What is Hospitalization Insurance in Health Insurance?

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5 min read

Updated on Jan 27, 2023

No matter how planned our life is, health issues never come announced. And a stay at a hospital even for a day can sometimes make a hole in your pockets. Does that mean you should always keep yourself ready with the kind of money that you may need for a one-day hospital stay? Well, not everyone can do that. The best way to take care of the hospital bills is by buying a hospitalization insurance plan. This kind of insurance policy takes care of both pre-hospitalization and post-hospitalization expenses. This included hospital stays, surgery, outpatient medical care, etc.

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What is hospitalization insurance?

Hospitalization insurance, also known as health insurance or medical insurance, is a type of insurance policy that helps cover the costs of hospital stays and medical treatment. The policy typically covers expenses such as hospital room and board, surgeries, diagnostic tests, and other medical treatments. Some plans may also cover pre-hospitalization expenses, such as doctor’s visits, and post-hospitalization expenses, such as follow-up care or physical therapy.

Features of hospitalization insurance

As you buy a health insurance policy with hospitalization benefits, you can get several very important features. With one such health insurance policy, you will be able to save quite a good amount of money. Some of the common features are mentioned herein below:

  • Covers pre-existing illnesses: Once the waiting period associated with pre-existing illnesses is over, any hospitalization that happens because of the illness is covered.
  • Surgery benefit: Surgical procedures are covered under most health insurance policies. The expenses should be used for an important reason, which can be something like surgery done for saving a life, or a treatment to prevent disease, etc.
  • Hospital cash benefit: Insurance companies also provide financial protection for expenses including food and travel.
  • Ambulance charges: Ambulance charges to and from the hospital are covered.

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4 types of hospitalization insurance coverage

As the types of coverage under hospitalization insurance are concerned, then here are some of them mentioned below:

1. Day Care Hospitalization Cover

A medical procedure that needs you to be hospitalized for less than 24 hours is called daycare treatment. Diagnostics, prescriptions, vitals, injections, hospitalization, and post-hospitalization expenses are included under daycare hospitalization coverage. Some of the health issues and conditions that are mostly covered are cancer radiotherapy, cancer chemotherapy, nasal sinus aspiration, cataract surgery, etc.

2. Pre and Post Hospitalization Cover

When you are undergoing medical treatment, several steps are needed to be followed before and after the procedure or during the treatment. Before you are admitted to a hospital, you might even need to get a blood test done, which is prescribed by your doctor. Therefore, the tests that are done 30 days before hospitalization are covered under conventional health insurance coverage. However, the number of tests covered totally depends upon the insurance you have bought. The pre-hospitalization expenses mostly cover X-rays, blood tests, urine tests, etc.

Once you are discharged from the hospital, you would be able to reimburse the post-hospitalization charges. The post-hospitalization expenses cover medicines, diagnostics, and follow-up appointments. Once you are discharged, the insurance will provide you coverage for 60 days. Nevertheless, you need to know that therapies are not covered. Also, post-hospitalization coverage is determined by the type of insurance policy that has been purchased by you.

3. In-patient Hospitalization Cover

An in-patient hospitalization is considered when you are admitted to the hospital for more than 24 hours and under medication and treatment. The in-patient hospitalization coverage includes ICU costs, doctor fees, room rent, operation theatre fees, nursing fees, anesthesia, etc. This means many of the charges related to treatment are covered under the in-patient hospitalization cover.

4. Domiciliary Hospitalization

It is a unique provision in a health insurance policy that enables you to take admission to the hospital while still being at home. The treatment has to be undergone due to an injury, illness, or any disease which leads to hospitalization. However, there has to be a valid reason for this. Either the accommodation at that point was not available or you were not in a state to be taken to the hospital. The duration of the treatment has to be at least three days.

Some of the health conditions of diseases that are not covered under domiciliary hospitalization include Arthritis, Gout, Tonsillitis, Chronic Nephritis, Bronchitis, Asthma, Diabetes, Pyrexia, Mellitus, and Insipidus, etc.

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Claim process of Hospitalization Insurance

Almost all health insurance companies come up with 2 types of the claim settlement process. You can choose any one. Here are both the claim settlement processes mentioned below:

Reimbursement Claim

  • To get the bills reimbursed, you must inform your health insurance provider once you are hospitalized
  • You then must collect all the bills and original discharge summary and submit all of those along with the claim form
  • Along with these documents, you also have to submit your ID proof which can be either Voter ID, PAN Card, or Aadhaar Card. You also would be required to provide a canceled cheque
  • Once the documents are evaluated by the insurance company, the reimbursement process is initiated.

Cashless Hospitalization

When you want to claim cashless hospitalization, there are two types that you need to be aware of, which are emergency hospitalization and planned hospitalization. Let us discuss both of them:

  • Emergency hospitalization
    • In case of emergency hospitalization, you have to inform your insurer within 48 or 72 hours of your hospitalization
    • The insurance company will then provide a confirmation letter
    • You would then be required to submit the confirmation letter along with your health card
    • The medical bill will then directly be settled by the insurance company.
  • Planned hospitalization
    • If the hospitalization is planned, you have to inform the insurance company 48 or 72 hours before hospitalization
    • You will then receive a confirmation letter from the insurer
    • Now, along with your confirmation letter, you have to submit your health card and other documents
    • The insurance company will then directly settle the medical bill with the hospital.

Hospitalization insurance is one of the types of insurance that you must buy. Even if you are getting hospitalized, you will not have to think about money and keep going with your treatment.

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Jan 23, 2023
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PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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