Hospitalization Cover under Health Insurance

Jun 22, 2020 (0) comment , , , ,

Hospitalization Cover is the most important benefit offered by health insurance companies. It involves covering medical expenses incurred on treatment when the patient is admitted in the hospital for at least 24 hours. Most health plans have a fixed amount of sum insured and an insurance plan will cover all those expenses in hospital till that sum gets exhausted.

In this blog, we will talk about different types of hospitalization cover, how to avail its benefit, how the expenses are paid and what diseases and illnesses are covered.

What is hospitalization cover?

Hospitalization cover includes cover for the cost of treatment due to medical procedures including operations, medicines and other consumables when a patient is admitted in a hospital. A patient can avail this facility for admission in both emergency as well as non-emergency situations.

How the expenses are paid in hospitalization cover?

The expenses incurred during treatment can be paid by the insurance companies either through cashless hospitalization facility or through reimbursement.

CASHLESS HOSPITALIZATION – In Cashless hospitalization, the patient does not have to pay the hospital or medical institution from his or her own pocket. The health insurance company, at the request of the patient, gets in touch with the hospital and makes payment directly to the said medical institution. This is the reason why it is also referred to as cashless hospitalization. This benefit is usually available in network hospitals and hardly involves any paperwork.

Benefits of Cashless Hospitalization


– Saves time and effort in documentation and paperwork

– Saves effort of arranging funds to pay medical bill during discharge

– Bill paid directly to hospital. Hence, removes scope of any likely delay in reimbursement of claims

– Helpful in case of both planned and unplanned (emergency) medical treatment

– An insurance plan with good network of hospitals ensures treatment is carried out in hospitals located to the client.

Click here to know more about Cashless Hospitalization in Health Insurance

CLAIM REIMBURSEMENT – The second method of payment is through reimbursement. In this the patient makes the initial payment for the treatment received in the hospital and seeks reimbursement from the insurance company. This procedure is a bit time consuming and is usually done in case of those hospitals which are in far flung areas or which do not fall in the insurance company’s network of hospitals. They also require a lot of paperwork.

Types of Hospitalization Cover

EMERGENCY HOSPITALIZATION COVER – Most health insurance companies provide cover for treatment undertaken due to medical emergency such as road accident, personal accident, sudden illness requiring emergency care etc. In such cases, a patient can be directly admitted to the hospital and does not require him or her to get a referral from a doctor. It also does not require a person so seek prior permission from the health insurance company to undergo treatment in a particular hospital. They also do not have any waiting period.

NON-EMERGENCY HOSPITALIZATION COVER – These mostly include elective surgeries and treatment which though grave, may not necessarily require emergency care. For example, a person suffering from kidney stone may undergo stone removal operation and get covered by the insurance company. However, in order to get coverage, a patient will have to get referral from the concerned doctor and seek permission from the insurance company which usually directs them to their network hospitals. Unlike emergency cases, non-emergency hospitalization cover takes into consideration, covered diseases and illnesses, as well as their respective waiting periods.

Diseases & illnesses covered

The illnesses and diseases covered depend on the coverage of a specific plan. Diseases and infections covered by health insurance plans include

– kidney or gall bladder stones,

– plaster and emergency surgeries for fractures, trauma

– heart attack and stroke,

– Vector borne diseases such as Malaria, Typhoid, Cholera etc.

– Jaundice and organ infection

Some plans may also provide coverage for critical diseases, organ replacement and may also provide cover for treatment for cancer, etc. Almost all health insurance plans provide cover for accidents and accident related treatment.

In Conclusion

Hospitalization coverage helps a person financially by paying for the cost of treatment in a hospital. However, in order to avail hospitalization benefit, one must get admitted in the hospital for a period of at least 24 hours. Hospitalization cover can be both cashless or reimbursement based. However, one should note that the amount of money paid by the hospital on behalf of the patient does not exceed the sum insured in the health insurance plan of that patient.

Disclaimer: The content of this blog is based on personal research of the writer. Reader’s discretion is advised. Neither Secure Cover nor the writer will be held responsible for any wrongful interpretation of the content of this blog.

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