Health Insurance Policies - Fine Prints - Day Care Procedures (or Less than 24 hrs admission) - Eligibility

Day Care Procedures (or Less than 24 hrs admission) - Eligibility

Expenses on hospitalization for minimum period of 24 hours are admissible. However, this time limit is not applied to specific treatments such as:

• Appendectomy
• Coronary angiography
• Coronary angioplasty
• Chemotherapy
• Colonoscopy
• Dental Surgery
• D&C
• Eye Surgery

• Fracture/dislocation excluding hairline fracture
• Radiotherapy
• Lithotripsy (Kidney Stone Removal
• Incision and Drainage of abscess
• Hemodialysis
• Hydrocele
• Hysterectomy
• Inguinal/Ventral/Umbilical/Femoral Hernia
• Piles/Fistula
• Prostrate
• Sinusitis
• Tonsillectomy
• Liver aspiration
• Sclerotherapy

Or any other surgeries/procedures agreed by the TPA/Company which requires less than 24 hours hospitalization and for which prior approval from TPA is mandatory.

Note: Procedures/treatments usually done in out patient department are not payable under the policy even if converted as an in-patient in the hospital for more than 24 hours.

The surgeries mentioned in the above are only applicable for qualifying under health insurance cover even if hospitalization is less than 24 hours.

Ailments/Diseases not included in the list and for which a patient seeks hospitalization for less than 24 hours duration, may attract repudiation of the claim. Even though the ailment may not necessitate or justify hospitalization, but less than 24 hours admission entails repudiation of the case. In brief, 24 hours hospitalization is essential.


Transfer from one hospital to another hospital - It is possible within a period of 24 hours. But the reasons for transfer should be valid, with ample proof from the hospital authorities. Only then can such a claim be considered for reimbursement. The final decision regarding this is taken by the TPAs in accordance with the guidelines issued by Insurance companies.

Relaxation of clause 2.3 is allowed only for the ailments mentioned in the above list.

Reference

1. Best Health Insurance Policy in India - (https://www.apnapaisa.com/insurance/health-insurance-india/index.html)

Disclaimer: The contents of the article are in tune with the regulations in Insurance and TPAs (Third Party Administrators) since the past 2 years. The same rules are likely to prevail and be in force for the year 2009-10, unless changes/modifications/alterations/deletions/additions in existing regulations are made by the Insurance Companies, in tune with the guidelines issued by IRDA (Insurance Regulatory Development Authority). The author of this article does not take responsibility for changes made in the existing health insurance policy coverage which would occur with passage of time.

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