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  • Meaning of 'Hospital' in a Health Insurance Policy

    “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 health insurance provider.

    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.

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    Meaning of 'Hospital' in a Health Insurance Policy Reviews

  • Page 1 of 25 1 2 3 4 5
    • Star Health Health Insurance
      "Start Health Insurance Fraud"
      0.5 0.5/5 "Unacceptable"
      My father purchased Star health insurance for family safety and was paying premium from last 2 years but when time came insurer refused to give claim stating that throughout the hospitalization and all investigation reports are within normal limits. My brother was admitted in family hospital delhi for 24 hours, doctors diagnosed him and billed approx 13500.
      Was this review helpful? 3
      , new delhi
      Reviewed on Sep 08, 2018
    • Religare Health Insurance
      "Good policy"
      0.5 4.0/5 "Great!"
      I have taken health insurance , am satisfied with the premium amount which am making . I am getting benefits of Cashless hospitalization and pre disease cover . Even they listed the network of hospital . Their customer representative explained the policy . Overall am satisfied with this policy.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Sep 05, 2018
    • HDFC Ergo Health Insurance
      "Best Policy"
      0.5 5.0/5 "Blown Away!"
      I took health insurance from Hdfc ergo Am satisfied with the premium amount which am making the payment , i don't have claim experience . But this policy hold benefits of cashless hospitalization and network of hospital. Their customer explained the policy very well.
      Was this review helpful? 0
      , bangalore
      Reviewed on Sep 04, 2018
    • Cigna TTK Health Insurance
      "Worst fraud company "
      0.5 0.5/5 "Unacceptable"
      IT professional pls dnt buy this policy it's total waste and you will end up losing ur money at the end of the day. Cash less payment it's all fake. You will end up paying extra amount in hospital. If u say cashless treatment pls do not buy this insurance.
      Was this review helpful? 0
      , bangalore
      Reviewed on Sep 01, 2018
    • Apollo Munich Health Insurance
      "Very Good policy"
      0.5 5.0/5 "Blown Away!"
      They are very good in settlement and i have never had any claim experience so far. I can claim the money upto Rs. 4 lakhs. I have taken the policy for me and my family. The hospital list mentioned in the policy is good and the maximum hospitals covered by this policy. Cashless treatment is also available. Premium amount is paid by my company.
      Was this review helpful? 0
      , jaipur
      Reviewed on Aug 02, 2018
    • Oriental Insurance Health Insurance
      "Satisfied health insurance policy"
      0.5 5.0/5 "Blown Away!"
      They have provided the very good services. They have not deducted any un-respected amount. I can use the policy upto 85000. I had a claim experience with oriental insurance in the year of 2016. I'm paying the premium of Rs. 16000 per day for my family. The customer care people also given a proper response. The hospital list was good and the cashless treatment also available.
      Was this review helpful? 2
      , mumbai
      Reviewed on Aug 01, 2018
    • New India Health Insurance
      "Good Service"
      0.5 4.0/5 "Great!"
      I've two health insurance policies with the New India Assurance. Being an employee I got it under a concessional rare. I find it god. It also offers cashless facilities and the list of hospital are also good. So far there hasn't been any issues with their services.
      Was this review helpful? 0
      , mumbai
      Reviewed on Jul 28, 2018
    • review Health Insurance
      "Good health insurance policy"
      0.5 5.0/5 "Blown Away!"
      I have taken this health insurance policy for 3 months before. I don't have any claim experience so far. I can claim the amount of Rs. 15 lakhs. I've paid the premium of Rs. 3800 for year. I have taken this policy for my family too. I have never checked about the hospital list which is mentioned under this policy. I have never call the customer care service since i don't need it.
      Was this review helpful? 0
      , mumbai
      Reviewed on Jul 25, 2018
    • ICICI Lombard Health Insurance
      "Good policy"
      0.5 5.0/5 "Blown Away!"
      I'm paying the premium amount of Rs. 11000 per year. I have taken this health insurance for my family. I have never had a claim experience with this policy. I can avail the claim amount of 3 lakhs maximum. Its easy to claim the policy. The hospital list was good. Cashless treatment is also available.
      Was this review helpful? 1
      , gurgaon
      Reviewed on Jul 25, 2018
    • Royal Sundaram Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have take health insurance form Royal sundaram . I even got my health card . Am satisfied with the premium amount which am making payment yearly through on-line payment . This policy covers cashless hospitalization and pre disease coverage with wide network of hospital . Overall I am very much satisfied with this policy.
      Was this review helpful? 0
      , gurgaon
      Reviewed on Jul 23, 2018
    • Religare Health Insurance
      "Yet to experience the policy "
      0.5 3.0/5 "Satisfactory"
