When medical emergencies strike, one of the first things most people think about is hospitalisation, and whether their health insurance will cover it. Fortunately, hospitalisation in health insurance is the core benefit of most policies in India. But not all hospitalisations are the same, and not all expenses may be covered automatically. So, what exactly does hospitalisation mean in the context of health insurance? Let’s take a closer look.
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Hospitalisation in health insurance typically refers to any medical treatment that requires admission to a registered hospital for at least 24 hours. This could include treatment for an illness, injury, or a planned procedure.
If your policy includes hospitalisation coverage, your insurer will usually cover:
Some policies may also cover pre-hospitalisation and post-hospitalisation expenses, like tests, consultations, and medicines before admission or after discharge, for a fixed number of days.
Many people confuse hospitalisation with doctor visits or diagnostic checkups. But these are treated differently in insurance.
| Hospitalisation | Outpatient (OPD) Treatment |
| Requires admission to a hospital for at least 24 hours | No admission required; treatment is done in a clinic or hospital on a walk-in basis |
| Covered under most standard health insurance plans by default | Usually not covered unless specifically included as an add-on or benefit |
| Claims can be settled as cashless or reimbursement | Typically settled through reimbursement only |
| Includes surgeries, ICU stays, emergency care, and planned procedures | Includes doctor consultations, diagnostic tests, minor treatments, and follow-ups |
| Requires documentation like discharge summary, final hospital bill, prescriptions, and test reports | Requires bills for consultation, prescriptions, and diagnostic reports |
| Higher overall costs; insurance provides major financial support | Generally lower expenses; coverage helps if you have frequent medical visits |
Understanding the types of hospitalisation your policy covers can help you make better use of your benefits:
This is when your hospital admission is scheduled in advance, such as for elective surgeries, such as knee replacement, or maternity, if the latter is covered. You can pre-inform your insurer and often get cashless treatment.
This happens due to sudden illness or accidents. Since it’s unplanned, you might not get time to pre-authorise the treatment, but you can still file a cashless or reimbursement claim afterward, depending on hospital tie-ups.
Medical advancements mean some treatments, like chemotherapy, no longer need a 24-hour stay. These short-duration procedures are still covered under hospitalisation, as long as they’re listed under your policy's approved daycare list.
When the patient cannot be moved to a hospital due to medical reasons or lack of beds, some policies allow treatment at home. This facility is only covered under specific conditions and usually requires prior approval.
These are costs incurred before admission, such as diagnostic tests, consultations, or prescribed medicines. These are typically covered for 30 to 60 days prior to hospitalisation.
In-patient hospitalisation is the main focus of hospitalisation coverage, which generally includes:
These cover follow-up consultations, repeat tests, and medicines after discharge, usually up to 60 to 90 days, depending on the plan.
Any short-duration treatments that don’t need a 24-hour stay are covered only if they are listed under your policy.
Even with hospitalisation coverage, not all expenses are reimbursed, such as:
Health insurance claims for hospitalisation can be settled in two ways:
-Available only at network hospitals
-Hospital bills your insurer directly after getting pre-authorisation
-You pay only for non-covered expenses
1. Show your health card at the hospital
2. Submit the pre-authorisation form
3. Hospital sends it to insurer/TPA
4. Treatment begins after approval
-Used at non-network hospitals
-You pay the full bill upfront
-File a claim with all documents for reimbursement
Many policies in India have room rent sub-limits, like ₹3,000/day or 1% of sum insured. If you choose a room above your eligibility, it can lead to proportionate deductions on your entire hospital bill, including doctor's fees and surgery charges. Always check your room rent eligibility before admission to avoid out-of-pocket costs.
To make the most of your health insurance during hospitalisation:
Hospitalisation is the foundation of your health insurance policy, and the reason most people buy one in the first place. But knowing how it works, what it includes, and how to make a successful claim can make a big difference during a medical crisis.
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Reviewed by Dr. Harshita Dahiya 
Acko Technology & Services Private Limited
#36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Bengaluru, Karnataka 560102
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