Pre and Post-Hospitalisation Expenses in a Health Insurance Policy

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Pre- and Post-Hospitalisation Expenses are an important feature of Health Insurance Policies in India. Policyholders are typically under the misconception that a Health Insurance Policy only covers hospitalisation expenses. However, the truth is that a Health Insurance Policy also covers Pre and Post Hospitalisation Expenses. This article will discuss Pre and Post Hospitalisation Expenses and how to claim the same in a Health Insurance Policy.

What Are Pre-Hospitalisation Expenses in Health Insurance Policy?

Pre-Hospitalization Expenses in a Health Insurance Policy means Medical Expenses incurred during pre-defined number of days preceding the hospitalisation of the Insured Person, provided that:

  1. Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalisation was required, and
  2. The In-Patient Hospitalization claim for such Hospitalization is admissible by the Insurance Company.

Some common pre-hospitalization expenses include:

  1. Doctor’s consultation fees: Charges for visiting a doctor or specialist for diagnosis and treatment planning before hospitalization.
  2. Diagnostic tests: Costs related to laboratory tests, X-rays, MRIs, CT scans, and other diagnostic procedures required to diagnose the condition before hospitalisation.
  3. Medicines: Expenses for medicines prescribed by the doctor before hospitalisation.

The coverage for Pre-Hospitalisation expenses varies among Insurance Companies and specific plans. Typically, these expenses are covered for a specified period before the actual hospitalisation, such as 30 to 60 days prior to admission. It’s essential to review the Insurance Policy Wordings carefully to understand the extent of coverage, limits, and any exclusions applicable to Pre-Hospitalisation expenses under your Health Insurance Plan.

What are Post Hospitalisation Expenses in a Health Insurance Policy?

Post-Hospitalisation Expenses in a Health Insurance Policy means Medical Expenses incurred during pre-defined number of days immediately after the insured person is discharged from the hospital provided that:

  1. Such Medical Expenses are for the same condition for which the insured person’s hospitalisation was required, and
  2. The Inpatient Hospitalisation Insurance Claim for such hospitalisation is admissible by the Insurance Company.

Post-Hospitalization Expense Coverage in a Health Insurance Policy typically includes:

  1. Follow-up consultations with doctors
  2. Medicines prescribed for the recovery period
  3. Diagnostic tests and scans to monitor the patient’s progress
  4. Physiotherapy or other rehabilitation treatments Most Health Insurance Plans provide coverage for Post-Hospitalisation Expenses ranging from a period of 60 to 120 days, depending on the Insurance Company and the Health Insurance Plan opted for.

How to Claim Pre and Post-Hospitalisation Expenses in Health Insurance Policy?

A Policyholder can claim hospitalisation expenses in 2 ways: Cashless Claim Settlement and Reimbursement Claim Settlement. However, the Pre and Post Hospitalisation Expenses can be claimed on a Reimbursement Basis only. To claim Pre and Post-Hospitalisation Expenses under your Health Insurance Policy, the Policyholder should follow the below mentioned steps:

  1. Notify the Insurance Company about the hospitalization and collect all relevant bills, receipts, and medical documents.
  2. Fill out the Claim Form and submit the required documents, including Original Bills, Prescriptions, Test Reports, and IPD Claim Settlement Letter.
  3. Submit the Claim Form and Documents to the Insurance Company within the specified timeline.
  4. The Insurance Company will verify the Claim and may request additional information if needed.
  5. Once approved, the Claim Amount will be reimbursed as per the Policy Terms.

What are the benefits of Pre and Post Hospitalization Expenses Coverage in a Health Insurance Policy?

Pre- and Post-Hospitalisation coverage in a Health Insurance Policy offers several benefits:

  1. Extensive Coverage: Pre and Post-Hospitalization Coverage under a Health Insurance Policy ensures that Policyholders have a more comprehensive Insurance Coverage. It addresses not only the Hospitalization Expenses but also the medical expenses preceding and following it.
  2. Financial Support for Diagnostic Tests and Consultations: Pre-Hospitalization Coverage helps Policyholders with the costs of Diagnostic Tests, Doctor Consultations, and other medical evaluations leading up to hospitalisation. This benefit allows the Policyholder to receive necessary medical attention and diagnosis before a hospital stay without worrying about the financial burden.
  3. Continuity of Care: Post-Hospitalisation coverage is crucial as it supports Policyholders in the recovery phase after being discharged from the hospital. It covers expenses such as Follow-Up Consultation, Medications, Rehabilitation Services, and other necessary treatments. By providing coverage for these expenses, the Insurance Policy ensures that individuals can continue to receive essential healthcare services without interruption.
  4. Reduced Financial Burden: Expenses incurred before and after Hospitalisation are substantial and coverage for the same ensures the financial burden due to these expenses is minimised.

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