Is Employer’s Mediclaim Insurance Useful, If I Am Hospitalized For Less Than 24 Hours?

April 18, 2023 12:09 am38 commentsViews: 213

Group health cover from the employer is something that makes you happy and content. It is valuable to you as someone who does not have enough time to look after such trivial yet important aspects of life. But, one question that’ll ring in your ears is…

“Whether your out-patient expenses are covered? Or must you be hospitalized for at least 24 hours to claim anything from this policy?”

As is a common perception with group health policies, that a minimum 24-hour hospitalization is necessary for the insurance to come to the rescue. But many serious medical processes do not even require patients to stay for more than 2 – 5 hours.

Medical Procedures Have Improved

There was a time when most health procedures would primarily involve hospitalization of at least 24 hours. In fact, most procedures took more than just one day to be done properly. However, medical science has advanced a great deal, and this advancement means the time for treatment of many health conditions has been cut down considerably.

For instance, procedures such as cataract removal, dialysis, chemotherapy, and so forth, can be done in under a day. That means you get to go home the same day as you have the procedure.

Treatment Costs Less Time but More Money

The cost of the procedures, however, has gone up, and the involvement of machines has risen too. It might leave you high and dry when it comes to claiming medical insurance for some of your health procedures. As you know, your insurance does not accept short-duration hospitalizations. So, do you have to bear the hospital costs, even though you have been wise enough to take adequate insurance?

Welcome to Day Care Hospitalization

Fortunately, there is a way out. Nowadays, health policies have a “Day Care Hospitalization” clause. The minimum 24-hour hospitalization stipulation is waived for certain procedures or treatments, such as cataract. The policy document will have the exact list of these procedures and treatments.

Thanks to this clause, you do not need to stretch your hospitalization to 24 hours just to claim insurance and save yourself the financial burden of footing the medical bill.

Which Day Care Treatments are Covered

Health insurance plans now cover Day Care Treatments as well, which means you can avail of insurance even if you have been in the hospital for far less than 24 hours.

Day Care Treatments refer to those medical treatments or surgical procedures that require only general or a local anaesthesia and last less than 24 hours, thanks to technological development in medical care. These treatments can be done at any hospital, or in a day care centre. Earlier, these treatments would have required a hospitalization of at least 24 hours.

Some of the Day Care Treatments that form part of both individual and corporate health insurance policies include:
“Cataract surgery, tonsillectomy, chemotherapy, radiotherapy, haemodialysis, coronary angiography, nasal sinus aspiration, free skin transplantation, arthroscopic knee aspiration, etc.”

However, this is not the complete list. Depending on the kind of plan you have, and your insuring company, your plan could include more – or fewer – treatments. However, you need to remember that out-patient expenses, such as doctor consultations, tests, and checks, do not form part of the day care treatments.

OPD Expenses

Another thing you need to keep in mind is that Day Care Treatments are different from OPD treatments. OPD procedures do not require hospitalization at all, regardless of technological development in medical science. On the other hand, Day Care Treatments do need hospitalization, but because of technological advancements, the duration of the stay is reduced.

So, the next time you need a cataract removal procedure, or dialysis, do not worry that you must foot the medical bill yourself as it will be excluded from your health insurance coverage in view of the 24–hour hospitalization rule. Because now you know that such treatments are covered in your health plan, and you also have the facility of cashless claim settlement.

Most group health policies cover Day Care Treatments. However, the covered processes might be different for different insurers.

Moreover, at network hospitals, these treatments can be availed with cashless claim settlement. But even if you are not able to claim the cashless facility, reimbursement of such claims is possible. An award-winning insurance company such as SecureNow can help you understand this facility even better and avail group health policies with these benefits for your organisation.


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