Medical emergencies can occur at any time. The last thing anyone should have to worry about during unexpected medical emergencies is their financial situation. A comprehensive health insurance policy serves as your safety net in this situation. Emergency medical care is always available when you have health insurance. If you are planning to get health insurance or have one already, you should know how health insurance works during an emergency hospitalisation.
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Emergency hospitalisation is the term used to describe unscheduled medical admissions. These are usually in case of emergency medical scenarios. These patients need to be treated right away to avoid major complications or save lives.
Common emergency hospitalisation scenarios may occur because of:
Here's how a health insurance policy helps during a medical emergency
With emergency hospitalisation, hospital bills, especially for surgeries, ICU stays, and diagnostics, can come up to overwhelming numbers. Having a health insurance policy makes sure you don't have to go back to your savings or borrow money from others to afford treatment.
If admitted to a network hospital, even in case of an emergency, you can claim cashless hospitalisation with a health insurance policy. With this option in network hospitals, bills are settled directly with the insurer, so you don’t have to arrange for funds during an emergency.
Health insurance policies typically cover room rent, nursing, and ICU charges, which most of the time include a major chunk of the hospital expenses. However, not that many insurers place a cap on room rent. Choosing a room above the allowed limit may lead to proportionate deductions on the entire hospital bill.
Pre- and post-hospitalisation treatment expenses (for a set period) are sometimes covered. These may include tests, medicines, and follow-up consultations (e.g., 30 days before and 60 days after admission).
| What’s Typically Covered | Details |
| 24-Hour Admission Rule | Most insurers require a minimum 24-hour stay for the claim to be valid. |
| Hospital Room Rent & Nursing Charges | Covered, but often subject to sub-limits (e.g., ₹3,000/day or % of sum insured). |
| ICU Charges & Specialist Consultation | Included in standard hospitalisation cover. |
| Surgery, Anaesthesia & Medications | Covered under inpatient treatment. |
| Diagnostic Tests & Imaging | X-rays, CT scans, blood tests, etc., are reimbursed during hospitalisation. |
| Ambulance Charges | Covered up to a certain limit (₹1,500–₹10,000), depending on policy. |
| Pre- & Post-Hospitalization Costs | Expenses incurred 90 days before and 120 days after admission are covered. |
In case of a medical emergency,
Call emergency services or rush to the nearest hospital.
Keep your health insurance card, photo ID, and any relevant medical history with you.
Notify them within 24-48 hours of admission to initiate the claim process.
If possible, have a trusted person manage insurance communication while you focus on treatment.
Emergency coverage may be limited during the initial 30-day waiting period, although many insurers waive it for accidents. Meanwhile, pre-existing conditions usually have a 2-3 year waiting period.
Exclusions still apply in case of emergencies and injuries due to alcohol, drugs, self-harm, or hazardous activities, unless specifically covered by the policy.
Emergency hospitalisation coverage, as the name suggests, gives you financial shelter during unexpected medical emergencies. Many may confuse it as a part of your basic health insurance policy. which makes it extremely critical to understand policy terms related to emergency hospitalisation, claim process, and coverage limits. Especially to ensure a smooth claim process.
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