Page 245 - IC38 GENERAL INSURANCE

Domiciliary hospitalization, if covered in a policy, is payable only if:

 The condition of the patient is such that he/she cannot be removed
to the Hospital/Nursing Home or

 The patient cannot be removed to Hospital/Nursing Home for lack of
accommodation therein

v. Duration of hospitalization

Health insurance policies normally cover hospitalization exceeding 24 hours
as an in-patient. Therefore the date and time of admission as well as
discharge becomes important to note if this condition is satisfied.

Day-care treatments

Technological developments in the healthcare industry have led to
simplification of many procedures that earlier required complex and
prolonged hospitalization. There are a number of procedures carried out on
day care basis without need for hospitalization exceeding 24 hours.

Most of the day care procedures are on pre-agreed package rate basis,
resulting in certainty in costs.

vi. OPD

Some policies cover treatment/consultations taken as an out-patient also,
subject to a specific sum insured which is usually less than the
hospitalization sum insured.

The coverage under OPD varies from policy to policy. For such
reimbursements, the clause for 24 hours hospitalization is not applicable.

vii. Treatment procedure/line of treatment

Hospitalization is typically associated with Allopathic method of treatment.
However, the patient could undergo other modes of treatment such as:

 Unani
 Siddha
 Homeopathy
 Ayurveda
 Naturopathy etc.

Most policies exclude these treatments while some policies cover one or
more of these treatments with sub-limits.

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