What is hospital?
Hospital is an institution established for medical treatment and Day Care Treatment of Illness and / or Injuries and which has been registered as a Hospital with the local authority and complies with all minimum criteria as under:
- Qualified nursing staff available 24/7;
- At least 15 Inpatient beds in urban areas and at least 10 in all other places;
- A qualified Medical Doctor in charge round the clock;
- A fully equipped operation theatre of its own where Surgical Procedures are carried out;
- Maintenances of patients’ records.
What is hospitalization?
A insured person getting admitted in a Hospital for a minimum period of 24 for medical treatment as per directive of his treating doctor; except for specified procedures/treatments, where such admission could be for a period of less than 24 consecutive hours.
- Hospitalization for Inpatient Treatment
Health Insurance policy will cover expenses for hospitalization due to disease/ illness/ Injury that requires an Insured Person’s admission in a hospital as an inpatient. Medical expenses directly related to the hospitalization for;
- Reasonable and Customary charges for Room Rent for accommodation in Hospital room up to category as per opted Sum Insured and as specified in the Policy Schedule,
- Intensive Care Unit charges,
- Operation theatre charges,
- Fees of Medical Practitioner/ Surgeon,
- Anesthetist,
- Qualified Nurses,
- Specialists,
- Cost of diagnostic tests,
- Medicines,
- Drugs and consumables, blood, oxygen, surgical appliances and prosthetic devices
- Modern Treatment
- Pre- Hospitalization
Pre-Hospitalization cover for expenses of Doctor Consultations, diagnostics test and medicines incurred up to the number of days as mentioned in the health insurance policy before the date of admission to the hospital. The pre hospitalization benefit is payable when insured is treated for medical treatment. Most of health insurance plans cover pre-hospitalization for up to 30 days before getting admitted in hospital for medical treatment.
- Post- Hospitalization
Post Hospitalization cover for expenses for Doctor Consultations, diagnostics test and medicines incurred up to the number of days as mentioned in the health insurance policy after discharge from the hospital. The post hospitalization benefit is payable when is treated for medical treatment. Many health insurance plans cover post hospitalization up to 60/ 90 days after getting discharge from hospital for medical recovery treatment.
- Day Care Procedures
Health insurance policy shall cover expenses for Day Care Treatment due to disease/illness/Injury in a hospital or a Day Care Centre. The list of such day care procedures is given in health insurance policy. Treatment normally taken on out-patient basis is not included in the scope of this cover.
- Ayush Treatment
Ayush treatment pays for the Medical Expenses incurred by the Insured Person in any AYUSH Hospital for Inpatient Care under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines. Ayush hospital should be central or state public hospital or teaching hospital attached to Ayush College recognized by central or state government.
- Domiciliary Treatment
Domiciliary Treatment cover for expenses related to Domiciliary Hospitalization of the insured person at home which in normal course would require hospitalization. The circumstances under which domiciliary treatment should be taken when a patient cannot be moved to hospital or there are no beds available in hospitals for hospitalization. At the time of claiming under this benefit, it shall require certification from the treating doctor fulfilling the conditions as mentioned under the definitions of health insurance policy.
Points to remember in hospitalization:
- There is should be hospitalization for medical treatment and not for diagnostics test purpose.
- Hospitalization should be for 24 hours, insures will not pay hospitalization expense if admission of insured is less than 24 hours.
- It is mandatory to submit all hospitals medical treatment paper, diagnostics test, hospital bills, doctors prescription to insurance company.
- In case of health reimbursement claim it is compulsory to initiate claim intimation and submission of all medicals treatment records and bills within 15 days to insurance company. Delays in claim intimation and submission of claim documents will result in claim rejection.
- Understand your health policy terms,be aware of specific conditions, such as room rent limits or excluded procedures in your health insurance policy.
Pre and post-hospitalization expenses are essential factor of a health insurance plan. They provide comprehensive protection, ensuring that your financial well-being is safeguarded not just during your hospital stay, but throughout your entire healthcare journey. To make the most of your health insurance, it’s crucial to understand the terms and conditions of your policy and be aware of the coverage it provides for these expenses. By doing so, you can enjoy peace of mind knowing that you’re prepared for any medical situation that may arise.
By understanding the scope of hospitalization benefits and adhering to the policy’s terms and conditions, insured individuals can optimize their health insurance coverage. This comprehensive approach ensures financial preparedness for medical emergencies and peace of mind during recovery