Many people believe that health insurance only provides benefits during in-patient hospitalisation. It’s essential to understand that health insurance can also cover domiciliary hospitalisation, allowing for hospital-like care and treatment at home. This benefit is valuable in managing the inflated costs of medical care, especially for elderly parents. Let’s explore the concept of domiciliary hospitalisation, its meaning, and how it can provide significant advantages for you and your loved ones.
What is domiciliary hospitalisation?
Domiciliary hospitalisation is a medical treatment that typically requires a hospital stay but can be administered in the comfort of your home. This coverage provides financial protection to patients unable or reluctant to be admitted to a hospital for extended periods. This is particularly beneficial for patients needing prolonged treatment or medical care for whom hospitalisation is inconvenient or cumbersome. Domiciliary hospitalisation coverage includes medical expenses such as nursing care, medical equipment, and prescription drugs required for home treatment. It is an alternative to in-patient hospitalisation with necessary infrastructure and services provided at their home comfort.
As people enter their silver years, the likelihood of requiring medical attention increases. However, it’s important to distinguish between home care and domiciliary treatment.
Home care vs. domiciliary treatment
Home care typically involves mild health issues like fever or flu. A person might take a couple of days off, rest, take medications, and then return to their daily routine. This form of care is relatively simple and doesn’t require intensive medical intervention.
On the other hand, domiciliary treatment is a more structured form of care prescribed by a medical practitioner for more severe conditions. There are several scenarios where domiciliary treatment becomes necessary:
Critical condition: If the patient is critically ill and cannot be moved to a hospital, domiciliary treatment ensures they receive the necessary medical care at home.
Inadequate hospital infrastructure: The chosen hospital may sometimes lack sufficient medical infrastructure, such as hospital beds. In such cases, domiciliary treatment becomes a practical alternative.
Infeasibility of continuous hospitalisation: For some patients, staying in a hospital continuously is not feasible for various reasons, such as long-term treatment needs or personal circumstances. The specialty hospital may be in another town or major city and supporting family members’ stay there is also costly and challenging.
One crucial aspect to remember about domiciliary treatment is the reimbursement process. Unlike cashless treatment available in hospitals, domiciliary treatment requires patients to cover their medical expenses and seek reimbursement from their insurance provider.
Benefits for senior citizens
Domiciliary treatment offers several crucial benefits for senior citizens. It allows them to receive care in the comfort of their home without the added stress of hospital transfers, especially in critical conditions. This personalised approach often results in better patient outcomes and more attentive care. It also eliminates the need for transportation to healthcare facilities, which can be challenging for older people. Family members can be more involved, providing emotional support and ensuring proper treatment. Additionally, home care can be more cost-effective than prolonged hospital stays, enhancing senior citizens’ overall quality of life.
Covered and non-covered
Most health insurance policies cover domiciliary treatment. However, thoroughly understanding this coverage’s specific inclusions and exclusions is crucial. Domiciliary hospitalisation coverage applies if the patient cannot be moved to a hospital due to their condition or if there is no available room in a hospital, provided the home treatment exceeds three days.
Insurance company may apply certain exclusions while offering domiciliary hospitalisation coverage, such as conditions where treatment is required for less than 3 days, chronic medical conditions requiring recurrent or long-term treatment e.g., asthma, gout, rheumatism, chronic nephritis, diabetes mellitus and insipidus, epilepsy, hypertension etc.
For senior citizens and others considering health insurance, opting for a plan that includes domiciliary hospitalisation can be a valuable choice. It allows for medical care in the comfort of one’s home for an extended period, enhancing both convenience and quality of life.
(The author is Head- Health Administration Team, Bajaj Allianz General Insurance)