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

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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.

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what are ENT daycare procedures?


Hi, My father [Age-62yr] underwent Cardiac by-pass surgery in 2006 and after that he undergoes annual cardiac check-up every year. He is in good health now. I want to take a Mediclaim policy for him which covers him for any possible future hospitalization (for all generally covered diseases including his pre-existing condition). Please recommend me good options which is also not very expensive.

Hi, I reside in a Metro city and my child is admitted in a Child Care Centre / Nursing Home last night due to illness last night. However the Nursing Home is a small one and has 5-6 beds only. But it is registered one under the regulatory authorities. I seek clarification on below: "HOSPITAL/NURSING HOME: means any institution in India established for indoor care and treatment of sickness and injuries and which either Is duly licensed and registered as a Hospital or Nursing Home with the appropriate authorities and is under the supervision of a registered and qualified Medical Practitioner. OR In areas where licensing and registration facilities with appropriate authorities are not available, the institution must be one recognised in locality as Hospital / Nursing Home andshould comply with minimum criteria as under: [1] It should have at least 15 in-patient medical beds in case of Metro cities, A Class cities......................." Will I be able to claim for reimbursement? Regards, Sameer

My Wife was Pregnant and was in 9th month. All was normal but one night we finish our dinner and went to our bed. But suddenly at midnight my wife found Heavy Bleeding. We immediately run for our Doctor treating her. She refer us to one of the Big n Best Hospital of our city. The problem raised is called Ante partrue Hemarhage [APH] according to Doctor. As due to heavy bleeding my wife was almost in shock. And to save the life of both (Baby n Mother) a Emergency LSCS was done. A baby born via Cesarean. So, I submit a file for claim against my Medical Policy with United India Insurance Co. but that was rejected by saying "Treatment arising from or traceable to Pregnancy (including Caesarean) not covored. But as per me, as My Wife have no Labour Pain nor the whole process was done because of or for Delivery. So, kindly guide me for the same. Should I go to Insurance Ombudsman???


I am 26 years old and I would like to undergo Lasik Operation. My sight is -7 in both eyes. Can I get free operation in Hospitals?

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