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Pre-Hospitalisation and Post-Hospitalisation Expenses in Health Insurance

Team AckoDec 30, 2024

Health insurance, is a ‘friend in need’ in case of medical emergencies. During such challenging times, a wide-ranging health insurance policy can help you to keep your savings intact by paying most of the medical bills. However, medical bills are not only restricted to hospitalisation. Medical expenses often occur pre-hospitalisation and post-hospitalisation as well. A good health insurance plan covers expenses such as pre-hospitalisation tests and post-hospitalisation treatments. Read ahead to know more about pre-hospitalisation and post-hospitalisation expenses in the health insurance sector.

Contents

What is Pre-Hospitalisation and Post-Hospitalisation Cover in Health Insurance?
What are Pre-hospitalisation Expenses?
What are Pre-hospitalisation Expenses?
What are Post-hospitalisation Expenses?
Benefits of Pre and Post-Hospitalisation Coverage
How Do Pre-Hospitalisation and Post-Hospitalisation Work?
Why Are Pre-Hospitalisation and Post-Hospitalisation Expenses Important?
How to Claim Pre-Hospitalisation and Post-hospitalisation Expenses?
When are Pre and Post-hospitalisation Claims Not Accepted?
- Things to Remember
Common Misconceptions About Pre and Post-Hospitalisation Coverage
How to Choose a Health Insurance Plan with Comprehensive Coverage?
Frequently Asked Questions

What is Pre-Hospitalisation and Post-Hospitalisation Cover in Health Insurance?

The pre-hospitalisation and post-hospitalisation, cover in health insurance refers to policy inclusions that cover the expenses incurred before and after the insured patient is admitted to a hospital. A health policy with such a cover is considered wide-ranging as it not only covers expenses incurred during hospitalisation but also covers select expenses incurred before being hospitalised and after being discharged.

These expenses can drain out your savings if not covered by your health insurance policy. Hence, pre-hospitalisation and post-hospitalisation coverages help to place a shield over your savings by offering financial support to settle medical bills during these difficult times.

What are Pre-hospitalisation Expenses?

Medical expenses incurred before being admitted to a hospital are considered as pre-hospitalisation expenses. Usually, when people feel uneasy, they visit their family doctor or specialist. The doctor might suggest certain tests and scans to reach a concrete diagnosis. If the diagnosis is severe, the patient is admitted to a hospital.

Generally, several medical tests are conducted before admitting a patient to the hospital. These tests include X-ray, CT scan, MRI, Angiography, Blood Sugar test, etc., which determine the person's medical condition. Expenses for such tests will be covered under pre-hospitalisation cover as per the plan's terms and conditions.

Most insurance companies offer pre-hospitalisation coverage for up to 30 days prior to the date of hospitalisation. However, this period may vary from one insurer to another. Please note that pre-hospitalisation expenses are covered for the same illness for which the insured is admitted.

What are Pre-hospitalisation Expenses?

What are Post-hospitalisation Expenses?

Expenses incurred (to treat the patient) after being discharged from a hospital are considered post-hospitalisation expenses. In hospitalisation cases, treatment does not usually end immediately after a patient is discharged.

Post-discharge recovery includes medications and care. Frequent medical consultation sessions with experts can also be a part of this recovery process. This is where covering post-hospitalisation expenses can be helpful.

Post-hospitalisation covers medical expenses incurred for the follow-up treatment for which the patient was hospitalised. Most health insurance policies cover these costs between 45 and 90 days after the discharge date from the hospital.

Benefits of Pre and Post-Hospitalisation Coverage

Here are the top reasons to buy medical insurance with pre-hospitalisation and post-hospitalisation coverage.

1) Superior Coverage:

A health insurance policy with pre-hospitalisation and post-hospitalisation coverage will help you tackle the financial challenges that may arise right from diagnosing the disease till recovery. Not all health insurance plans offer such coverage. Thus, it becomes imperative to read through policy inclusions and exclusions to know more about the coverage before buying the plan.

2) Includes Treatment Cost:

Sometimes, the post-hospitalisation treatment cost of a disease can be more financially draining than initial hospitalisation. For example, a person might be hospitalised for a disease for a week, but regular post-discharge treatment might run for months. Post-hospitalisation insurance usually covers the treatment cost for surgeries, dialysis, day-care treatment, etc. thereby reducing the financial burden.

