Can You Claim Health Insurance for Hospitalization of Less than 24 Hours?

Health insurance policies are designed to cover a range of medical expenses, including emergency and planned hospitalizations. Generally, insurance companies require you to be admitted to a hospital for at least 24 hours to qualify for a medical insurance claim. But what if your hospitalization lasts for less than 24 hours? Can you still file a health insurance claim? Read on to find out.

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      Is it Possible to Claim Health Insurance for Hospitalization of Less than 24 Hours?

      Yes, it is possible to claim health insurance for hospitalization of less than 24 hours. Traditionally, most health insurance policies required a minimum of 24 hours of hospitalization to file a claim. However, multiple insurers today allow claims for hospitalization of 2 hours and more under selected plans, including Niva Bupa Reassure 2.0 plan, Care Ultimate Care plan, Bajaj Allianz My Health Care plan, Niva Bupa Aspire plan, ICICI Lombard Elevate plan and Care Supreme plan.

      Besides, with advancements in medical technology, day care procedures have been introduced that do not require prolonged hospital stays of at least 24 hours. Hence, health insurance claims are accepted for less than 24 hours of hospitalization if it is a day care treatment. However, you must meet the applicable terms and conditions to successfully claim health insurance for hospitalization of less than 24 hours.

      Day Care Treatment in Health Insurance

      Day care treatments in health insurance are medical procedures or surgeries that can be completed in less than 24 hours because of technological development, which would have otherwise required a hospitalization of 24 hours.

      Some common day care treatments included in mediclaim insurance plans are as follows:

      • Cataract surgery
      • Tonsillectomy
      • Chemotherapy and radiotherapy
      • Haemodialysis
      • Coronary angiography
      • Nasal sinus aspiration
      • Endoscopic polypectomy
      • Lithotripsy
      • Free skin transplantation
      • Arthroscopic knee aspiration

      All health insurance companies in India provide coverage for day care treatments. However, the exact list of treatments and surgeries covered varies from plan to plan.

      Are OPD Treatments Included in Day Care Treatments?

      No. OPD treatments are not included in day care treatments. This is because OPD treatments do not require hospitalization at all. On the other hand, day care treatments require hospitalization for a very short duration because of medical advancements.

      Hence, outpatient Department or OPD expenses, like doctor consultations, diagnostic tests & investigations, medicines, etc., are excluded from the scope of day care treatments, even if they do not require 24 hours of hospitalization.

      Things to Keep in Mind While Filing Claims for Day Care Treatments

      When filing a claim for day care treatments, it is essential to keep the following tips in mind:

      • The treatment must be deemed medically necessary and prescribed by a qualified doctor.
      • You should be admitted to a hospital or a day care centre for treatment.
      • The procedure should require less than 24 hours of hospitalization.
      • Ensure the treatment or procedure is listed in your health insurance policy's list of day care treatments.
      • Keep all essential documents ready, such as doctor's prescriptions, bills, diagnostic reports, discharge summaries, etc.
      • Be aware of treatments or procedures that are not covered under day care treatments of your mediclaim policy, such as cosmetic treatments.

      FAQs

      • Q1. Is 24-hour hospitalization mandatory for insurance claims?

        Ans: No, a 24-hour hospitalization is not mandatory for all health insurance claims. Multiple health plans offer coverage for a hospitalization of at least 2 hours, such as ICICI Lombard Elevate plan, Care Ultimate Care plan, Niva Bupa ReAssure 2.0 plan, Bajaj Allianz My Health Care plan, etc. Moreover, all insurance policies cover day care treatments that do not require a full day of hospitalization.
      • Q2. Is hospitalization necessary for an insurance claim?

        Ans: No. Hospitalization is not necessary for a health insurance claim, provided your policy has OPD cover.
      • Q3. What is the minimum period of stay in hospital to get covered in health insurance?

        Ans: You need to stay in a hospital for a minimum of 24 hours to claim your health insurance policy. However, if you are undergoing a day care treatment, you can file a claim even if you are admitted for less than 24 hours. Moreover, if you have the Niva Bupa Aspire plan, ICICI Lombard Elevate plan, Care Supreme plan, Niva Bupa ReAssure 2.0 plan, Care Ultimate Care plan and Bajaj Allianz My Health Care plan, you need to be hospitalized for at least 2 hours to file a claim with your insurer.
      • Q4. Is it possible to claim insurance if I am admitted in an emergency ward for 3 hours?

        Ans: Yes. You can claim your health insurance policy if you were admitted to an emergency ward for 3 hours, provided you underwent a day care procedure. You can also raise a claim if you have Bajaj Allianz My Health Care plan, Niva Bupa Aspire plan, Care Ultimate Care plan, ICICI Lombard Elevate plan, Care Supreme plan and Niva Bupa ReAssure 2.0 plan that require a minimum of 2 hours of hospitalization.
      • Q5. Can 2 hours hospitalization be claimed under ICICI Lombard health insurance?

        Ans: Yes. 2 hours of hospitalization can be claimed under the ICICI Lombard Elevate plan.
      • Q6. Can we claim medical bills in insurance without hospitalization?

        Ans: You can claim medical bills in your health insurance policy without hospitalization if you have an OPD cover.
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      Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

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