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Does your Health Insurance Policy Cover Home Treatment?

Taking into consideration the acute shortage of hospital beds and a steep rise in the number of COVID-19 cases in India, health insurance companies are also offering domiciliary hospitalization cover to the policyholders. The stupendous flow of patients during the ongoing pandemic made us shed some light on the importance of home treatment facilities under health insurance plans.

Domiciliary hospitalization refers to a situation when the insured person avails the medical treatment at home. Undoubtedly, it has proven to be useful to many Covid-19 patients since the hospitals had to turn them away due to a shortage of beds, oxygen, medicines, etc.

These patients in the pandemic had no choice but to avail of home treatment.  A lot of them were also left gasping for breath due to the unavailability of beds.

Have a look here for what can be included under the domiciliary feature in a health insurance policy, its cost, how to claim, its limitations, and what all to watch out for.

When is Domiciliary Hospitalization required?

It is needed when:

  • Your doctor advises treatment at home instead of hospitalization
  • Despite all efforts if a patient is not able to procure a hospital bed or if it is not available
  • Some patients cannot get hospital admission due to pre-existing conditions and co-morbidities

Some health insurance plans include a feature of Home Care reimbursement; while some others provide it as an in-built feature and some offer it as an add-on cover. Since this is not a mandatory or standard feature in medical insurance plans, the coverage provided can differ from one plan to another and from one insurer to another.

What Treatment Costs will be covered?

You must be wondering what all expenses are covered under the homecare facility?

Technically it covers all the expenses that are covered under domiciliary hospitalization, including the cost of medical equipment, medicines, doctor’s consultation fee, and even oxygen cylinders like in the case of Corona kavach health insurance plans. This policy covers COVID- 19 home treatment up to a maximum of 14 days.

If you want to know more about COVID-19 home treatment you can click here

Sub-limits of Domiciliary Reimbursement

Sub-limits refer to the percentage of the amount of the sum insured that will be paid by the insurer. Some health insurers provide the domiciliary treatment benefit up to a certain percentage of the coverage amount and some offer it as an add-on cover only.

For example, if your health insurance policy provides coverage of Rs 10 lakh and the coverage limit for domiciliary hospitalization is 15% of the sum insured; then the actual payout by the insurer would be Rs 1.5 lakh.

Remember that during home care treatment cashless facility is not available, and if your policy provides domiciliary hospitalization cover then you can claim for reimbursement of the treatment expenses.

How to Claim Reimbursement for Homecare Treatment?

Be mindful of saving all your medical documents to have a hassle-free claim experience.

What do you need to do?

You need to submit proof that ‘home treatment’ was advised by the treating doctor and hospitalization was required. For example, in the case of COVID-19 hospitalization, a lot of patients availed treatment at home and then filed for reimbursement.

Have a look at the documents required-You need to furnish all the investigation reports including medical tests, prescriptions, CT scans and other diagnostic tests would be required. The insurer can ask for receipts and bills of the expenditure incurred at the time of claim reimbursement.

Be it online consultation through video or voice call, or a personal visit to the doctor, the doctor always provides a prescription. It should mention regarding the hospitalization or home treatment. So, you need to make sure that you follow up the call to get a prescription for domiciliary hospitalization.

In case of medical supplies it can sometimes be difficult to get the receipts but you should try and make it a point to get the receipts as far as possible.

However, do remember that home care treatment is not a default feature that will be provided in every health insurance policy. Also, do keep in mind that policies with lower sub-limits for domiciliary treatment may have a lower premium in comparison to a policy that provides domiciliary treatment cover up to the sum insured.

To check out plans on domiciliary treatment you can write to us at This email address is being protected from spambots. You need JavaScript enabled to view it. or speak to our healthcare experts at 1800-208-8787

Takeaway

If your existing health insurance policy does not cover domiciliary hospitalization expenses then you can always upgrade it with the add-on benefit or port it to a new plan while buying a new policy. And do read the policy features and benefits in detail.  

Written By: PolicyBazaar - Updated: 09 June 2021
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Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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