Explained: Domiciliary Hospitalization Cover in Group Health Insurance Policy

Sometimes, an insured patient can’t avail medical treatment at hospital due to various reasons such as

1. Serious medical condition
2. Lack of hospital beds

In such cases, the patient needs to avail medical treatment at home in cases where he is not able to go to hospital.

A Group Health Insurance Policy usually covers only hospitalisation expenses. However, many Group Health Insurance Providers offer a feature known as Domiciliary Hospitalisation Cover.

Domiciliary Hospitalization Cover in a Group Health Insurance Policy reimburses the patient for treatment availed at home as well.

Domiciliary Hospitalisation is an important Group Health Insurance Coverage and it is necessary for employers to understand this feature of a Group Health Insurance Policy in detail.

What is the meaning of Domiciliary Hospitalization Cover in a Group Health Insurance Policy?

The meaning of Domiciliary Hospitalization Cover in a Group Health Insurance Policy is a medical treatment for an illness/disease/injury which in the normal course would require care and treatment at a hospital but is actually taken while confined at home under any of the following circumstances:

a) The condition of the patient is such that he/she is not in a condition to be removed to a hospital, or

b) The patient takes treatment at home on account of non-availability of room in a hospital

Thus, Domiciliary means something that is related to a person’s home and Domiciliary Hospitalisation means that the Insured Patient is availing medical treatment at home.

So, most Group Health Insurance Policies do not pay for Domiciliary Hospitalisation Treatment which is availed at home. Availing Domiciliary home treatment can be very expensive.

However, If the employer opts for a Domiciliary Hospitalisation Cover, the Group Health Insurance Plan will pay for the home treatment (ie Domiciliary Claims) as well. Thus, Domiciliary Hospitalisation Cover is an important feature of a Group Health Insurance Policy.

5 Things to know about Domiciliary Hospitalisation

1. Domiciliary Hospitalisation is not a default feature that is provided by all Group Health Insurance Companies in India.
2. There might be a Sub-Limit on the amount that the Insured Person can claim under the Group Health Insurance Policy under a Domiciliary Claim
3. The Group Health Insurance Provider may require certain terms and conditions to be fulfilled before the patient can avail Domiciliary Treatment
4. Group Health Insurance Company may charge additional premium to grant a Domiciliary Hospitalisation Cover under the Group Medical Insurance Policy
5. There might be a Waiting Period before the Insured Patient can avail coverage Domiciliary Hospitalisation Cover of the Group Health Insurance Policy

Remember that most Group Health Insurance Companies would offer coverage for Domiciliary Hospitalisation Expenses only in cases where Hospitalisation is not possible. Remember to read through the Group Health Insurance Policy Wordings in detail to understand the Domiciliary Hospitalisation Coverage in Detail.

What is not covered under Domiciliary Hospitalisation Cover of a GMC Policy?

Domiciliary Hospitalisation Cover in a Group Health Insurance Policy does not usually cover Domiciliary Expenses for home treatments arising out of conditions such as ashthma, bronchitis, epilepsy, cough, diabetes, diarrhoea, hypertension etc. A thorough read of Group Health Insurance Policy Wordings will specify the exclusions under the Domiciliary Hospitalization Cover of a Group Health Insurance Policy.

Domiciliary Hospitalisation Claim Examples under a Group Health Insurance Policy

Scenario1: Consider an elderly patient who has difficulty moving around suddenly breaks her leg. Owing to her medical conditions, the doctor recommends a treatment at home as transferring her to hospital might destabilise her condition.

In such a case, the Insured Patient undergoes treatment at home based on the doctor’s recommendation and her treatment would be covered under Domiciliary Hospitalisation Cover.

Scenario 2:  A middle aged person suddenly develops intense diarrhoea and fever. However, he does not go to hospital for fear of contacting COVID and undergoes the treatment at home.

In such a case, the Group Health Insurance Provider would not cover Domiciliary Treatment under Domiciliary Hospitalization, because his reason for not traveling to the hospital was a personal decision and not dictated by his medical condition.

Conclusion

Domiciliary Hospitalization is an extremely important feature of a Group Health Insurance Policy.

It is important to note that not all Group Health Insurance Policies offer Domiciliary Hospitalisation Coverage. Hence, the employer needs to check the Group Health Insurance Policy Wordings thoroughly to know the inclusions and exclusions under the Domiciliary Hospitalisation Cover. In some cases, even though the cover is provided, the Insured would be able to claim only a percentage of the Sum Insured under the Domiciliary Hospitalization Cover.

It is important to compare the Group Health Insurance Coverages amongst the various Group Health Insurance Companies in India to know the coverages and exclusions in detail before purchasing a Group Health Insurance Policy.

Select the best Group Health Insurance Policy for the organisation based on the profile and needs of the employees, average age group etc. Purchasing a GMC Policy should not be based on the lowest quote but a careful consideration of Group Health Insurance Coverages and Exclusions as well

You can speak to one of our experienced team members for your Group Health Insurance Policy who will assist you in selecting the best group health insurance plan for your company.

Drop a mail to insurance@qian.co.in or call us at +91-22-22044989 for a free Group Health Insurance Quote.

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