Meaning of 'Hospital' in a Health Insurance Policy

Under health insurance, a hospital refers to an institution that offers medical treatment and care to patients and this can include day care as well as inpatient care. The hospital should have a qualified medical practitioner.

“Health is Wealth”, this is a saying we have all grown up listening to, but as we grew older, we realised that priorities change, and wealth often becomes more important than health. A look around us will reveal the fact that people are no more concerned about their health, throwing caution to the wind as they embark on a journey to establish themselves, often ignoring everything associated with health. Given the amount of money people make, it would be natural to think that most of us invest in a good health insurance policy, but this is not the case, for expert reports indicate that under 20% of our population has health insurance, which is a dismal number given world standards.

It is no wonder then, that we end up paying tons of money out of our own pockets when we fall ill, with hospitals and medicines taking away our soul. With close to 2 lakh hospitals and over 1.5 lakh sub-centres in the country, India is fast emerging as a hub for global medical treatment, but a majority of our own population finds it hard to secure a bed in most towns and cities, with the average ratio being 1 bed for every 1,000 people. Given these numbers, finding the right hospital can be the difference between life and death, and one cannot really compromise here.

Hospital, as We Know It:

A hospital, for most of us, is a place where we go to when we fall ill and cannot be treated at home. While this is about right when it comes to what it does, it is very elementary and works well to educate the general population. It is a building which specialises in treating people with ailments, with doctors and nurses offering their services. Specialised equipment and an ability to treat multiple ailments have made hospitals a necessity rather than a luxury. In India, we come across different types of hospitals, right from multi-speciality ones which treat a number of ailments to specialised ones which cater to a specific need. In addition to hospitals, there are government health centres which look after minor issues.

Hospital, as Defined by Your Health Insurance Policy:

Health insurance in the country might be on the low side, but a number of us are waking up to its benefits, choosing to protect our interests. Most of us often ignore the terms and conditions when we buy a health insurance policy, but doing this can come back and bite us for the most trivial reason. Your health insurance policy contains a list of definitions which your health provider relies on when they compute your claim, with anything which doesn’t match their accepted standards liable for rejection. One such definition which is extremely important is that of “Hospital”.

Here is what a hospital typically means for your

A hospital is an institution which has been exclusively created to provide care and treatment to a patient. This combines both inpatient and day care, wherein a patient can get treated for ailments/injuries either as an outpatient or requiring hospitalisation overnight. Said institution should be registered as a hospital, with all necessary permissions taken from local authorities.

In addition to all the registration and paperwork, it should have a registered and qualified medical expert and practitioner who supervises it’s working. Additional support staff should be present to assist this practitioner perform his/her duties.

Each policy also has a certain number of minimum criteria which must be met in order for a hospital to comply with their requirements. The most common criteria are mentioned below.

  • Number of beds – A hospital should have a minimum number of beds, as per the population of the city/town it is in. Typically, a minimum of 10 inpatient beds are necessary if the population is under 10 lakh people, while places with a population exceeding this number should have a minimum of 15 such beds.
  • Qualified practitioner - A hospital cannot function if it doesn’t have a qualified medical practitioner who is in charge of the facility. Doctors need to be present in the hospital at all times. This individual should be registered with the medical council of a respective state and should have a license to practice medicine in said jurisdiction.
  • Qualified staff – A hospital should have qualified staff (nurses and technicians) to assist the medical practitioner. These staff members should be available 24/7. Said nurse should be registered with relevant nursing authority.
  • Equipment – A facility which does not have a fully functional and equipped operation theatre does not qualify as a hospital. Surgical procedures can be carried out only in hospitals which are equipped with a functional operation theatre.
  • Records – A hospital should maintain records of its patients. Institutions which fail to keep daily records of all patients will not fall under the bracket of a hospital. These records are critical, for they provide an insurance company details about the patient, which can then be used to settle/dismiss a claim.

Technically, an institution which meets all the above criteria falls under the bracket of a hospital and an insured individual can avail necessary treatment here.

Hospitalisation and What it Means:

Now that we know what a hospital means from the point of view of your insurance provider, it is time to know what exactly constitutes hospitalisation. Admission to any institute which satisfies the definition of a hospital, for a period of 1 day/24 hours typically constitutes hospitalisation. This time period can be reduced if a specialised treatment/surgery is being done.

Knowing a few basic definitions and concepts can go a long way in ensuring that your health insurance policy provides the necessary benefits which it was designed to. Keeping yourself abreast as to what a policy provider expects from you could ensure that your health and any claims made by you are honoured, helping you save money and effort.

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