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Can Health Insurance Claims Be Made Even in Hospitalization of Fewer Than 24 Hours?

Published On Apr 15, 2019, Updated On Dec 04, 2020

Health insurance policies are gradually becoming the norm in India. This is because a lot of people resort to health insurance as a solution to skyrocketing expenses of health care in India. However, buying a health insurance plan does not prevent them from being a drain on the patient’s expenses, but provide relief by fully or partially paying the expenses. 

But there is a twist here. Usually, health insurance companies cover the treatments which require a minimum of 24 hours of hospitalization. But there are some illnesses where hospitalization is not necessary. In the light of this, health insurance companies have made it now possible to get the daycare procedures too, thus, bypassing the 24-hour hospitalization rule.   

What is a Day Care Procedure? 

A daycare procedure can be defined as a surgery or medical procedure that required a prolonged stay in the hospital, but can now be completed in less than 24 hours. So, while the patient is in the hospital for a short time period, he/she does not spend complete 24 hours in the hospital. Otherwise, 24 hours is the minimum period of hospitalization to which health insurance claims can be filed. 

List of Day Care Procedures:

Following are listed the operations and their procedures/inclusions for reference. 

  • Eyes- Cataract operation; corneal and eyelid incision; corrective surgery for entropion, ectropion; removal or foreign body and tear duct operations.   
  • Ear- Stapedotomy; Operations on the auditory ossicles; tympanoplasty; stapedectomy; operations on the middle ear; incision of the inner ear; reconstruction of the middle ear and other operations on the inner ear.
  • Nose and sinus- Operations on the nose; nasal sinus aspiration; operation on nasal concha and foreign body removal. 
  • Tongue- Glossectomy; reconstruction of the tongue and other operations on the tongue. 
  • Skin and subcutaneous tissue- Incisions to the skin and subcutaneous tissue; skin transplantation and restoration; excision of diseased skin and subcutaneous tissues and chemosurgery to the skin.
  • Face- Plastic surgery of the mouth; incisions to the mouth, jaw, and face and other operations to the mouth and face.
  • Bones- Ligament tear and meniscus tear surgery; dislocation surgery; orthopedics and trauma surgery; other joint and bone surgery and fractures and sutures on tendons.
  • Other operations- Haemodialysis; lithotripsy; radiotherapy (for cancer), chemotherapy and coronary angiography. 

Daycare procedures are covered only if they are in the list of procedures covered by a particular health insurance company. If you are in search of health insurance policies that cover daycare procedures, then you must opt for the ones which cover a wide range of categories over the ones that list specific procedures. This is because broad categories usually cover more surgeries and procedures comparatively.       

All that is good, but how to ensure that the bills do not fall on your shoulders, and get duly fulfilled by the health insurance companies instead? 

Settlement of claim in a health insurance plan 

While filing a claim for a daycare procedure, the policyholders are are required to follow the same process as a regular health insurance claim as they are also a part of protection provided under many health insurance policies.  

For claim settlement in health insurance for less than 24 hours of hospitalization, there are no special conditions to be fulfilled. Similar to other health insurance claim settlement procedures, here also, the insured should be covered by the plan. He/she should be admitted in a network hospital that meets certain qualifying criteria. The claim should be filed properly by providing all the required documents.

Note that when filing the claim for a daycare procedure, 18% GST is applicable for all financial services effective July 1, 2017. The premiums vary depending on various factors such as age, location, and prevailing taxes/GST. 

Also Read

Best Health Insurance Companies in Claim Settlement

Take Away

Daycare procedures are covered by the health insurance companies but are subject to them being in the list of procedures. So, when in search for the best health insurance plan, go for the one that covers a broad range of categories and not the ones that list specific procedures. This is because broad categories cover a lot more surgeries and procedures. 

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