Most of us know that health insurance kicks in only when the policyholder is hospitalised for a minimum of 24 hours. Procedures that take a shorter time, say, two hours, may not be covered under health insurance. However, that is changing.
Over the past decade or so, medical advancements have transformed how treatments and surgeries are done. This has also significantly reduced the time required for such treatments. Many common procedures, such as cataract surgeries, chemotherapy sessions, angiographies, or even emergency observations can be completed within just a few hours, without the need for prolonged admission.
Says Siddharth Singhal, head, health insurance, Policybazaar: “Conditions that earlier warranted overnight monitoring or post-operative care can now be safely managed with a few hours of hospital stay due to minimally invasive procedures, such as laparoscopy, laser surgery, and advanced imaging allow for quicker diagnostics and faster recovery.”
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Previously, only hospitalisations above 24 hours were valid for health insurance claims; but now, the insurance industry is also keeping up with the changes brought about by advancements in medical healthcare. Accordingly, the 24-hour hospital stay has now been reduced to two hours.
“This means, you can claim your health insurance for hospitalisations of even two hours. All leading insurers have introduced this flexible provision in their health plans. The industry is clearly moving towards a more realistic, patient-centric model,” says Singhal.
What Is The Benefit
Medical inflation is at an all-time high, and even day procedures can cost anywhere between Rs 20,000 and Rs 1.5 lakh.
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“Without this provision, if a person undergoes a short surgery or observation lasting under 24 hours, they would have to pay the entire amount out-of-pocket, despite having insurance,” says Singhal.
These updated norms ensure reimbursement or cashless facility is available even for such brief, but costly procedures. The shift also promotes better utilisation of insurance for routine, but essential interventions (like chemotherapy cycles, short-stay dialysis, injections under observation, etc.). It encourages early treatment-seeking behavior, as people are less reluctant to visit hospitals if they know insurance will support even minor procedures. Early intervention and reduced hospitalisation time also means lower infection risk, faster home recovery, and improved mental well-being of patients.
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How It Is Different From OPD Coverage
In contrast to this, outpatient department (OPD) add-on coverage covers outpatient visits without any hospitalisation requirement (routine consultations, basic tests, medications). It also requires an additional premium payment, operates with fixed sub-limits (typically Rs 5,000- Rs 50,000 annually), and has shorter waiting periods.
“Essentially, two-hour hospitalisation bridges the gap between traditional inpatient care and outpatient services by covering procedures that need hospital-level supervision, but not overnight stays, while OPD covers routine medical visits that don't require admission at all,” says Abhishek Kumar, a Securities and Exchange Board of India (Sebi)-registered investment advisor (RIA), and founder and chief investment advisor of SahajMoney, a financial planning firm.
