Pre and post-hospitalisation expenses in health insurance

Things to know about pre- and post-hospitalisation in health insurance and how they can be covered in your health plan.
Pre-and post-hospitalisation expenses in health insurance
3 mins

Keeping a check on vital parameters, regularly exercising, or following healthy eating habits is important. It is always wise to purchase a good health insurance plan so that the medical help does not burn a hole in your pocket. While we make every effort to keep health issues at bay, it is always wise to purchase a good health insurance plan so that for all the times that you need medical help, it does not burn a hole in your pocket.

When purchasing a health insurance plan, it is essential to understand the coverage well. What is the sum insured that the plan is offering? How much do you need to pay as premium? What conditions are covered? What is the waiting period and policy tenure of the plan? Besides all of this, it is important to know if your policy covers your expenses pre-hospitalisation and during the recovery phase.

Give this situation a thought; you have a stomach ache and contact OPD of a hospital to consult a doctor. They suggest a few tests and even sonography to get to the root cause of the issue. To decide the course of treatment, diagnosis is essential. On the other hand, let us say once your hospitalisation is over, you may need to have follow-up visits with your doctor or even need specific medication or tests to track your recovery. Such costs before and after hospitalisation may add to your expenses.

To deal with such situations, majority of insurers offer coverage for pre-and post-hospitalisation expenses up to 30 and 90 days respectively depending on the policy you choose and the insurer’s product.

What are pre-hospitalisation expenses?

Pre-hospitalisation expenses refer to medical charges incurred before being admitted to a hospital. It comprises physical examinations, doctors' fees, medicines, vaccinations and more.

However, the number of days covered under pre-hospitalisation is indicative and varies from policy to policy and insurer to insurer. In most cases, a policyholder can raise a claim a month before getting admitted to a hospital to confirm financial protection on pre-hospitalisation expenses.

What are post-hospitalisation expenses?

Even after undergoing surgery or treatment, patients need post-hospitalisation treatment to recover quickly. Sometimes surgeons may prescribe diagnostics tests, follow-up check-ups, physiotherapies, naturopathy, acupuncture, etc., to speed the recovery progress. The charges associated with these are known as post-hospitalisation expenses.

In post-hospitalisation, one needs to claim two months after being discharged from the hospital. Besides, the number of days covered depends on the insurance policy and provider.

For both pre- and post-hospitalisation expenses, policyholders need to produce the original receipts and doctor's certificates. In addition, individuals must thoroughly go through the inclusion list to alleviate the benefits.

Also read: What is a mediclaim insurance policy?

Benefits of pre- and post-hospitalisation coverage

Here are some advantages of purchasing a medical insurance policy that includes pre- and post-hospitalisation charges:

Improved financial protection

Health insurance policies that cover pre- and post-hospitalisation charges facilitate policyholders to manage expenses involved from diagnosis to recovery efficiently. Thus, one must carefully review the terms and conditions of an insurance plan to make an informed choice.

Minimising the burden of treatment costs

Depending on the type of surgery or treatment, at times, the costs of pre and post-hospitalisations may overshoot the hospitalisation charges. For example, a patient who has undergone organ transplantation may need regular post-discharge follow-ups for an extended period to confirm complete recovery. A medical insurance plan inclusive of pre-and post-hospitalisation expenses will unburden such financial stress.

The convenience of network hospitals

Several renowned insurance companies collaborate with hospitals to facilitate the convenience of cashless treatments. Therefore, a policyholder can choose a network hospital anywhere in the country to utilise this advantage.

Nevertheless, insurance providers offer these benefits if the policyholder completes the claim application and documentation within the stipulated timeframe. If not done within the specified deadline, insurance providers may reject applications based on non-compliance.

When choosing an insurance company, individuals must conduct in-depth research to understand the policy terms and conditions thoroughly. Furthermore, one needs to go through the list of inclusions and exclusions to make an informed decision. This is where it is prudent to choose a company, which offers not only extensive coverage but also boasts a huge list of network hospitals.

How to claim pre-hospitalisation and post-hospitalisation expenses?

Claiming pre-hospitalisation and post-hospitalisation expenses is a crucial aspect of health insurance. To initiate the process, you must first understand the steps involved.

Pre-hospitalisation expenses

When you anticipate a hospitalisation, ensure to keep all medical bills, prescriptions, and diagnostic reports as they may be essential for reimbursement. Contact your insurance provider to report your upcoming hospitalisation. Submit all relevant documents, including medical records, bills, and consultation fees, to the insurance company within the stipulated timeframe.

Post-hospitalisation expenses

After being discharged, continue to collect bills for follow-up consultations, medications, and any post-hospitalisation treatments. Submit these expenses to your insurance provider along with the necessary documentation.

To streamline the claim process, here's a list of essential documents:

  • Medical bills
  • Doctor's prescriptions
  • Diagnostic reports
  • Consultation fees
  • Hospital bills
  • Discharge summary
  • Receipts for medicines and treatments
  • Bills for follow-up consultations
  • Medication receipts
  • Post-hospitalisation treatment invoices

In this regard, Bajaj Finance extends tailor-made health insurance plans in partnership with some of the reputed companies. It offers comprehensive coverage for miscellaneous medical expenses. It includes ambulance fees, doctor's charges, diagnostics test costs, pre- and post-hospitalisation expenses.

In addition, they provide insurance plans curated to cover the medical expenses of family members to cater to diverse requirements. A few among them include group or employee health insurance, family floater insurance, critical illness insurance, etc.

With such extensive coverage, policy buyers can confirm best-in-class treatment for their families against a single policy premium. Besides, one can opt for free preventive annual health check-ups every three years without filing a claim against the policy.

Apart from these, Bajaj Finance facilitates the convenience of buying and renewing policies online to do away with the tedious conventional procedure.

Also read: Health insurance for senior citizens

Frequently asked questions

What is covered under pre-hospitalisation expenses?

Pre-hospitalisation expenses usually include medical consultations, diagnostic tests, and medications prescribed before admission to the hospital. Depending on the policy, coverage is typically extended up to 60 days prior to hospitalisation.

What is covered under post-hospitalisation expenses?

Post-hospitalisation expenses generally cover medical expenses incurred after the patient is discharged from the hospital. These expenses may include follow-up consultations, medications, and diagnostic tests, and may be covered for a period of up to 90 days after hospitalisation.

How to claim post-hospitalisation expenses?

To claim post-hospitalisation expenses, you must submit a claim along with the necessary documents such as medical bills, prescription documents, and receipts. Additionally, you will need to provide a discharge summary that details the medical condition and treatment provided during the hospitalisation.

When are pre- and post-hospitalisation claims not accepted?

Claims for pre- and post-hospitalisation expenses may not be accepted in some situations, such as if the treatment or tests were deemed medically unnecessary, if the expenses are not in line with the policy's coverage, or if the claim is submitted beyond the specified timeframe. It is important to carefully review your policy terms and conditions to understand the coverage offered and the exclusions applicable to your policy.

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