3) The Convenience of Network Hospitals:

Insurance companies provide a list of hospitals for your treatment. Here, you have the liberty to choose your preferred hospital from the list at your convenience. With this cover, you can choose a hospital in your locality and settle your claim hassle-free.

How Do Pre-Hospitalisation and Post-Hospitalisation Work?

Pre-hospitalisation and post-hospitalisation in health insurance usually work on a reimbursement model. Here’s an example.

10th January – Patient approaches doctor and the doctor suggests some tests (pre-hospitalisation expense)
12th January – Doctor examines the test results (pre-hospitalisation expense)
13th January – Patient is admitted in a hospital (hospitalisation expense)
20th January – Patient undergoes treatment in the hospital and is discharged (hospitalisation expense)
25th January – Follow-up treatment (post-hospitalisation expense)
30th January – Follow-up treatment (post-hospitalisation expense)

The bills for medical expenses related to the disease for which the insured was hospitalised need to be submitted to the insurance company or the appointed Third-party Administrator (TPA) as per the company policy.

Post verification, the insurer will reimburse the applicable pre-hospitalisation and post-hospitalisation cost within a specified period, which may vary from one insurance company to another.

Why Are Pre-Hospitalisation and Post-Hospitalisation Expenses Important?

Important elements of health insurance coverage are pre- and post-hospitalisation charges. These charges guarantee thorough financial and medical care outside of hospital stays, lessening personal stress during trying circumstances.

Financial Significance

Medical treatments carry large expenses both before and after hospitalisation. Usually, pre-hospitalisation costs cover medical visits, diagnostic testing, and drugs taken in the interim before admission. Depending on the coverage, such costs often cover 30 to 60 days. These initial expenses can swiftly mount up without insurance, jeopardising finances.

After discharge, post-hospitalisation charges cover follow-up visits, rehabilitation treatments, drugs, further testing, and recovery fees. Depending on the insurance, policies cover these for 30 to 90 days. This helps guarantee the continuation of treatment, allowing people to concentrate on their recovery free from financial concerns.

Medical Significance

Coverage related to pre-hospitalisation promotes quick medical response. Knowing the expenses are paid for increases people's likelihood of completing required diagnostic tests or consultations. Early diagnosis and treatment help prevent diseases from getting worse, improving the general state of health.

Coverage following hospitalisation is vital since healing does not stop when one leaves the hospital. Complete healing and avoiding problems depend on regular visits and continuous therapy. Financial help for these costs guarantees patients follow recommended treatment plans, therefore promoting faster recovery and a lower chance of relapse.

Comprehensive Coverage Benefits

Including these costs in health insurance plans provides total defence. It relieves financial load and offers mental peace of mind so people may concentrate on their health. Furthermore, this kind of coverage lowers out-of-pocket costs, improving healthcare availability to families of different incomes.

Understanding policy terms—including coverage length and restrictions for pre- and post-hospitalisation expenses—helps one to maximise the benefits. Choosing a plan with enough coverage will help people protect their finances and health in unanticipated medical events.

How to Claim Pre-Hospitalisation and Post-hospitalisation Expenses?

Timing plays a crucial role in claiming pre-hospitalisation and post-hospitalisation expenses. Insurance companies follow a strict time frame for settling such claims. For example, the claim application and document submission process for post-hospitalisation expenses need to be completed within the stipulated time of availing the treatment. Otherwise, it can be rejected on the grounds of non-compliance. Therefore, you must know the time limit for such claims and abide by it during claim settlement.

For filing a claim, you need to submit the following documents for verification:

Original hospital bills
Applicable medical certificates
Original Prescriptions
Discharge summary
Medicine and drug bills
Other supporting documents requested by the insurance company

The claim verification/validation process begins after the documents are submitted. The insurer will check whether the expenses are related to the same medical condition for which the patient was admitted or not. Claim rejection is a likely possibility if expenses are not related. After verification, the claim amount will be compensated as per the terms and conditions of the policy.

Also, read: Pre-Policy Medical Check-Up and Tests

When are Pre and Post-hospitalisation Claims Not Accepted?

There are times when claims are denied. In order to avoid that situation, keep these points in mind.

