Health Insurance Policies - Fine Prints - Non-Active Treatment during Hospitalization

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Non-Active Treatment during Hospitalization

Charges incurred at Hospital or Nursing Home primarily for diagnosis, x-ray or Laboratory examinations or other diagnostic studies, not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any ailment, sickness or injury, for which confinement is required at a Hospital/Nursing Home.

Under this clause, expenses incurred on hospitalization purely for diagnostic or investigation purposes without any active treatment during the course of hospitalization are not reimbursable by Insurance.

Treatment that does not justify hospitalization or extended stay in hospital without ample justification is liable to attract rejection of the claim. Under this clause, treatment can be taken at home and the presenting symptoms may not necessitate immediate hospitalization.

Admission of an aged person in the hospital for medical check-up, treatment and rest also falls under this category and fails to qualify for reimbursement.

Hospitalization wherein no active treatment has been administered to the patient does not qualify for reimbursement procedure. There are instances wherein a patient gets hospitalized on account of some minor ailment such as mild fever (100 degrees or less temperature) with 1 or 2 episodes of vomiting that do not justify hospitalization and during the hospitalization period only 2-3 vials of injections may be administered (just for show), are also likely to be rejected. Other instances include hospitalization for abdominal pain, flatulence, false labor pains etc. But this depends on individual case-to-case study for taking an appropriate medical decision by the competent authority. This is quite common with corporate employees who try to manipulate this clause in order to make a quick buck, not only for themselves, but also for their family members by getting the necessary reimbursement from Insurance companies. Insurance companies have already made a serious note of this moral hazard which is being knowingly carried out to derive benefits out of health policy cover provided by their employers which has resulted in severe bleeding of the Insurance sector. This in turn has resulted in fiscal bleeding of the Indian economy and a tab on such cases is being kept by Insurance companies. Plans are being prepared to take action against erring policyholders for their personal benefits or quick gains.

Hospitalization for the sake of investigation that has no co-relation with the presenting signs and symptoms in an individual is likely to attract repudiation of the claim.

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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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