No one plans on getting hospitalised, but when it happens, the last thing you want to worry about is how to pay for it. This is when your health insurance steps in and you will come across important terms like ‘inpatient hospitalisation’. Let’s take a look at what it means and why it’s important to know what inpatient hospitalisation is when it comes to your health insurance.
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In simple terms, inpatient hospitalisation refers to a healthcare or medical situation where the patient is admitted to a hospital and stays there for more than 24 hours. They could be there for surgery, a serious illness, injury or multiple injuries, childbirth, or other health issues that require treatments at a hospital. It is also called the Inpatient Department of the hospital or IPD for short.
The main factor here is the duration of the stay - you need to be admitted or occupy a hospital bed for at least 24 hours to be considered as an inpatient hospitalisation case. Insurance companies will generally offer policies that provide higher coverage as inpatient hospitalisation has more expenses than outpatient hospitalisation.
The following are the inpatient hospitalisation expenses that are covered by health insurance. Keep in mind that these may vary depending on your insurance company and the type of policy you have.
Along with inpatient hospitalisation, there's also something called Outpatient Care. It is when you get treated at a hospital without having to be admitted there. For example, doctor consultations, follow-up visits, diagnostic tests, etc. These are all done at the Outpatient Department of the hospital or OPD for short.
Here are some of the differences between inpatient hospitalisation and outpatient care:
| Inpatient Hospitalisation | Outpatient Care | |
| Meaning | Medical care provided for patients who need to be admitted to the hospital | Medical care provided for patients who do not need to be admitted to the hospital |
| Duration of stay | More than 24 hours | Less than 24 hours |
| Example treatments | Surgery, childbirth, major illness | Doctor visits, minor tests |
| Hospital admission | Being admitted is necessary | Being admitted is not necessary |
| Cost | Typically higher than outpatient hospitalisation | Generally lower than inpatient hospitalisation |
| Bed requirement | Requires a hospital bed for the patient | No hospital bed is required |
There are generally two types of claims:
This type of claim is only available at a network hospital. A network hospital is a hospital that has a tie-up with your insurance company. You inform the hospital’s insurance help desk about your policy and they send your insurer an authorization request. After that is approved your insurer settles the claim directly with the hospital.
This type of claim is applicable to non-network hospitals. A non-network hospital is a hospital that does not have a tie-up with your insurance company. You pay all the bills upfront and later submit the required documents to your insurance company. Once they approve your claim, you receive reimbursement based on your health insurance policy.
You can check the list of network hospitals on your insurance company's website, or mobile app, or speak to their customer care representative.
There are some advanced treatments like cataract surgery, chemotherapy, or dialysis that take less than 24 hours but still require a hospital setup. These fall under the category of daycare procedures and might be covered under special clauses. Remember to check your health insurance company’s daycare list for exact details.
Inpatient hospitalisation becomes a crucial part of your health insurance coverage. It’s what kicks in when you really need major medical help. So whether you’re planning to have surgery in the future or just want to be prepared in case of emergencies, knowing what inpatient hospitalisation covers can help plan ahead and give you peace of mind during stressful situations.
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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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