Does Health Insurance Cover Critical Care Unit Charges?

Yes, most health insurance plans in India cover ICU (Intensive Care Unit) charges when hospitalisation is medically necessary and recommended by a treating physician.

Medical emergencies are unpredictable occurrences that may necessitate treatment in an ICU. But ICU treatment costs can be high, particularly in metros and private hospitals. Read on to know more about how health insurance covers ICU charges.

What is ICU Treatment?

ICU is a specialised unit in a hospital that provides intensive care and regular monitoring to patients with severe illnesses.

ICU care is usually needed for patients who:

• Have serious infections or sicknesses


• After accidents, seek emergency care.


• Need monitoring following a big surgery.


• Have breathing problems or organ failure.


• Requires life support systems and/or special equipment

What are ICU Charges?

ICU charges are the expenses incurred in the Intensive Care Unit for the treatment and stay. Such costs can cover:

• ICU room charges


• Doctor consultation fees


• Nursing care


• Airway support or oxygen therapy


• Medicines and injections


• The use of diagnostic tests and monitoring.


• Emergency procedures

Average ICU Costs in India

In India, the average cost of ICU treatment is approximately INR 1,50,000. However, the figures may vary depending on the city and hospital:

When Does Health Insurance Cover ICU Charges?

Typically, hospitalisation coverage in health insurance plans will cover the costs of ICU services. If health insurance coverage is to be provided, then:

• The patient has an acute medical condition and is in need of admission to the ICU.


• The treatment is recommended by a qualified doctor.


• The condition is serious enough to warrant ICU admission, as determined by the treating physician.


• The treatment is covered by the policy terms and conditions.


• Documents and hospital records are submitted as required.

What is Covered Under Insurance?

Many health insurance and mediclaim policies can cover a number of expenses relating to the treatment in an intensive care unit.

Hospitalisation Expenses

Most health insurance plans will pay for the following types of hospital costs:

• ICU room charges


• Costs of doctors and specialists


• Nursing charges


• Operation theatre expenses


• Medicines during hospitalisation


• Diagnostic tests and scans

Cashless Treatment Facility

Numerous insurance providers provide cashless treatment in network hospitals. It allows the insurer to directly settle approved medical bills with the hospital under the facility.

Pre-Hospitalisation Expenses

You might also have a lot of expenses before being admitted to the ICU, and your insurance plan may cover these costs.

Post-Hospitalisation Expenses

Post-discharge, patients might require medication, follow-up appointments and additional treatment. These costs are usually covered by a variety of health insurance plans for a limited time following a hospital stay.

Ambulance Charges

In case of emergency, some health insurance companies also cover the expense of getting the patient to the hospital by ambulance.

What is Not Covered Under Insurance?

Claims will not be paid when:

• The treatment is not necessary for medical reasons.


• The policy waiting period is not fulfilled.


• The treatment is excluded from the policy coverage.


• Required medical documents or hospital records have not been submitted.


• Applicable sub-limits or co-payment clauses reduce the claimable amount, as specified in the policy.