Medical condition not covered: A medical condition is not covered in your insurance policy's pre or post-hospitalisation expenses.
Lapse of time: If the claim is raised after the acceptable period i.e., after 45-90 days of hospitalisation.
Incorrect information: If the bills and reports provided are incorrect, the insurer will not accept the claim. Claims might get rejected even if some of the mandated documents are missing.
Discrepancy in treatment: If the reports and expenses submitted are different from the reason for in-patient admission.

Things to Remember

Here is a list of things to be noted concerning pre-hospitalisation and post-hospitalisation expenses:

The treatment cost before and after hospitalisation should be for the same condition for which the patient was admitted.
The expenses for the post-hospitalisation claim will be considered only if they were made during a specified period (for example, 45 to 90 days). These days may differ for different insurance companies. The insurer will not cover any expenses incurred after the mentioned time limit.
For filing a claim, make sure you submit all the necessary documents as requested by the insurer/TPA.

Common Misconceptions About Pre and Post-Hospitalisation Coverage

Though many people misinterpret or undervalue their advantages, pre-hospitalisation and post-hospitalisation coverage are absolutely vital aspects of health insurance policies. Addressing these misunderstandings would enable policyholders to use their insurance and prevent unanticipated financial burdens properly.

1. Myth: Coverage is Unlimited

Many people believe that pre- and post-hospitalisation coverage covers all medical costs without any cap. Most insurance companies may impose financial restrictions and must specify a period, say 30 days before hospitalisation and 60 days following. The coverage excludes general health expenses; it only covers expenses directly connected to the disease-causing hospitalisation.

2. Myth: Only Hospital Stay Expenses Matter

Most people believe that hospitalisation itself is the most expensive, so pre- and post-hospitalisation expenses are low. However, pre-hospitalisation charges include medical visits and diagnostic tests, and post-hospitalisation expenses like follow-ups and drugs can go up rather dramatically. For these phases as well, thorough coverage guarantees financial safety.

3. Myth: All Expenses Are Automatically Covered

Some policyholders think they will be reimbursed for any medical expenses paid during the covered period. Still, claims are handled just for treatments connected to the same illness that called for hospitalisation. Unrelated health problems during the covered period might not be eligible for a refund.

4. Myth: Claim Process is Too Complex

Many choose not to claim for these expenses since they believe the process is difficult. Actually, most insurance companies want simple documentation like receipts, medications, diagnostic results, and the hospital discharge narrative. Following the policies of the insurer guarantees a seamless operation.

5. Myth: It’s an Unnecessary Add-On

Some people, particularly those who expect few hospital trips, believe pre- and post-hospitalisation coverage is superfluous. From this angle, one ignores the erratic character of healthcare expenses. Complete health insurance coverage guarantees readiness for unplanned medical costs.

6. Myth: It Covers Non-Hospitalisation Cases

Many times, people are unsure whether these advantages apply to outpatient procedures. Coverage, both pre- and post-hospitalisation, only applies when hospitalisation is in place. Outpatient charges unrelated to hospital stays call for different coverage.

7. Myth: It’s the Same Across Insurers

Insurance companies may have quite different terms, restrictions, and conditions. To grasp particular phrases, policyholders must go over their policy papers and clarify information with their insurers.

How to Choose a Health Insurance Plan with Comprehensive Coverage?

Securing financial and medical security depends critically on choosing the appropriate health insurance plan. Comprehensive coverage from pre-hospitalisation to post-hospitalisation benefits guarantees you are covered from major medical costs. These important guidelines will assist you in selecting the best health insurance plan:

1. Understand Comprehensive Coverage

Search for plans covering pre-hospitalisation charges, including diagnostic tests, consultations, and medication, as well as post-hospitalisation expenditures, including follow-ups, rehabilitation, and prescription medications. Make sure the policy material specifically notes these characteristics to prevent surprises down the road.

2. Evaluate the Coverage Period

Usually offering a set term for pre- and post-hospitalisation coverage—30 days before and 60 days after hospitalisation—insurance companies Compare policies to identify one with long-term coverage times, which would be especially beneficial for diseases needing long-term care or recovery.

3. Check Network Hospitals

For cashless treatment, insurers can team up with a chain of hospitals. Make sure the nearby hospitals provide great treatment and belong to the network. This guarantees that you will be free from upfront payments and may concentrate on rehabilitation rather than financial concerns.

4. Scrutinise Claim Procedures

Particularly for pre- and post-hospitalisation costs, which could call for several receipts and documentation, a seamless claim process is essential. Choose an insurer whose track record is for quick and hassle-free claim settlements. Reliability can be judged in part by customer feedback and insurance ratings.

