple medical diagnosis can sometimes translate into a long-term treatment course. But if you were to stay in the hospital until you are completely healed, the costs could put a significant dent in your pocket. Even if you have an excellent Health Insurance plan  with a substantial sum insured, you could end up incurring a lot of out-of-pocket expenses. Plus, a prolonged hospital stay might impact your spirits, make you feel restless, and slow down your recovery. So, if home is where you feel the most at ease, there’s no reason why you cannot recover there. Thankfully, a coverage concept called domiciliary hospitalization in Health Insurance exists. Here’s everything to know about it.

What Is Domiciliary Hospitalization in Health Insurance?

Domiciliary hospitalization in Health Insurance represents the changing face of healthcare, offering a patient-centric approach that extends medical care beyond the traditional confines of a hospital. This concept refers to the provision of essential medical treatment for illnesses or injuries within the comfort of the policyholder/patient’s home, eliminating the need for conventional hospitalization.

Skilled healthcare professionals, including doctors and nurses, play a pivotal role in delivering necessary treatments, monitoring progress, and ensuring continued care within the familiar environment of your home. By extending domiciliary hospitalization facilities as part of your Health Insurance cover, your insurer recognises that certain medical conditions can be effectively managed in a home setting, providing both comfort and convenience.

How Does Domiciliary Hospitalization Work?

The meaning of domiciliary hospitalization is that it denotes a unique healthcare model that provides essential at-home medical care. The system operates on a patient-centric approach and a recognition that certain medical conditions can be effectively managed outside traditional hospital settings. The process typically unfolds as follows:

1. Physician Recommendation

The process starts with a recommendation from the treating physician who assesses the patient’s condition. The physician decides whether domiciliary care is suitable based on the nature and seriousness of the ailment.

2. Insurer Approval

Following the physician’s recommendation, you as a policyholder can seek approval from your Health Insurance provider. This often involves submitting detailed medical reports and obtaining an endorsement from the treating physician.

3. Engagement of Healthcare Professionals

Once approval is secured, qualified healthcare professionals, including doctors and nurses, are engaged to provide necessary treatments at the patient’s home. This includes giving medications, conducting diagnostic tests, and monitoring the patient’s overall well-being.

4. Regular Monitoring

Continuous monitoring of the patient’s health is integral. Regular home visits by healthcare professionals ensures the effectiveness of the treatment plan and allows for adjustments as needed.

5. Documentation and Reporting

Comprehensive documentation, including medical reports and ongoing treatment progress, is essential for the continuous approval and coverage of domiciliary care.

This patient-centric approach not only provides comfort and convenience to the patient but also offers a cost-effective alternative to traditional hospitalization, emphasising how flexible and approachable the healthcare system is in India.

Inclusions and Exclusions Under Domiciliary Hospitalization?

Understanding the inclusions and exclusions under domiciliary treatment is important for you as a policyholder to manage expectations and make sensible decisions about your healthcare coverage. It makes you aware of what is covered and what is off-limits in terms of hospitalization.

The Inclusions

Domiciliary hospitalization coverage under your Health Insurance plan includes a range of medical services designed to provide you with comprehensive healthcare coverage in the comfort of your home. It typically includes:

• Medical Consultations:

Fees associated with consultations provided by qualified healthcare professionals, such as doctors and nurses, who deliver care at the patient’s residence.

• Diagnostic Tests:

Coverage extends to the costs associated with diagnostic tests conducted at home, allowing you to carry out the necessary medical assessments smoothly.

• Medications:

Expenses related to prescribed medications administered during domiciliary care are typically covered.

• Nursing Care:

Coverage may extend to the fees of hiring qualified nursing professionals who provide necessary care and assistance to the patient at home.

• Medical Equipment:

Some Health Insurance policies may include coverage for the rental or purchase of medical equipment essential for domiciliary care.

