SHA: Inside Your Inpatient Coverage – Hospital Care Benefits Explained
Everything You Need to Know About Hospital Admission Benefits
When serious illness or injury strikes, knowing exactly what your medical cover includes can provide peace of mind during challenging times. The TSC-POMSF scheme offers comprehensive inpatient coverage that goes far beyond basic hospitalization.
What Qualifies as Inpatient Care?
Inpatient benefits apply to any treatment requiring admission and stay in a hospital or day care surgery/procedure. All inpatient benefits are paid net of SHIF rebates, meaning the scheme covers what the Social Health Insurance Fund doesn’t.
Core Inpatient Services Covered
Medical Personnel and Facility Charges
- Doctor’s fees: Full coverage for physicians, surgeons, and anesthetists
- ICU/HDU/Critical care charges: Intensive and High Dependency Unit costs included
- Theatre charges: Operating room costs fully covered
Medical Supplies and Equipment
- Drugs and medicines: All prescribed medications during hospitalization
- Dressings: Wound care and surgical dressings
- Internal surgical appliances: Medical devices implanted or used during surgery
Diagnostic Services
- Pathology and Laboratory tests: Complete coverage for all diagnostic testing
- X-rays and Ultrasounds: Standard imaging services
- ECG (Electrocardiogram): Heart monitoring and diagnostic tests
- Computerized Tomography (CT Scans): Advanced imaging
- MRI Scans: Magnetic Resonance Imaging for detailed internal views
Specialized Treatment Modalities
Cancer Care
- Radiotherapy: Radiation treatment for cancer patients
- Chemotherapy: Full coverage for chemotherapy medications and administration
- Cancer treatment and related procedures: Comprehensive cancer care including diagnostic procedures and tests
Rehabilitation Services
- In-Patient Physiotherapy: Physical therapy during hospitalization
- Hydrotherapy: Water-based therapeutic treatment
- Occupational therapy: Therapy to help patients regain daily living skills
Family-Centered Care
Accommodation for Parents/Guardians: For hospitalized children below seven years of age, the scheme covers hospital accommodation for an accompanying parent or guardian. This ensures young patients have parental support during treatment without additional financial burden.
Special Coverage Areas
Congenital and Genetic Conditions
The scheme covers congenital defects and genetic disorders—conditions present from birth or inherited. This is particularly important for young families and removes the financial barrier to treating these often-complex conditions.
Renal Dialysis
Full coverage for kidney dialysis treatments, which can be life-saving for patients with kidney failure.
In-Vitro Fertilization (IVF)
The scheme includes IVF coverage, recognizing reproductive health as an essential component of comprehensive medical care.
Post-Hospitalization Benefits
Medical needs don’t end at discharge. The scheme recognizes this by providing:
For General Illnesses:
- Up to two weeks of post-hospitalization benefits
- Covers follow-up consultations, medications, and necessary care after discharge
For Accident Cases:
- Extended coverage for up to six weeks after discharge
- Recognizes that accident recovery often requires longer rehabilitation periods
Day Care Surgery
Not all procedures require overnight hospital stays. The scheme covers day care surgery for minor surgical treatments that don’t necessitate admission but still require surgical facilities and medical supervision.
Medical Education and Wellness Programs
For members with pre-existing and chronic conditions, the scheme provides:
- Medical education programs to help patients understand and manage their conditions
- Wellness programs designed to improve health outcomes and quality of life
Emergency Evacuation
Medical Emergency Road Evacuation: When medical emergencies occur far from appropriate facilities, the scheme covers road evacuation services leading to hospital admission. This includes ambulance services and emergency transport.
Critical Limitations to Remember
While coverage is comprehensive, teachers should note:
- SHIF Rebates: Benefits are paid net of SHIF rebates, so SHIF enrollment remains important
- Annual Limits: All benefits are subject to the annual limits based on your job group
- Approved Providers: Services must be obtained from approved panel providers except in emergencies
In our next post, we’ll explore outpatient benefits—the services you can access without hospital admission.