What Is Domiciliary Treatment?

Domiciliary treatment (also called home hospitalisation) is medical treatment taken at the patient's home due to the patient's inability to be moved to a hospital or due to non-availability of hospital beds for conditions that would otherwise require hospitalisation. This benefit became particularly relevant during the COVID-19 pandemic when hospitals were overwhelmed and many patients recovered at home under medical supervision.

IRDAI Definition and Coverage Conditions

For domiciliary treatment to be covered under health insurance:

  1. The medical condition must require hospitalisation as per medical standards
  2. The patient cannot be moved to a hospital (due to severity of condition or mobility limitations), OR no hospital beds are available in the area
  3. A registered medical practitioner (doctor) must certify both the medical condition and the reason for home treatment
  4. The treatment must last for at least 3 consecutive days (24×7 medical supervision at home) — this threshold has been reduced from the traditional 3-day requirement in newer plans

What Expenses Are Covered

  • Doctor consultation fees for home visits
  • Nursing charges (professional nurse hired for home care)
  • Medicines and consumables prescribed for the condition
  • Diagnostic tests conducted at home or at a nearby diagnostic centre
  • Medical equipment rented for home use (oxygen concentrator, nebuliser, IV stand)

What Is NOT Covered Under Domiciliary

  • Diseases explicitly excluded from domiciliary benefit (varies by insurer — commonly: asthma, bronchitis, cataract, anaemia, pyorrhoea, tonsillitis, arthritis, chronic nephritis, diarrhoea, gastro-enteritis)
  • Treatment that does not require hospitalisation (standard OPD illnesses)
  • Physiotherapy alone without hospitalisation-equivalent treatment
  • Domestic nursing for non-medical care of elderly (not covered)

Plans with Best Domiciliary Coverage

  • Niva Bupa ReAssure 2.0: Domiciliary hospitalisation covered as standard with no explicit disease exclusion list — broader than most competitors
  • HDFC ERGO Optima Secure: Domiciliary cover without the traditional 3-day minimum in certain variants
  • Star Comprehensive: Domiciliary cover with standard disease exclusion list
  • Care Supreme: Domiciliary hospitalisation covered; disease exclusion list applies

How to Claim Domiciliary Treatment

  1. Obtain a certificate from your treating doctor clearly stating: (a) the diagnosis, (b) that hospitalisation is warranted but not possible due to stated reasons, (c) the treatment plan for home care
  2. Intimate the insurer before starting domiciliary treatment if planned, or within 24 hours for emergency home care
  3. Maintain a daily record of all expenses — doctor visit receipts, nursing bills, medicine bills, diagnostic bills
  4. At the end of treatment, obtain a summary certificate from the doctor confirming the treatment period and outcome
  5. Submit all original bills, doctor certificates and claim form within 30 days of treatment end

COVID-19 and Domiciliary Coverage

During the COVID-19 pandemic, IRDAI issued specific circulars directing insurers to cover COVID home treatment under domiciliary benefits — a significant policy change that helped millions of patients. This precedent has expanded awareness and use of domiciliary benefits across the industry.

Practical Tips

  • Always get the doctor's certificate first — without it, domiciliary claims are rejected
  • Keep all bills in chronological order with the specific illness clearly noted
  • Cross-reference your policy's domiciliary disease exclusion list — if your condition is excluded (e.g., diarrhoea), claim will be rejected
  • Consult the insurer's helpline before starting domiciliary treatment if time permits — get pre-authorisation in writing