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Treatments are important for people to get them out of a certain medical situation like a disease or an accident. While you mostly think of a hospital whenever you hear the word treatment, sometimes it can be brought up in a house. Yes, it is called domiciliary hospitalisation, which doctors recommend in several scenarios. But does a health insurance policy cover it? Can you make a claim for it? Let's find out the answer.
To begin with, let's understand the meaning of domiciliary hospitalisation. It refers to treating a patient at the ease of their home. It means if a patient is being treated at home for their disease; it is called domiciliary treatment. There are many reasons that a doctor may recommend this type of treatment, one of which is the patient's inability to be admitted to the hospital. Now, since the patient is not being admitted to the hospital, their insurer may deny the claim for the treatment expense. Here, comes the role of domiciliary claim.
The domiciliary claim is the component of health insurance which lets you claim the treatment cost in case of domiciliary hospitalisation. So, even if the treatment is brought up at home, the insurance company will cover the cost. However, there are certain terms and conditions for domiciliary claims which ensure that the patient or his/her family members do not opt for the treatment voluntarily.
Let's have a look at three of such conditions where the insurance company will cover domiciliary treatment if they offer the component in their policy:
1. The first condition is very straightforward when the patient can't be moved to the hospital due to the present health conditions. It mostly happens when the patient is old or has a disease that makes moving the patient to the hospital impossible.
2. Sometimes, the hospital cannot treat a patient due to the unavailability of a bed or other equipment. In this case, the treatment is done remotely by any other suitable hospital.
3. Lastly, if it is known that the patient's treatment will take long, moving them to their home becomes a more suitable option. In this case, the domiciliary claim can be made. For example, if a patient is in a coma, then moving them to their home is commonly recommended by the family and the hospital.
However, you should know that a domiciliary claim is not a compulsory component of a health insurance policy. This means you must ensure that your policy covers domiciliary treatment at the time of purchase.
We recommend you opt for FG Health Elite, a health insurance policy for Generali Central's premium customers. It is a family health insurance plan that covers up to 15 family members. It also includes the claim for domiciliary hospitalisation, along with other benefits.
The process of domiciliary hospitalisation mostly replicates the below steps:
1. As the first step, the doctor's consultation takes place. If the doctor recommends that domiciliary treatment should be done for the patient based on their evaluation, then the patient or their family members can move ahead with the procedure.
2. Once the doctor states that it is required, they have to prepare a treatment plan where they brief the treatment requirements, like any medical equipment or a dedicated nurse for everyday medical processes and many more.
3. After that, the patient's family member should share the estimation and treatment plan with the insurance company. If there is any other need, the company will mention it, and the patient's well-wisher has to provide the company with the requirements.
4. If the disease and the treatment for the disease are found to be covered under the policy, the company will give them the treatment green flag. However, if anything is not covered in the policy, like the disease, the company may not pass the claim for the domiciliary hospitalisation.
Here, you must understand that you should have a domiciliary claim as a part of the policy or an add-on. Moreover, you should also know about the sublimity of the claim. For example, if a company offers a 100% claim for domiciliary treatment, you can claim the full amount of the insured sum. But if there's a sub-limit assigned to the domiciliary claim, like 20 or 30%, the max coverage will be restricted to 20 or 30% of the insured sum.
To sum up, this is what domiciliary treatment and claim are. In addition to the above information, you should check a policy's inclusions and exclusions of domiciliary components. For example, some diseases are covered under domiciliary treatment, and some are not. Similarly, you must check the sub-limit of the treatment at home before buying the policy.
You can find the best health insurance plans in Generali Central's DIY Health Insurance, FG Health Absolute, and FG Health Elite.
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