Health insurance is a technical product. It requires policyholders to understand the basic terms and conditions of their policy to make a successful claim. Due to a lack of awareness of its technical nature most of us get stumped when making a successful claim on the health insurance provider. More so if the treatment is taken at home because we believe that our health plan would pay only when we face hospitalization. Is the belief correct? Can’t we raise a claim for a treatment taken at home? We can.
Yes, you heard me right. There is a concept in our health insurance plan called ‘Domiciliary Hospitalization’ which permits treatments availed at our homes. Do you know about it?
What is Domiciliary Hospitalization?
Treatments taken at home for a disease or injury either because of non-availability of hospital beds or because the patient is not in a condition to be moved to a hospital are called domiciliary hospitalization.
This was the basic definition of domiciliary hospitalization but the concept doesn’t end here. There are certain terms and conditions which should be fulfilled for a treatment to be categorized as domiciliary hospitalization. Let us see what such terms and conditions are:
Terms and Conditions for Domiciliary Hospitalization
- The treatment would be allowed at the policyholder’s home only when:
- There is a lack of accommodation at a hospital, or
- The patient’s condition does not permit him to be moved to a hospital
- The treatment should be required for such a medical condition which, in normal circumstances, would require treatment at a hospital
- The medical treatment availed at home should be for a period of more than 3 days.
Treatments fulfilling all the above conditions would only qualify under the concept of domiciliary hospitalization.
Common exclusions for Domiciliary Hospitalization
There are some exclusions which are not covered under the purview of Domiciliary Hospitalization even when the above three conditions are met. Such exclusions are as follows:
- While pre hospitalization might be covered under some plans, post hospitalization expenses incurred for such treatment would be excluded from the cover.
- There are some treatments for which domiciliary hospitalization availed would not be covered. Such treatments include the following:
- Diabetes Mellitus and Insipidus
- Chronic Nephritis
- Diarrhea, Dysentery and Gastroenteritis
- Cough, cold and Influenza
- Pyrexia of unknown origin for a period of less than 10 days
- Psychiatric or Psychosomatic Disorders
- Arthritis, Gout or Rheumatism
- Tonsillitis and Upper Respiratory Tract Infection, Laryngitis or Pharyngitis
Points of importance
A domiciliary hospitalization entails other points too. Here are some important points to remember in addition to the conditions and the exclusions of a domiciliary hospitalization:
- Not every health insurance plan covers domiciliary hospitalization. Even in plans where the coverage is available, it might either be inbuilt or provided as an optional cover. In case of an optional cover an additional premium is required to opt for the cover.
- Some plans cover domiciliary hospitalization up to the Sum Assured while in some plans the coverage is restricted. Such a restriction might either be in absolute terms or depicted as a percentage of the Sum Assured.
So, by now you must have had a clear understanding of what domiciliary hospitalization actually is. The next time when you read the term in your plan’s features you would know exactly what your policy would cover and what not, isn’t it?
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