Why modern health insurance should cover short hospital stays
Yet, while hospitals modernise, health insurance policies often remain stuck in the past—still requiring a 24-hour stay for a valid claim. This mismatch is creating a growing coverage gap for millions of Indians.
By 2025, with over 1.46 billion citizens to serve, India's healthcare demand will only grow. While flagship government schemes like Ayushman Bharat—Pradhan Mantri Jan Arogya Yojana (PMJAY) provide safety nets for over 10.74 crore families, they focus on secondary and tertiary hospitalisation. This still leaves more than a billion Indians—particularly from the aspiring middle class—dependent on private hospitals and insurance systems.
The rise of day-care surgeries
What once required several days of hospitalisation—hernia repair, cataract operations, even certain orthopaedic and oncology procedures—can now be completed in a matter of hours, thanks to minimally invasive technologies.
The increasing health burden from lifestyle diseases like diabetes, hypertension, and heart ailments has driven demand for rapid interventions that reduce complications. This need has accelerated the adoption of minimally invasive procedures that don't require extended hospital stays.
Even Tier-2 and Tier-3 hospitals are adapting to this new standard of rapid recovery.
Health data backs this shift. Today, nearly 29% of total health insurance claims in India are for day-care procedures. But here's the catch: many are rejected, not due to costs or complications, but because the patient wasn't hospitalised for 24 hours.
When efficiency backfires
Consider Meena Devi, a 63-year-old woman from Ranchi. She underwent successful cataract surgery at 9 AM and returned home the same day. But her insurance claim was denied—because she didn't meet the 24-hour hospitalisation requirement.
This outdated clause penalises modern medicine. Ironically, the more efficient the healthcare system becomes, the higher the risk that claims will be denied. It's a classic case of policy lagging behind practice.
Regulatory momentum must continue
The Insurance Regulatory and Development Authority of India (Irdai) has supported innovative coverage models before—such as the Standard Vector-Borne Disease Health Policy in 2021 and the rollout of short-term health covers during crises.
Now, a similar regulatory push is needed to standardise and mandate short-stay hospital coverage across insurers. Bridging the gap between how care is delivered and how it's insured is essential for both policyholders and providers.
Thankfully, some insurers are catching up. A few now offer products with expanded lists of day-care procedures, eliminate the 24-hour clause, or include standalone short-stay coverage. These plans are especially useful for urban professionals, young couples, and senior citizens who opt for time-efficient care.
Adjusting to reduced hospital stays isn't just about improving customer experience—it's about staying relevant in a fast-evolving healthcare system.
What consumers should watch for
Consumers must dig deeper than just premiums and coverage caps. Does your policy still insist on a 24-hour stay? If so, you may face rejection for even medically necessary day-care procedures. Always check:
A little attention now can protect you from frustration and financial stress later.
Conclusion
India's healthcare is evolving—becoming faster, smarter, and more efficient. To remain effective, health insurance must evolve too. A policy built around 24-hour stays is no longer in step with the way medicine works.
If India is to build a future-ready healthcare system, our insurance industry must move at the same pace as our surgeons and diagnostics. After all, a few hours in the hospital should not mean months of paperwork—or a denied claim.
Priya Deshmukh, head—health products, operations & services, ICICI Lombard
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