5. Understand Exclusions

Read the tiny print to find what is not covered under pre- and post-hospitalisation benefits. Certain insurers might exclude alternative therapies, experimental treatments, or pre-existing condition treatments. Clear knowledge of exclusions will enable you to make a wise decision.

6. Customisation Options

Certain insurance companies allow policy customisation through add-ons, including maternity coverage, critical illness riders, or extended domiciliary benefits. See whether the scheme provides flexibility to improve your coverage per your particular requirements.

7. Balance Premiums and Benefits

A comprehensive plan may come with higher premiums, but it should align with your financial capacity. Compare multiple plans using online tools or seek advice from a licensed insurance agent to strike the right balance between affordability and benefits.

8. Opt for a High Sum Insured

Given rising healthcare costs, ensure the plan provides a high sum insured. This ensures you are adequately covered for both in-patient hospitalisation and pre- and post-hospitalisation expenses without exhausting your policy limit.

9. Assess Policy Renewability

Look for policies with lifetime renewability. This ensures coverage even as you age when healthcare needs might increase, and pre- and post-hospitalisation benefits could become more critical.

10. Read Reviews and Seek Recommendations

Customer experiences and recommendations can offer valuable insights into an insurer’s service quality, claim process, and transparency. Consult family, friends, or financial advisors to make a well-rounded decision.

Choosing a health insurance plan with comprehensive coverage is an investment in your peace of mind and well-being. You can ensure financial security during medical emergencies by evaluating policy terms, insurer reputation, and specific features like pre- and post-hospitalisation coverage. Take your time to compare plans, ask questions, and choose a policy that meets your current and future healthcare needs.

Takeaway

Buying health insurance is the smartest thing you can do to secure your health and wealth. While choosing your health insurance provider and plan, make sure you take time to research the offerings and choose a plan that suits your needs the best. Take care!

Frequently Asked Questions

Here are some frequently asked questions related to the above-mentioned topic:

Q1) What is usually covered under pre-hospitalisation expenses?

A pre-hospitalisation cover usually includes the expenses incurred for the tests before the patient is admitted to the hospital. For example, the cover includes expenses for X-rays, CT scans, MRI scans, consultation fees for physicians, etc.

Q2) What is post-hospitalisation expenses coverage?

Patients often need medical care and treatment after being discharged from the hospital. Such expenses are included under post-hospitalisation coverage. The medication expenses, therapies related to the conditions, and post-discharge consultation are usually included under post-hospitalisation cover.

Q3) How do I claim pre-hospitalisation and post-hospitalisation expenses?

To file a successful claim, you need to submit the required documents and follow the claim process diligently.

Q4) Do I have to purchase pre-hospitalisation and post-hospitalisation coverage separately?

In most cases, such covers are included in a wide-ranging health insurance policy and do not need to be purchased separately.

Q5) Are ayurvedic treatments covered under post-hospitalisation?

Some insurers might cover such expenses while some might not, it depends upon the chosen insurer and the policy. Please go through the inclusions and exclusions of the health insurance policy to know if ayurvedic treatments are covered under post-hospitalisation expenses or not.

Q6) What are hospitalisation expenses?

Hospitalisation expenditures are those paid for when a patient is admitted for treatment. Usually, these cover room rents, nursing fees, doctor's fees, surgery costs, ICU charges, medications, diagnostic tests, and pre- and post-hospitalisation expenses. For instance, if you are in for a procedure costing ₹2,00,000, your health insurance policy will pay the hospitalisation-related charges according to policy terms.

Q7) What medical expenses are covered by health insurance?
Health insurance policies cover a wide range of medical expenses, including:

In-patient treatment: Costs incurred during hospitalisation.
Pre- and post-hospitalisation: Expenses for tests or follow-up treatments before and after hospitalisation, typically for a specified period (e.g., 30 days before and 60 days after).
Daycare procedures: Treatments like cataract surgery or chemotherapy that do not require 24-hour hospitalisation.
Ambulance charges Costs for transporting the insured to the hospital during emergencies up to a defined limit.
Domiciliary treatment: Medical treatment at home if hospitalisation isn't possible due to the patient's condition.
Coverage specifics vary, so reviewing your policy document to understand what’s included is essential.

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