24-Hour Hospitalization Rule with IRDAI: What You Need to Know

People who buy medical insurance plans may be well aware of the need to have the right kind of financial support when faced with a medical emergency. For example, having a parent who is growing older may mean having to worry about their changing medical needs over time. Similarly, one may also have to worry about any unfortunate health crises faced by them or their spouse. If you think about your family and finances, you may realise that having a health policy to cover a significant part of the cost of your healthcare situations can help you start living more worry-free and less stressed about the uncertainties of the future. But what would you do in a situation where the policy that you were reliant on, cannot support your healthcare costs because your situation is not covered by the policy? Irrespective of how high the costs are, if you are not prepared to pay them because you thought your policy would cover them, could put you in a financial quandary. Thus, it is important to go through your policy inclusions and exclusions when you are buying it as well as when you are renewing it.

What is the 24-hour Hospitalisation Exclusion?

Among the various exclusions that medical insurance comes with, an important one to know about is the 24-hour hospitalisation. What is it? And do all policies have it? This exclusion is where the claim you make with your insurance provider for your health insurance policy may be rejected if the hospitalisation of the patient covered under the policy was for less than 24 hours. There are a number of procedures which, while crucial, require the patient to be in the hospital for less than a day. Moreover, with advancements in medical science, several procedures that traditionally required days of recovery and monitoring in the hospital are now easier and quicker, with the entire process from end to end requiring no more than a few hours of hospital stay. In such cases, some policies may not cover the hospitalisation. Thus, the policyholder may have to pay from their pocket and end up making an unexpected dent in their savings. However, this may not be the case with all policies. You may check your policy details to see whether such a treatment may be covered. Some policies offer a Day Care Treatment inclusion, where hospital stays for less than a day may be covered. You can check with your insurance provider about whether your policy may cover such a treatment, so you may not be blindsided in your time of need.

Policies With 24-Hour Hospitalisation Exclusion

Even today, a significant number of policies may come with this exclusion, which may be inconvenient for several policyholders. However, this may cease to be a cause for concern in the future. The Consumer Affairs Ministry announced in December of 2023 that it will soon take up this issue with the IRDAI (Insurance Regulatory and Development Authority of India). The action is said to have been spurred after the concern was raised by the President of the National Consumer Disputes Redressal Commission when he was speaking at an event on the occasion of National Consumer Rights Day. In his speech, he is said to have pointed towards procedures which now require less time than they used to, owing to scientific and technological developments. Supporting this observation, the ministry has expressed the inclination to discuss this issue with the IRDAI in hopes of finding a solution to support consumer interests.

Should You Still Buy Health Insurance?

If you are worried about exclusions of this sort, and how it may not work in your favour, remember that even the simplest cashless health insurance policy has a range of features to offer that you may benefit from. Moreover, this sort of exclusion may not be seen in all policies. You may choose a policy with a Day Care Treatment inclusion, after reading the policy document carefully. When choosing a health insurance plan, it is crucial to understand your needs and what the various types of policies have to offer. You may start by browsing the plans available online and use a health insurance calculator to figure out how much premium you may have to pay for the policy you seek. Once you have the right policy, you may rest assured that your financial freedom may not be significantly hampered even when faced with some unexpected healthcare situations, such as an accident or cancer. It is also necessary to understand how to claim your health insurance plan and things to avoid so as to minimise the chances of your claims being rejected. Today, buying a health insurance plan online is easy and accessible, so you may get your insurance cover within a few clicks.* Claims are subject to terms and conditions set forth under health insurance policy.   *Standard T&C Apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.