      I never had claim experience. I have taken this policy for past 3 years. I have taken this policy for my family. I used to pay the premium of Rs. 13000 every year. Most of the hospital are covered in this health insurance. The given sum assured amount is a satisfied one. I did not call the customer care since i don't have any claim need so far.
      Was this review helpful? 0
      , pune
      Reviewed on Jul 23, 2018
    • New India Health Insurance
      "Awesome insurance company"
      0.5 5.0/5 "Blown Away!"
      My company provided me the health insurance. I claimed this policy many times. They are very simple and accessible in all the places. I always go through my company portal to get things done. They have hotline number to reach easily. There very good hospital mentioned in the list. The customer care response is also good. First of all, i have to admit in the hospital, the limit is 2 lakhs. For any higher hospitalization, then i can avail a claim of Rs. 12 lakhs. My family members also added in this policy
      Was this review helpful? 0
      , thane
      Reviewed on Jul 02, 2018
    • review Health Insurance
      "Need to experience the policy"
      0.5 5.0/5 "Blown Away!"
      I have been using this policy for 2 years and i have never used the claim about the policy. The policy coverage for 7 to 8 lakhs. I think Rs. 10 K i have to pay premium amount. I have taken this policy for myself. Their is no pre-existing disease coverage not applicable. They have a very good high end hospital lists are covered. Its a cashless treatment is covered in their listed hospitals.
      Was this review helpful? 0
      , gurgaon
      Reviewed on Jun 26, 2018
    • Star Health Health Insurance
      "Everyone can avail health insurance"
      0.5 5.0/5 "Blown Away!"
      It was smooth process. They are not refunding the money for the plastic items like syringe items. I had a very good claim experience with them. They have a very good hospital list. If they make it fully cashless transaction it will be good. Then they will get lots of customer. I used to pay the premium of Rs. 11000 for my family. The premium amount is increasing every year.
      Was this review helpful? 0
      , bangalore
      Reviewed on May 31, 2018
    • Tata AIG Health Insurance
      "Excellent Insurance Policy"
      0.5 5.0/5 "Blown Away!"
      They are very customer friendly people. I have a very good claim experience with them. It is very friendly claim experience and cashless mediclaim. Almost most of the hospital has been covered in the city where I'm living in. There is a sufficient amount of Coverage. If I'm not claiming the policy in this year. Next year i will get extra 50000 as add on in my claim amount.
      Was this review helpful? 0
      , nasik
      Reviewed on May 24, 2018
    • Bajaj Allianz Health Insurance
      "Excellent Service"
      0.5 5.0/5 "Blown Away!"
      I've a health insurance form the Bajaj Allianz . I pay a premium of 3000 annum, for a coverage of 3 lacs. I had a claim experience with the policy where they paid 95% for a cash less treatment. Everything was done from the hospital. The whole process was quick and hassle free.
      Was this review helpful? 0
      , bangalore
      Reviewed on May 18, 2018
    • Star Health Health Insurance
      "GOOD"
      0.5 4.0/5 "Great!"
      Actually i have my health insurance with the STAR and my overall experience with star is good. Once i had my claim experience with this insurance i had to claim it in one hospital an obviously the limit for claim will always depends upon the hospital. I had a good claim experience and customer service is also good.
      Was this review helpful? 0
      , hyderabad
      Reviewed on May 13, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with National insurance from last 5 years, i am not aware of the premium amount as my company pays it. My claim experience was very good and there was no cashless treatment as the hospital was not listed. I have a coverage value of Rs 5 lakhs for this insurance.
      Was this review helpful? 0
      , bangalore
      Reviewed on May 11, 2018
    • ICICI Lombard Health Insurance
      "Best service"
      0.5 5.0/5 "Blown Away!"
      I have taken Health insurance with ICICI Lombard.The premium amount is 12,000 per annum.The policy coverage amount is one crore.I have no claim experience with them.I get 100% cashless treatment.I make online payments.The insurance is tied with best hospital in my place.
      Was this review helpful? 0
      , pune
      Reviewed on Mar 09, 2018
    • Star Health Health Insurance
      "Genuine Claim Rejected "
      0.5 0.5/5 "Unacceptable"
      My husband was admitted 1st time in Shalby Hospital,Jaipur and was diagnosed with Pancreatitis.The Doctor wrote on case paper that he has recurrent pancreatitis and is a known case of pancreatitis,However the Doctor was seeing my husband for 1st time.The company asked us to submit previous case papers,but we did not have any reports or case papers as it was the 1st time my husband was diagnosed with pancreatitis.For this we submitted an application and a letter from treating Doctor that he has treated my husband for 1st time.On the basis of this our claim was rejected that we didnâ??t submit the previous case papers and cannot take a claim within 2 years of taking the policy for an existing disease.When we donâ??t have any previous case papers or reports,how can we submit them to the company.
      Was this review helpful? 0
      , ajmer
      Reviewed on Mar 09, 2018
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