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The Insurance Times

(v) Domiciliary Hospitalization benefit - This has historically been offered in
mediclaim policies, and now in some other newer policies also. It implies to
medical treatment for a period exceeding three days for such illness which in
normal course would require care and treatment at a hospital/nursing home, but
usually takes place confined at home due to either of the following circumstances
(i) the condition of patient is such that he/she cannot be shifted to the hospital/
nursing home or
(ii) due to lack of accommodations (usually in small towns).

(vi) Cashless Hospitalization Procedure - Cashless facility is offered to the
customers through the insurers' in-house channels or Third Party Administrators
(TPA), who coordinate with the customer and the hospital to ensure that the
admissible bills are not required to be paid in the hospital by the customer, but
directly settled by the TPA/insurer in due course.

Admission should be taken in a listed hospital in the empanelment list of the
insurer/TPA and is subject to pre-authorization being granted by the insurer/
TPA. The TPA , validates the claim and need not necessarily always approve the
claim, and ask for more information/documents or may even reject the claim.
However, denial of cashless facility does not reflect on the admissibility of claim,
and the customer can submit the papers directly to the insurer/TPA.

(vii) Deductibles - They are a cost sharing mechanism. These are the initial amount
of admissible claim which must be borne by the insured.

(viii) Co-payment or Co-insurance - In the Indian context, these terms are used
interchangeably to reflect the percentage of risk that the insured is required to bear.

160 Guide for Health Insurance