- Also known as home hospitalization, domiciliary hospitalization is a situation where patients are considered hospitalized even when they are getting treatment at home.
- Due to the state of illness, it gets difficult to shift the patient to a hospital.
- The patient has to receive treatment at home since they couldn’t find occupancy in the hospital.
- The treatment lasted at least 3 days.
Sanjay, a high BP patient was alone at home when he received a distress call from his brother that their uncle, whom he was very close to, had passed away. In a state of distress, Sanjay’s BP shot up so much so that he got a paralytic attack.
When he got the attack, he was alone at home so it took a lot of time to receive care. When the doctors finally came in, they said it’s unsafe to relocate Sanjay to the hospital.
Now, Sanjay had already taken an insurance plan that allowed for a claim for home treatments. Because of this, the out-of-pocket expense which he had to make was reduced by great numbers.
This is a classic case of domiciliary hospitalization examples.
What is domiciliary hospitalization?
Domiciliary hospitalization is an insurance benefit provided by multiple health insurance plans where the insured is considered hospitalized even when they are receiving treatments at home. In this case, since the health insurance covers home hospitalization, the insurer pays for the medical treatment as part of the sum insured.
The policyholder is usually compensated for all the medical expenses made during the policy period upon the written advice of the doctor. The compensation is generally 10% of the sum insured.
However, domiciliary hospitalization is not offered in every instance. There are some conditions which have to be met.
What are the conditions for domiciliary hospitalization?
1. The patient should suffer from an ailment, disease, or an injury for which a certified medical practitioner has advised hospitalization.
2. The patient should have an active, ongoing health policy.
3. The treatment period should be a minimum of 3 days.
4. The patient should not be in a state to be shifted to a hospital.
5. There is no availability of hospital accommodation and the patient doesn’t have an option but to get the treatment at home.
Which diseases are not covered in domiciliary hospitalization?
- Cough, cold, or influenza
- Diabetes Mellitus or Insipidus
- Pyrexia of unknown origin
- Chronic Nephritis
- Psychiatric or Psychosomatic Disorders
- Diarrhea, dysentery, and gastro-enteritis
- Arthritis, Gout, or Rheumatism
- Tonsillitis and Upper Respiratory Tract Infection, Laryngitis, Pharyngitis.
Things to know about domiciliary hospitalization
1. Home hospitalization is not a default cover. You could be asked to pay an additional premium on the basis of the terms and conditions of the cover.
2. While there are some policies that cover domiciliary hospitalization up to the sum insured, there are also others that come with limited coverage. So check with your provider before investing in one.
3. There are multiple criteria for the treatment which can be availed at home and also the illness for which treatment can be received at home.
4. In case of domiciliary hospitalization, it is important to prove to the insurance provider that it is impossible for you to be admitted to the hospital. You should note that the insurance company will only pay the expenses when they are satisfied with your reasoning.
Domiciliary hospitalization under Onsurity Plus
Under the group health insurance with the Onsurity Plus Membership, our insurance partner provides coverage for domiciliary hospitalization without a cap. That means you can claim up to the full amount of your Sum Assured for hospitalization if you need to. Our insurance partner will cover cases of domiciliary hospitalization where medical treatment is availed for a period exceeding three days for an illness/disease/injury which in the normal course would require care and treatment at the hospital/nursing home.
You can access the terms and conditions of your group health insurance provided under the Onsurity Plus Membership plan through the Onsurity App. All you need to do is tap the ‘Policy Details’ tab under Insurance. If you need any help or are unclear about the terms and conditions, feel free to get in touch with our friendly Good Doctors Team.
The team of experts can help you understand your employee healthcare benefits plan. With the Good Doctors Team, you are always clear when it comes to hospitalization. The team can also help with the reimbursement process, by telling you what you need.
Please note that Onsurity is only an administrator. We cannot process or verify your claims, that can only be done by our insurance partner.
We hope that you understood the context of domiciliary hospitalization – at least enough o talk to your insurance provider. So next time you talk to your insurance provider if you think domiciliary hospitalization is something that you might require, ask them to help you choose a policy or top-up that offers the functionality. Rest assured, the domiciliary hospitalization benefit will help you be at physical and financial ease at the time of emergency.
This article was our contribution to explaining to you what the popular term of the group health insurance space stands for. Hope it helped.