Personal Finance

How you can claim domiciliary hospitalisation benefit

Aarati Krishnan | Updated on May 15, 2021

In-built in some health covers

Santosh and Sophia logged on to their regular morning Zoom call at work and finding that their other colleagues had not joined in, they struck up a conversation while waiting for others.

Santosh: Hope all’s well at home, Sophia? Didn’t see you on the call for the last one week.

Sophia: I did have a problem, Sandy, but compared to what’s happening around us, it’s not so bad.

Santosh: Hey, sorry to hear. What’s up?

Sophia: You know I live with my 85-year-old grand-dad right? He suffered a fall on his morning walk on the terrace and fractured his ankle.

Santosh: Goodness! What did you do? Its quite risky to take him to the hospital in these times.

Sophia: Yes, and the doctor also felt it was inadvisable to attempt to move him and advised us to treat him at home.

Santosh: Hope you were able to treat him at home. But what about the expenses? Our office health insurance only covers actual hospitalisation.

Sophia: Well, I have a separate floater health cover personally, that covers domiciliary hospitalisation. That is taking care of it.

Santosh: What’s that? It’s the first I’ve heard of it.

Sophia: If your health insurance policy covers domiciliary treatment, the insurer will reimburse you for any hospital-like treatment taken at home. A doctor must certify that it is not advisable to move the patient to the hospital. If the patient is unable to get a bed in time, domiciliary hospitalisation covers that too.

Santosh: Very useful in these times! I wish I had known about this last year, when I had a bad case of food poisoning after hogging biriyani and was laid up at home.

Sophia: Haha, not really Sandy! Health insurers don’t offer domiciliary treatment cover for everything. First, your health insurance policy should specifically cover domiciliary treatment. While this feature is in-built in some health covers, in some you have to opt for it separately. Two, for you to apply for reimbursement of domiciliary cover, the treatment needs to last for a minimum of three days. Three, the doctor needs to certify that your condition needed hospitalisation, but you couldn’t go to a hospital either because of your condition or because of beds being unavailable. You can’t simply refuse to go to the hospital and hope to get the money. Your food poisoning episode wouldn’t have met any of these conditions.

Santosh: I should’ve known there will be a million strings attached. Any other stuff that’s excluded?

Sophia: Yes, plenty. Most insurers list out set of illnesses for which domiciliary cover won’t be offered. Usually, they won’t reimburse you for home treatment for asthma, bronchitis, cough, cold,flu, diabetes, hypertension, epilepsy, diarrhea, arthritis, rheumatism, respiratory infections and psychiatric disorders. And yes, I forgot ayurvedic and homeopathic treatment – that’s not covered either.

Santosh: Looks like only life-threatening conditions such as Covid will be covered. Will all the expenses you incurred towards your grandad’s treatment be paid by the insurer? Or do you have to pay out of pocket too?

Sophia: No, I’m afraid. You see, as I didn’t see foresee not being able to go to the hospital, I opted for domiciliary cover as an add-on. My policy covers such treatment only to the extent of 10 per cent of the sum assured. As my health policy is worth ₹10 lakh in total, I’ll get about ₹1 lakh as reimbursement towards domiciliary treatment. But something is better than nothing.

Santosh: Well, I’ll be glad to help you out. This was one useful chat, Sophia. Far more useful than most of our office Zoom calls, I must say!

Published on May 15, 2021

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