You need health cover regardless of what you take two at a time - pills or stairs.

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 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 26 1 2 3 4 5
  • review Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have taken my health insurance with Adiyta birla insurance, there service is good, there agent had explain me about the policy which is covered in this insurance and they have tie up with many hospital and they have shared me there location , and the premium amount they have charged me was nominal, i use to pay through on line.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 23, 2019
  • Religare Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my health insurance with Religare insurance from long time,their service is good, they have tie up with many hospital , and they have shared me an excel with there location, and the agent had explained me clearly about the policy benefit,overall service is good.
    Was this review helpful? 0
    , jaipur
    Reviewed on Jan 23, 2019
  • Apollo Munich Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have taken my health insurance with Apollo Munich, there service is good, there agent had explain me about the policy which is covered in this insurance and they have tie up with many hospital and they have shared me there location , and the premium amount they have charged me up to 13,000, i use to pay through on line.
    Was this review helpful? 0
    , new delhi
    Reviewed on Jan 22, 2019
  • Bajaj Allianz Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I took my Health insurance with Bajaj allianz general insurance, they have tie up with many hospital, and they have shared me location regarding this, so far there was no claim experience with them . There is cashless treatment option available , the premium amount they have charged me previously on monthly basis, it was nominal premium charges, i have been paid for 4-5 years continuously, now maturity period got completed.
    Was this review helpful? 0
    , new delhi
    Reviewed on Jan 22, 2019
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have been using my health insurance with HDFC ERGO , the agent that explain me clearly about the policy, and there benefits,and they have tie up with many hospital and they have shared me excel regarding this, i had claim experience on 2016 , my claim experience with this bank was good, the premium amount they have been charged on yearly basis,they have charged premium nominal.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 21, 2019
  • Universal Sompo Health Insurance
    "Speedy claim recovery"
    0.5 4.0/5 "Great!"
    Holding my health insurance from Universal sompo. I'm not getting any mails or messages from Universal Sompo regarding the updates. The policy is really good. This is a 100% covered policy. They have processed the claim immediately with the cashless treatment. The hospital list is really good.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 20, 2019
  • ICICI Lombard Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have taken my health insurance with ICICI Lombard general insurance, there service is good, there agent had explain me about the policy which is covered in this insurance and they have tie up with many hospital and they have shared me there location , and the premium amount they have charged me was nominal,i use to pay on yearly basis.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • HDFC Ergo Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I took my medi claim with HDFC ERGO, they have tie up with many hospital,and they have shared me the location regarding this,they have mention the location on excel,and the premium amount they have charged me is nominal,they have charged me on yearly basis.overall service is good.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • Apollo Munich Health Insurance
    "Average Policy"
    0.5 3.0/5 "Satisfactory"
    My organization has given me a health insurance from Apollo Munich. I have not gone through about the documents and hospital list. My entire family has been covered in this policy. They have given me a satisfied coverage value. I have not contact the customer care so far.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Jan 20, 2019
  • Star Health Health Insurance
    "Less premium with Extra benefits"
    0.5 3.0/5 "Satisfactory"
    Taken my health insurance policy recently from Star. Till now i have not spoke with the customer care. Since my age is above 50, i made the premium amount of Rs. 17000. Myself, my wife and child has been covered in this policy. They have given me a coverage value of Rs. 4 lakhs. Almost major hospital has been covered in this list.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I experience my health insurance with HDFC Ergo,they have tie up many hospital ,i have not have claim experience yet,there is cashless treatment option available,the premium they have charged me on monthly basis,they have charged me up to 700 which is nominal , i pay premium through on line.
    Was this review helpful? 0
    , kolkata
    Reviewed on Jan 20, 2019
  • ICICI Lombard Health Insurance
    "Bad experience"
    0.5 1.0/5 "Really Bad"
    I hold health insurance with ICICI lombard,they have tie up with many hospital , and even they have shared me the location in pdf form, and i pay previously premium on yearly basis, but now it is flexible pay option is available, and i use to pay on monthly basis, up to 878 rupees ,it is bit high compare to market value,there is cashless treatment available.
    Was this review helpful? 0
    , ahmedabad
    Reviewed on Jan 19, 2019
  • Star Health Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have been using health insurance with Star health insurance, the agent had clearly explain me amount the claim policy, and they have tie up with my hospital, and they have charged me location regarding to hospital location, there premium amount is on yearly basis, and it use to get auto debited from my account.
    Was this review helpful? 0
    , thane
    Reviewed on Jan 19, 2019
  • United India Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my mediclaim insurance with United state of India,the premium i use to pay on yearly basis,i need to pay through on line,they have tie up with many hospital , i no doing much important is that they have share the location,i have no claim experience yet,till now no issue ,any changes they use to notify and use to send hard copy.
    Was this review helpful? 1
    , bangalore
    Reviewed on Jan 19, 2019
  • United India Health Insurance
    "Good Claim Experience"
    0.5 5.0/5 "Blown Away!"
    I got group insurance from company, on time I got policy. My father was not good at the time I have used the policy. I got the reimbursement around Rs. 23,000 the total value is Rs. 33,000. I went to shobha hospital they don't have tie up with United India, hence I got the reimbursement.
    Was this review helpful? 1
    , bangalore
    Reviewed on Jan 18, 2019
  • Star Health Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have my health insurance with Star health insurance, i had claim experience with it, my experience was good, they have good tie up with my hospital and they have mailed me about the location of it, and i am happy with there service, they have charged me premium amount on yearly basis, and the premium amount is nominal for me, and i use to pay through on line mode.
    Was this review helpful? 2
    , chennai
    Reviewed on Jan 17, 2019
  • Max Bupa Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I got the health insurance with Max bupa health insurance, there service is good, they have charged me premium nominal ,and the premium is on yearly basis, and they have tie up with many hospital , and had shared the details via mail, and i pay premium amount through on line mode.
    Was this review helpful? 0
    , new delhi
    Reviewed on Jan 17, 2019
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I got the health insurance with HDFC Ergo, they got tie up with many hospitals, and they have shared me location on those hospital in mail, and they have charged me nominal premium amount ,they have charged me up to 17000-18000 as premium, it is on yearly basis, and i use to pay the premium on an on line basis.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 17, 2019
  • ICICI Lombard Health Insurance
    "Good Health insurance provider"
    0.5 3.5/5 "Pretty good"
    This policy was part of my employment, I took the medical coverage of Rs. 5 lakhs for the tenure of one year, this medical benefits for my entire. They have good networks of hospital with major disease cover. But I think it doesn't have no claim bonus.
    Was this review helpful? 0
    , chennai
    Reviewed on Jan 11, 2019
  • Reliance General Health Insurance
    "On time approval with reliance"
    0.5 4.0/5 "Great!"
    For my spouse operation I used the health policy, I approached them for the claim through hospital. I submitted the form and they send the papers to the Reliance insurance company. I got the cash less treatment, but I paid some amount which was not covered. But they gave me the on time approval.
    Was this review helpful? 1
    , kolkata
    Reviewed on Jan 11, 2019
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