Health insurance claims typically require proof of hospitalization, but what happens when someone is too old or unwell to be admitted to a hospital and can only receive treatment at home? In such cases, domiciliary treatment, also known as home healthcare, can be an option. This type of treatment covers medical consultation, nursing care, medication, and diagnostic tests conducted at home. However, there are certain exceptions, such as treatments done for convenience or those that do not require hospitalization.

Several insurance products offer domiciliary treatment, which is designed for people who are unable to go to the hospital and need to be treated at home. This feature is particularly relevant for older adults who may have chronic conditions or mobility issues. According to Kapil Mehta, MD and principal officer of Secure Now Insurance Brokers, domiciliary treatment is a less-used feature, but it is essential as we grow older.

The coverage and exceptions for domiciliary treatment vary depending on the insurance policy. Typically, it covers ailments and diseases that would otherwise require hospitalization, but it may not cover minor treatments such as physiotherapy or treatments done solely for convenience. Policyholders should review their policy documents thoroughly or consult their insurer to understand the scope and limits of domiciliary coverage.

Despite its importance, insurance coverage for home healthcare services is still in its nascent stage, with low awareness and slow adoption. According to an IRDAI report, only about 10% of health insurance policies cover home care services, primarily for specific conditions such as fever management and physiotherapy. With over 70% of India’s elderly population suffering from chronic illnesses, the need for comprehensive insurance for home-based care is urgent.

Experts believe that such policies should cover a broader range of medical services, be affordable, and be endorsed by clinicians. Implementing these measures could significantly reduce hospitalization rates and improve clinical outcomes, leveraging the personalized approach of home healthcare services. Overall, domiciliary treatment is an essential feature of health insurance policies that can provide relief to individuals who are unable to receive treatment at hospitals.