Exclusions Under Domiciliary Treatment

The costs associated with the following are outside the scope of coverage, even if your Health Insurance policy offers domiciliary treatment coverage:

• Routine Check-ups:

Regular health check-ups unrelated to the specific ailment are typically not included in the scope of coverage.

• Non-Essential Treatments:

Procedures that can be delayed without risking the patient’s health may not be covered in the plan.

• Preventive Care:

Services that focus on preventive health measures rather than addressing an existing medical condition are generally excluded.

• Non-Recommended Domiciliary Care:

Instances where the treating physician does not recommend home-based care may be excluded.

• Experimental Treatments:

Procedures or therapies that are not widely accepted in normal medical practice are typically not eligible for coverage.

• IRDAI-Specified Illnesses:

The treatment of certain IRDAI-specified chronic ailments such as asthma, bronchitis, epilepsy, influenza, hypertension, arthritis, diabetes, etc., are not eligible for coverage.

Benefits Under Domiciliary Treatment Cover In India

Getting the domiciliary treatment cover as part of your Health Insurance plan beneficial in several ways. Here are the advantages you leverage by having this cover under your policy:

• Cost Savings:

Domiciliary care is often more economical than traditional hospitalization, reducing the financial burden on you as a policyholder.

• Comfort and Convenience:

Patients receive treatment in the familiar environment of their home, which, in turn, enhances their overall well-being while reducing the stress of hospital-based treatments.

• Individual Care:

Treatment plans are designed as per the specific needs of the patient, ensuring a personalised approach to healthcare.

• Reduced Infection Risk:

Home settings minimise the exposure to hospital-acquired infections, thereby providing patients with a safer healing environment.

• Family Involvement:

Domiciliary care encourages the patient’s family members to be involved in their recovery process, by providing emotional support.

• Flexibility:

Patients can have a flexible daily routine, which contributes to a smoother and easy healthcare experience.

• Best Use Of Resources:

Domiciliary care reduces the load on hospital resources, freeing up beds needed for critical cases.

• Improved Monitoring:

Regular home visits enable regular monitoring of the patient’s health, ensuring timely adjustments to the treatment plan.

• Access to Qualified Professionals:

Domiciliary hospitalization involves skilled healthcare professionals, including doctors and nurses, providing expert care at the patient’s home.

Is Domiciliary Hospitalization Covered Under My Health Insurance Policy?

Whether or not domiciliary hospitalization is covered under your Health Insurance policy largely depends on who your insurer is and the scope of coverage included under your chosen plan. In most cases, you can enjoy domiciliary hospitalization coverage as part of your regular Health Insurance plan. However, if your policy doesn’t include this coverage, you may purchase it as an additional rider. If you choose this option, you have to pay a little extra, above your policy’s existing premium rate.

Irrespective of whether you opt for a policy with domiciliary hospitalization as a standard coverage benefit or an add-on, your insurer only covers the costs up to the sum insured amount or up to a specific sum as mentioned under your health plan’s terms and conditions.

Domiciliary Hospitalization Costs

The costs associated with domiciliary hospitalization can be broadly categorized into two types.

1. The Basic Costs:

As mentioned earlier, domiciliary hospitalization may be included as a bundled feature in your policy, or you can purchase it as an additional rider. In case of the former, it can be rather difficult to find out the exact cost or the premium charged against such an inclusion. If however, you purchase it as an add-on rider, your insurer will clearly mention the cost associated with adding the rider.

2. The Claim/Settlement Costs:

The claim or settlement amount is the cost borne by your insurer. It is the amount the insurer is liable to pay if you choose to encash your Health Insurance policy for domiciliary treatment. This amount typically varies depending on how severe the insured’s patients illness or disease is, where they are based, and the duration for which they need domiciliary treatment at home.

For instance, if an insured patient chooses to seek treatment in a smaller town or city, Ahmednagar, for example, then the costs of domiciliary hospitalization are typically lower compared to someone seeking treatment in a metropolitan city like Mumbai. This is because medical costs, doctor charges, living costs, etc., tend to be higher in Mumbai due to the availability of high-end equipment. The same facilities may not be available in the smaller towns, where living costs are also typically low.

