What is domiciliary hospitalisation benefit in the context of health insurance?
Siddharth Raman, Gandhinagar
The domiciliary hospitalisation benefit is available in case of health insurance where the stipulated minimum 24 hour hospitalisation is impossible or does not happen. Typically, a health insurance claim is paid only when the insured is hospitalised for a minimum 24-hour period. It is for this reason that most heath insurance policies do not pay for treatments that do not result into hospitalisation. For instance, a fracture of the elbow, resulting in a minor surgery that does not require any hospitalisation is not covered under the health insurance policy.
However, there are circumstances that make it difficult to meet this criterion. There are instances when the insured patient’s condition does not let them be moved to a hospital, or if the hospital can’t accommodate them due to non availability of beds. In such cases, the patient may be treated at home and under medical advice. Such a situation is termed domiciliary hospitalisation and the insurer pays out the compensation related to the health conditions under such a situation under the domiciliary hospitalisation benefit in such exceptional cases. There are certain conditions imposed by health insurers when extending this cover, such as the duration of the treatment under such cases cannot exceed three days and the scope of insurance cover is also limited with a cap that is less than the full sum assured. Moreover, cases like asthma and diabetes are not covered under this clause as well, making domiciliary hospitalisation benefit a limited scope policy, which one should avail only in case of extreme situations.
