What is domiciliary hospitalization

Health insurance is a technical product. It requires policyholders to understand the basic terms and conditions of their policy to make a successful claim. Due to a lack of awareness of its technical nature most of us get stumped when making a successful claim on the health insurance provider. More so if the treatment is taken at home because we believe that our health plan would pay only when we face hospitalization. Is the belief correct? Can’t we raise a claim for a treatment taken at home? We can.

Yes, you heard me right. There is a concept in our health insurance plan called ‘Domiciliary Hospitalization’ which permits treatments availed at our homes. Do you know about it?

What is Domiciliary Hospitalization?

Treatments taken at home for a disease or injury either because of non-availability of hospital beds or because the patient is not in a condition to be moved to a hospital are called domiciliary hospitalization.

This was the basic definition of domiciliary hospitalization but the concept doesn’t end here. There are certain terms and conditions which should be fulfilled for a treatment to be categorized as domiciliary hospitalization. Let us see what such terms and conditions are:

Terms and Conditions for Domiciliary Hospitalization

  • The treatment would be allowed at the policyholder’s home only when:
  1. There is a lack of accommodation at a hospital, or
  2. The patient’s condition does not permit him to be moved to a hospital
  • The treatment should be required for such a medical condition which, in normal circumstances, would require treatment at a hospital
  • The medical treatment availed at home should be for a period of more than 3 days.

Treatments fulfilling all the above conditions would only qualify under the concept of domiciliary hospitalization.

Common exclusions for Domiciliary Hospitalization

There are some exclusions which are not covered under the purview of Domiciliary Hospitalization even when the above three conditions are met. Such exclusions are as follows:

  • While pre hospitalization might be covered under some plans, post hospitalization expenses incurred for such treatment would be excluded from the cover.
  • There are some treatments for which domiciliary hospitalization availed would not be covered. Such treatments include the following:
  • Bronchitis
  • Asthma
  • Diabetes Mellitus and Insipidus
  • Chronic Nephritis
  • Diarrhea, Dysentery and Gastroenteritis
  • Hypertension
  • Epilepsy
  • Cough, cold and Influenza
  • Pyrexia of unknown origin for a period of less than 10 days
  • Psychiatric or Psychosomatic Disorders
  • Arthritis, Gout or Rheumatism
  • Tonsillitis and Upper Respiratory Tract Infection, Laryngitis or Pharyngitis

Points of importance

A domiciliary hospitalization entails other points too. Here are some important points to remember in addition to the conditions and the exclusions of a domiciliary hospitalization:

  • Not every health insurance plan covers domiciliary hospitalization. Even in plans where the coverage is available, it might either be inbuilt or provided as an optional cover. In case of an optional cover an additional premium is required to opt for the cover.
  • Some plans cover domiciliary hospitalization up to the Sum Assured while in some plans the coverage is restricted. Such a restriction might either be in absolute terms or depicted as a percentage of the Sum Assured.

So, by now you must have had a clear understanding of what domiciliary hospitalization actually is. The next time when you read the term in your plan’s features you would know exactly what your policy would cover and what not, isn’t it?

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What is health insurance?

Medical emergency can arise without any warning. Just as you go the extra mile to keep your health in check, why not also prepare to face the other side? Let us go another mile to understand what is health insurance with the help of this Infographic.

What is health insurance

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Cover amount and premium

Raj and Sunil are best of friends. They discuss every other aspect of their lives except financial decisions. Only when Raj met with an accident while coming back from their annual backpacking trip, Sunil was dumbfounded to realize that his best friend had no clue about his health insurance plan and its coverage benefit. In fact, Raj had no clue of how much coverage his health plan would provide, the network hospitals, other terms and conditions, etc.

Trust me they are not the only ones. There are quite a lot of us who don’t discuss financials even with our near and dear ones, let alone best of friends.

