WHAT IS PRE AND POST HOSPITALIZATION IN HEALTH INSURANCE

Pre and Post-hospitalization are two terms that a layman must know clearly so as to reap the complete benefits of his Mediclaim. Basically, the expenses that get incurred 30 to 50 days before a patient gets admitted to the hospital are called pre-hospitalization expenses. On the other hand, those expenses which one incurs within 60 to 90 days of getting hospitalized fall under the category of post-hospitalization expenses.

Any health insurance plan which covers both pre and post-hospitalization expenses can indeed be considered as wide-ranging. It covers the expenses –

  • Before hospitalization
  • During hospitalization
  • After discharge

Pre-hospitalization expenses include:

  • Vaccinations
  • Medicines
  • Medical tests like sugar, BP, urine, and blood tests
  • Consultation fees of doctors

Generally, most health insurance companies will offer coverage up to 30 days prior to the date of hospitalization.

Post-hospitalization expenses include:

  • Advance vaccinations
  • Medical tests like kidney, MRI, ECG, Angiography, Endoscopy, and PET SCAN.
  • Advance machines
  • Doctor’s consultation charges
  • Organ replacement, dialysis, day care treatment, surgery, chemotherapy, etc.

Generally, insurance companies offer coverage for up to 45 to 90 days from the date of hospitalization. This period is called as the post-hospitalization period.

Why it is advisable to get pre and post-hospitalization insurance health covers?

If you did not know that these two expenses are covered by any comprehensive health insurance plans, then this article is meant for you. Get the much-needed details regarding pre and post-hospitalization in health insurance.

5 key benefits of buying a health insurance plan with pre and post hospitalization coverage:

  1. Cashless hospitalization: This cover enables you to opt for cashless hospitalization in any of the network hospitals which your insurer has enlisted. There need not be any cash arrangement before admitting the patient to the hospital. Fret not as you will get the best treatment without having to pay cash in a moment of urgency.
  2. Reimbursement of expenses: You need to submit your medical bills as well as reports of recent diagnosis for getting reimbursement from your insurer. All expenses up to the insured sum will be covered by your insurer, and you will not have to pay even a single penny.
  3. Treatment in network hospitals: Suppose your doctor has advised you to get hospitalized for a speedy and better recovery. Simply refer to the list of network hospitals that your insurer has provided. All you need to do is to get admitted to these hospitals quite easily and settle your claims.
  4. Absolute peace of mind: You will experience absolute peace once you add both pre and post-hospitalization expenses to your health insurance cover. You will survive easily in case of any financial emergency. Also, your hard-earned money won't go down the drain as you can save that precious money for their future.
  5. Coverage of treatment expenditure: This one is an all-encompassing insurance plan which covers expenses like medicines, diagnosis, doctor's fee, as well as chemotherapy, surgeries, day care facilities, and dialysis.

How to claim for pre and post-hospitalization expenses?

Timing has always been a key factor that either makes or breaks the deal while placing claims for pre and post-hospitalization expenses. Most of the insurance companies adhere to a stringent time frame for setting these claims. For instance, the claim application and document submission process regarding post-hospitalization expenditure need to be completed within the given amount of time. Otherwise, the insurer can very easily reject your claims on the grounds of non-compliance. Hence, always enquire about the time limit for making such claims from your insurer.

In order to file the claim, you need to submit all the required documents, such as:

  • Genuine hospital bills
  • Original prescriptions
  • Applicable medical certificates
  • Discharge summary
  • Doctor’s certificate
  • Medicine and drugs bills
  • Any other documents requested by your insurer

Once you submit all of the above-mentioned documents on time, the process for claim verification begins. The insurer will first check whether or not all the expenditures are related to the medical condition for which the patient has been admitted to the hospital. Once the verification is done, and everything is clear, the claim amount gets compensated depending on the terms and conditions of the health insurance plan.

Key points to keep in mind:

Are you looking forward to getting pre and post-hospitalization coverage in your health insurance? Then considering these few points will be of great help to you.

  • Expenses incurred because of Ayurvedic or Naturopathy therapies generally do not come under pre and post-hospitalization expenses coverage. Check with your insurer if it is offering you this facility or not.
  • Go through the policy terms to know about the time period for which these expenses will get covered. Generally, the coverage period is around 30 to 90 days.
  • Suppose a patient gets admitted because of kidney stone issues. The insurance plan will cover the expenses related to this health condition only. God Forbid, if the patient needs treatment for some other disease as well, he won’t get any coverage.

FAQs

Q: Should I buy the pre and post-hospitalization expenses separately?

Ans:No. It is better to opt for an all-encompassing health insurance plan which covers both pre and post-hospitalization expenses.

Q: What are the various expenses that get covered under post-hospitalization coverage?

Ans:It covers expenses that incur because of hospitalization and on-going treatments and those that get incurred during the recovery process after discharge.

Q: Can I get coverage for fever-related treatments even though I was hospitalized because of diarrhoea?

Ans: No. Your insurance plan will cover only those expenses which have been incurred because of the health condition that has brought you to the hospital.

Q: Up to how many days will I get the coverage on my post-hospitalization expense coverage plan?

Ans: Although the time period varies as per different health insurance companies, still, on average, the plan offers coverage of up to 45 to 90 days.

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