When you're unwell and need to be admitted to a hospital, your health insurance kicks in to cover many of the related expenses. But for your policy to cover the treatment, it must usually fall under what's called in-patient treatment in health insurance. So, what exactly does in-patient treatment mean? How does it affect your claim process? Let’s break it down in this article.
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In-patient treatment in health insurance refers to any medical treatment that requires you to be admitted to a hospital for at least 24 hours. This could include surgeries, serious illnesses, or conditions that require constant monitoring and support from medical staff.
In health insurance, in-patient treatment is the core coverage; it’s the part that most standard policies focus on. If you’re hospitalised and the treatment meets the in-patient criteria, your insurance will typically cover:
Here are some situations that are usually classified as in-patient treatment:
As long as your hospital stay is 24 hours or longer, and your policy doesn't exclude the condition, these expenses will be covered as in-patient care.
Many policyholders often confuse in-patient treatment with out-patient and day-care procedures. Here's how they are different:
| In-patient Treatment | Out-patient (OPD) Treatment | Day-care Treatment |
| Requires hospitalisation for 24 hours or more | No hospital stay needed | Requires hospital admission, but less than 24 hours |
| Covered by most standard health insurance plans | Usually not covered unless you have OPD add-on cover | Covered if listed under your policy as day-care |
| Used for major surgeries, serious illnesses, ICU care | Used for doctor visits, minor treatments, and diagnostics | Used for minor surgeries and procedures like cataract, dialysis, etc. |
| Eligible for cashless or reimbursement claims | Expenses are paid out-of-pocket, unless covered | Eligible for cashless or reimbursement, if listed |
| Example: Heart surgery, pneumonia, accident care | Example: Fever check-up, dental consultation | Example: Chemotherapy, tonsillectomy, cataract surgery |
Health insurance in India allows two ways to settle your hospital bills under in-patient treatment:
Available only at network hospitals, where your insurer directly settles the bill with the hospital. You need to pre-authorise the treatment through your insurer or Third Party Administrator (TPA). At the time of discharge, only non-covered expenses, such as consumables or admin fees, need to be paid by you.
Used at non-network hospitals. You pay the bill out of your pocket first, then submit all required documents like the final bill, discharge summary, test reports, etc. to your insurer. The insurer reviews and reimburses you the eligible amount as per policy terms.
Whether you’re going for cashless or reimbursement, here are the typical documents required for an in-patient claim:
Make sure to keep copies of everything and ensure all bills are on the hospital’s official letterhead, duly signed and stamped.
Even though in-patient treatment is widely covered, there are a few situations where your claim might not be accepted:
Always read the policy wording carefully to know what’s excluded from in-patient coverage.
In-patient treatment forms the foundation of your health insurance coverage. It ensures that when you’re facing a serious illness or medical emergency requiring hospitalisation, your insurance will step in to handle most of the expenses.
Understanding what qualifies as in-patient care can help you plan better and avoid last-minute surprises during claims.
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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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