Most policyholders assume health insurance only covers hospital admissions. But domiciliary hospitalisation — treatment at home that would normally require a hospital stay — is covered by most comprehensive health policies.
The Two Conditions for Domiciliary Coverage
IRDAI specifies two circumstances: first, the patient's condition is such that they cannot be safely moved to a hospital; second, the patient takes treatment at home because no hospital bed is available. Both conditions require that the treatment would normally require hospitalisation.
What You Need to Prove Domiciliary Treatment
Claims for domiciliary treatment require: a certificate from your doctor stating hospitalisation was required but could not be undertaken, a daily monitoring chart signed by the treating doctor for each day of treatment, prescriptions for all medications, records of all investigations, and receipts for all medical expenses.
How Coverage Differs Across Policies
Some policies limit domiciliary coverage to a specified number of days or a sub-limit amount. Others — particularly comprehensive policies — cover domiciliary treatment up to the full sum insured. Chemotherapy and peritoneal dialysis at home are specifically covered by most comprehensive policies.
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