Example Explaining How Claim Limits Work For Domiciliary Hospitalization Coverage

Let’s say you have a Health Insurance policy with domiciliary hospitalization as an included benefit. This policy comes with a sum insured of ₹20,00,000. Your insurer has set aside 10% of the policy’s sum insured, i.e., ₹200,00 as the amount you can claim towards domiciliary hospitalization coverage.

The insurer may ask you to either provide original bills on a weekly/fortnightly basis and release the payment in tranches, paying off part of the total ₹200,000 you are eligible for coverage. Alternatively, you may be required to send the total final bill to the insurer once the patient has recovered.

Domiciliary Hospitalization Facts Everyone Should Know

Understanding the impact and considerations surrounding domiciliary treatment is essential for policyholders to be able to use their healthcare coverage to the fullest:

• Duration Limits:

Policies may have stipulated maximum durations for domiciliary care, beyond which traditional hospitalization may be necessary.

• Approval Process:

The insurer may often require pre-approval for domiciliary hospitalization. You cannot make the decision to seek domiciliary treatment on your own.

• Documentation Requirements:

Proper documentation, including the treating physician’s recommendation letter and detailed medical reports, are required for the claims process.

• Coverage Limits:

Not every aspect of domiciliary care may be covered. There may be certain expenses or sub-limits on expenses, beyond which you may have to bear the costs out of your own pockets.

• Regular Monitoring:

Insurers may require you to monitor the patient’s health frequently and provide regular reports to them for ongoing approval and coverage.

• Policy Renewal Implications:

If you opt for domiciliary hospitalization, you should be prepared for certain implications at the time of policy renewal, including higher premiums for the next policy year.

• Responsible Usage:

Sticking to the recommended treatment plans is crucial to ensure continued coverage under domiciliary care.

• Provider Network:

While buying Health Insurance, you must check your insurer’s network of healthcare professionals offering domiciliary services to ensure smooth and co-ordinated care.

• Flexibility and Customization:

It also helps to check the flexibility of the policy and the extent to which it allows customization to meet specific healthcare needs.

• Standard Coverage vs Add-on:

You must check if you are eligible for domiciliary hospitalization coverage as not all policies include it. In such cases, you can purchase it as an additional rider.

When Is Domiciliary Hospitalization Necessary and Permissible In Health Insurance 

Domiciliary hospitalization becomes both necessary and permissible under specific circumstances, including:

• Severity of Illness or Injury:

When the nature of the ailment necessitates effective treatment and management at home.

• Limited Hospital Bed Availability:

In situations where hospital beds are scarce or entirely unavailable, domiciliary care serves as a good alternative.

• Patient’s Preference:

If the patient, in consultation with the treating physician, expresses a preference for home-based care, domiciliary treatment is considered.

• Physician’s Recommendation:

When the treating physician recommends domiciliary care as the most suitable and effective mode of treatment for a specific medical condition.

• Critical Conditions:

In cases where immediate hospitalization poses significant challenges or risks to the patient’s health, domiciliary care becomes a permissible and logical option.

Witness The Changing Face of Health Care in India with Manipal Cigna Health Insurance

Your Health Insurance policy indeed offers extensive coverage, ensuring your out-of-pocket costs are minimal to zero. At Manipal Cigna Health Insurance, this is what we strive for, which is why we offer an array of Health Insurance plans suiting your coverage needs and affordability. You can also enjoy domiciliary hospitalization coverage under our policies. Besides our exhaustive coverage benefits, and an extensive network of hospitals, we offer convenience in the form of easy claim processes, 24x7 customer care facilities and an array of add-on riders, allowing you to get all-around protection for yourself sand your loved ones!

Access the best medical care money can provide with Health Insurance Plans from Manipal Cigna.