It is a common myth that insurance claims for hospitalisation are valid only when you are admitted for at least 24 hours. With modern medical advancements, many essential treatments no longer need an overnight stay. From cataract surgeries to chemotherapy sessions, patients often leave the hospital in just a couple of hours. This shift raises an important question: Can you still claim your health insurance benefits in such cases?
Let’s see what your health insurance policy might cover in these situations and how insurers assess such claims.
What Does Your Health Insurance Policy Typically Cover?
It helps to understand what’s generally covered under a standard health plan.
A comprehensive health insurance policy may cover:
- Hospitalisation expenses (pre and post)
- Surgeries and operations
- Room and ICU charges
- Ambulance services
- Diagnostic tests and consultation fees
- Daycare treatments
What are Daycare Treatments?
Many insurance providers have a category called daycare procedures, treatments that don’t need 24-hour hospitalisation but are still covered under your policy.
Examples of common daycare procedures are:
- Cataract surgery
- Chemotherapy and radiation
- Dialysis
- Minor orthopaedic procedures
- Sinus-related surgeries
- Colonoscopy or endoscopy
These are medically recognised treatments, often completed in just a few hours, but significant in terms of cost and necessity. Daycare treatment eligibility is a crucial reason that a two-hour hospital stay can be claimable.
The 24-Hour Rule – Is It Still Relevant?
Traditionally, health insurance claims were only approved if the insured was hospitalised for 24 hours or more. However, this condition has evolved over time.
Thanks to medical advancements and updated regulations, the Insurance Regulatory and Development Authority of India (IRDAI) allows exceptions to this rule. Many insurers now accept claims for recognised daycare procedures, even if they take less than 24 hours.
When Can You Claim Insurance for a Two-Hour Hospital Stay?
You may claim insurance for a short stay if:
- The procedure is listed in the insurer’s approved daycare treatments.
- The treatment is medically necessary and recommended by a qualified doctor.
- All documentation, including diagnosis and procedure reports, is provided.
- The facility is a registered hospital and not an outpatient clinic.
Here are a few tips to ensure approval of your claim:
- Always check the insurer’s daycare treatment list.
- Inform the insurer beforehand if it is a planned procedure.
- Maintain all relevant reports, prescriptions, and discharge summaries.
Understanding what your health insurance policy covers, especially for brief hospital stays, can
- Prevent out-of-pocket surprises
- Help plan elective procedures better
- Maximise the use of insurance benefits
What is Cashless Health Insurance and How Does It Help?
Claiming for short procedures becomes easier with cashless health insurance. Instead of paying from your pocket and claiming later, you can get treated at a network hospital without worrying about costs.
Benefits of a cashless facility:
- Saves upfront payment hassle
- Speeds up approval time for known daycare procedures
- Eliminates paperwork post-discharge
Ensure that:
- You are admitted to a network hospital
- You inform the insurer beforehand (for planned procedures)
- The treatment is on the approved list
Points to Consider Before Planning a Short Stay Treatment
Not all policies are alike. Here’s what you should keep in mind:
- Review Your Policy Document
- Look for daycare inclusions
- Understand exclusions clearly
- Speak with Your Insurer
- Ask whether a specific procedure qualifies
- Enquire about documents required
- Choose a Network Hospital
- This simplifies the cashless health insurance process
- Speeds up admission and discharge formalities
Conclusion
Claiming health insurance for a short, two-hour hospital stay is possible, provided the procedure qualifies as daycare and your insurer supports it. With the added benefit of cashless health insurance, managing such claims has become more convenient than ever. As a policyholder, staying informed and proactive is the best way to get the most out of your coverage.
Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.
