Everything you need to know about domiciliary hospitalization

Many assume health insurance only pays when you are admitted to a hospital. But what about the situations when hospitalisation at home becomes the only option? That’s where domiciliary hospitalisation comes into play. This benefit ensures that you're not left uncovered when treatment shifts from a hospital to your living room.

In this blog, let’s discuss everything about domiciliary hospitalisation cover and how it fits into a group insurance plan.

What is the domiciliary hospitalisation cover in GHI?

Domiciliary hospitalisation refers to medical treatment you receive at home when hospital admission isn’t possible. This could be because your medical condition prevents you from being moved. In a group health insurance policy, domiciliary hospitalisation cover is a feature that ensures your home-based treatment is also covered, provided it meets certain conditions:

• The treatment is for an illness, disease or injury that would typically require hospitalisation.
• A doctor has advised hospital-level care at home.
• The treatment lasts for at least 72 hours (varies slightly depending on the insurer).

This cover bridges the gap between traditional in-patient care and the evolving need for home care, especially in situations like pandemics or severe bed shortages.

Key features of domiciliary hospitalisation cover

Let’s look at what this benefit brings to the table when included in your group health insurance plan:

• Home treatment covered: As long as a doctor advises it, treatments like chemotherapy, dialysis or respiratory therapy can be done at home and covered.
• Pre-and-post-hospitalisation expenses: Some policies include expenses incurred before and after the home-based treatment.
• Medicines and consumables: Cost of prescribed medication, diagnostic tests and medical equipment used during home treatment can be included.
• Doctor consultations and nursing care: Charges for visiting doctors and in-home nurses may be part of the claim.
• Flexibility during emergencies: Helps in times when hospitals are overwhelmed, such as during natural disasters or pandemics.

Domiciliary hospitalisation cover vs. traditional hospitalisation cover

While both options aim to provide financial support during health treatment, here’s how they differ:

Domiciliary care is useful when hospitalisation isn’t feasible, but it often comes with stricter documentation requirements and approval processes.

Eligibility for domiciliary hospitalisation cover

Not every home-based treatment qualifies for this cover. Here are the usual eligibility factors under group insurance plans:

• Doctor's recommendation: You must have a written recommendation from a registered medical practitioner stating that home treatment is necessary.
• Minimum duration: The treatment should usually last at least 72 hours. Shorter treatments may not be eligible.
• Covered illnesses: Commonly accepted conditions include cancer, paralysis and other severe diseases requiring long-term care.
• Exclusions: Some illnesses like asthma or fever might not be covered under domiciliary treatment. Always check the list of exclusions.

Also, not all group health insurance plans offer this cover by default. Employers may opt to include or exclude it based on budget and employee needs.

Conclusion

As healthcare trends shift and the need for at-home treatment rises, domiciliary hospitalisation is becoming more than just an add-on. Including this in your group health insurance policy ensures a broader safety net for employees. Whether it's due to full hospital beds or a severe medical condition, having the option to get hospital-level care at home brings both comfort and coverage.

FAQ

1. What is the minimum treatment duration to claim domiciliary hospitalisation?
   Generally, the treatment should last a minimum of 72 hours to qualify under domiciliary hospitalisation cover.
2. Are all diseases covered under domiciliary care?
   No, some ailments like fever or common cold are excluded. Treatments like chemotherapy, respiratory conditions or stroke aftercare are more commonly covered.
3. Can I claim pre-and post-hospitalisation expenses for domiciliary care?
   Yes, in many group health insurance policies, but you’ll need to check if your policy explicitly includes these expenses.
4. Does this cover increase the group policy premium significantly?
   It might cause a marginal increase in premiums. However, the added protection usually outweighs the slight cost.
5. Is domiciliary hospitalisation automatically included in group insurance plans?
   No, it depends on the employer's chosen plan. It is a good idea to confirm with your HR or insurance provider.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is advised to verify the currency and relevance of the data and information before taking any major steps. Please read the sales brochure / policy wordings carefully for detailed information about on risk factors, terms, conditions and exclusions. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.