While more and more individuals are insuring themselves and their families under a health insurance cover, most of us lack the basic knowledge of a health insurance plan. It’s time to wake up and discuss the same so that we are aware of the basic terminology of our own health insurance plan!

Let’s talk about the most basic two features of a health insurance plan – the coverage and the premium amount. Do all of us know what exactly does the cover amount and the premium of a health insurance policy mean?

What is Coverage Amount?

This is the MOST important thing you must understand about any health insurance plan. The coverage amount, also called the Sum Assured or the Sum Insured, is the maximum amount of money payable by the insurance company when a claim is made. It is also called the amount of risk covered by the insurance company.

Thus, if you have a Health Insurance Plan for say Rs.10 lakhs, then under all circumstances, over the entire year, the total money that the Insurance Company will pay for your medical treatment on hospitalization cannot be more than Rs.10 lakhs.

How much Health Insurance Cover should you choose?

You need to opt for health insurance coverage depending on your need. You may choose a lesser coverage if your company has provided some medical coverage as well. Also, you need to choose as per the hospitalization expenses you may incur, the type of bed you would be choosing, your previous history of hospitalization, etc.

There is a range of cover amount or Sum Assured options available under health insurance plans and you have to choose a cover amount from the available range.

The next important consideration is ‘Premium’.

What is Premium?

The premium is the amount of money which you, as a policyholder, are required to pay to avail insurance coverage from a company. The premium is also called the cost of insurance.

Basically, premium is the amount of money you need to pay every year to the insurance company so as to buy the Health Insurance Coverage for that particular year. It needs to be paid annually and renewed every year with fresh policy document being issued.

How is the cover amount (Sum Assured) and the premium related?

A health insurance policy is a contract between the insurance company and you (policyholder). Under the terms of the contract, the company promises to cover you for the chosen level of Sum Assured. You, on the other hand, promise to pay the premium for availing the cover. The amount of premium depends on the Sum Assured selected.

So, if you (Age 30) buy a Health Plan for Rs.10 Lakhs and pay a premium for Rs.8200 approximately without tax, then Rs.8200 + tax is your Annual Premium payable for the entire policy year for coverage of Rs.10 lakhs.

The premium payable is directly proportional to the cover amount opted for. Higher the level of Sum Assured, higher would be the premium and vice-versa.

How are they relevant?

There is a constant battle among individuals to choose between the Sum Assured and the premium rates. Sadly, our pockets always win the battle and we buy plans with cheapest premium outgoes. This results in a very minimal cover amount, the brunt of which is felt at the time of claims. Since our coverage is limited, we end up paying any excess claim from our pockets. Here is where the relevance of a plan with a balanced Sum Assured and premium feature comes in –

  • The cover amount denotes the maximum liability of the insurance company in case of claims. You would have to bear the expenses exceeding the cover amount. Thus, you should choose an optimal Sum Insured in your health plan.
  • The premium denotes your liability. It is the amount of money you are required to pay for the coverage. Though an optimal coverage is essential, you should factor in your affordability while choosing the health plan.

Important points to note

Now you know what a cover amount and the premium means. While the latter is the financial extent up to which your plan would pay the claim, the former is the cost of availing the cover amount. So, premium depends on the cover amount (Sum Assured). Here are some important points which you should remember:

  • The optimal level of Sum Assured when you are insuring only yourself and when you are also insuring your family members differs. When family members are also covered in your health plan, you should choose a higher cover amount.
  • Premium not only depends on the cover amount. Other factors which influence the premium rate are age of the insured, number of members covered under the plan, optional coverage features added in the plan, medical history of the insured, etc.
  • Under no circumstances would the claim paid exceed the cover amount.
  • The cover amount (Sum Assured) can be increased when the health plan is renewed.
  • There is a limit on the maximum Sum Assured which is allowed under a health plan. This limit varies among the different plans.

Now you know what a cover amount and premium of a health plan denote. So, the next time you are asked about it, you would be sure.You can visit our site to compare and buy health insurance plan.

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