Pre-Post Hospitalisation Expenses in Health Insurance

Pre-hospitalisation expenses are the medical costs you incur before being admitted to a hospital for treatment. In health insurance, such expenses are covered for up to 30 – 60 days before hospitalisation, provided they are directly related to the illness or injury for which you are eventually hospitalised and are covered under your policy terms.

Expenses covered under Pre-Hospitalisation:

• Doctors Consultation
• Diagnosis tests such as X-rays, CT scans, MRIs
• Physical examination such as blood tests
• Cost of Medication

Example: Suppose a person experiences severe abdominal pain and visits a doctor. Before surgery, they may undergo consultations, blood tests, and purchase prescribed medicines. If the condition later requires hospitalisation, these medical expenses incurred before admission may be covered as pre-hospitalisation expenses under the health insurance policy, subject to policy terms and limits.

Post-hospitalisation expenses are the medical costs incurred after you are discharged from the hospital for continued treatment, recovery, or monitoring of the condition for which you were hospitalised. Generally, health insurance plans cover post-hospitalisation expenses for up to 60 - 90 days after discharge, provided the expenses are directly related to the illness, injury, or treatment that required hospitalisation.

Expenses covered under Post-Hospitalisation:

• Follow up care
• Medical consultation
• Post-surgery diagnostic tests
• Medication

Example: Suppose a patient undergoes surgery and is discharged after a few days. During recovery, they may need follow-up doctor visits, medicines, and diagnostic tests. If these expenses are related to the treatment received during hospitalisation, they may be covered as post-hospitalisation expenses under the health insurance policy, subject to policy terms and conditions.

The following expenses are generally covered under pre and post-hospitalisation benefits, provided they are related to the same illness, injury, or treatment that resulted in hospitalisation:

• Doctor consultation fees related to the hospitalised condition
• Diagnostic tests such as blood tests, X-rays, MRI scans, CT scans, and ultrasounds
• Medicines prescribed by the treating doctor
• Follow-up consultations after discharge
• Medically necessary investigations during recovery
• Physiotherapy or rehabilitation prescribed as part of recovery (if covered under the policy)
• Other treatment-related medical expenses linked to the hospitalisation

The following expenses are generally not covered under pre and post-hospitalisation benefits:

• General health check-ups unrelated to the hospitalisation
• Tests conducted for unrelated medical conditions
• Medicines without a doctor's prescription
• Expenses related to illnesses that are still under the waiting period
• Cosmetic or non-medical treatments not covered under the policy
• Expenses incurred outside the policy's pre or post-hospitalisation coverage period.

When it comes to claiming pre and post-hospitalisation expenses, the time frame varies based on the specific health insurance policy. Always read your insurance policy for coverage. Here is the time duration for claiming the expenses:

• Pre-Hospitalisation Expenses: Hospitalisation expenses incurred 30 - 60 days before the admission date are covered under these expenses.
• Post-Hospitalisation Expenses: Hospitalisation expenses incurred 60 - 90 days after admission are covered under these expenses.

There are times when claims can be rejected. Before filling out a claim under pre and post-hospitalisation, there are a few things you need to remember to avoid rejection. It includes:

• Time Duration: The claims can be rejected if they are made after the allotted time period, which is between 30 – 60 days before and 60 - 90 days after being hospitalized.
• False Information: The insurer will reject the claim if the bills and reports are inaccurate. It can be denied if some of the required documentation is not provided.
• Fake Reports: The claim can be rejected if the diagnostic reports and expenses don't match.
• The Expenses are Not Related to the Hospitalised Condition: Pre and post-hospitalisation expenses must be directly linked to the same illness, injury, or treatment that resulted in hospitalisation. If the expenses relate to a different medical condition, they may not be covered.
• The Expenses are Not Covered: Expenses falling under exclusions in health insurance are generally not eligible for reimbursement.

Before purchasing a policy, it is important to understand how these benefits work and whether they meet your healthcare needs.

• Only Same Medical Condition Covered: Generally, only the illness or medical condition for which you are undergoing treatment will be covered under pre and post-hospitalisation costs by your insurance provider.
• Timeframe: The expenses are only reimbursed for a predetermined period of time, typically 30, 60, or 90 days for pre and post-hospitalisation, respectively. Check for the timeframe with your insurance company.
• Hospitalisation Required: The coverage for pre and post-hospitalisation costs becomes active only once you are admitted to the hospital. If you were treated at home instead of in a hospital, you are not eligible for reimbursement for these costs.
• Bill & Receipts Submission: When buying such coverage, make sure that you know the type of documents you need to submit to claim the expenses.
• Review the Policy Exclusions: Read the policy exclusions carefully to understand which expenses, treatments, or services are not covered. This can help prevent claim-related surprises later.
• Consider Waiting Periods: If you are getting coverage against specific illnesses or pre-existing diseases, review the applicable waiting period in health insurance.