New
AROGYA SEVA KENDRA - Free Health Consultation -Click Here to Know More|BIMA BHAROSA - An Integrated Grievance Management System to facilitate the policyholders and complainants to file their grievances with IRDAI -Click here to know more|Click here to link your KYC|Policies where the risk commencement date is on or after 1st October 2024, all the policy servicing shall be as per the IRDAI (Insurance Products) Regulations, 2024 dated 20th March 2024 and Master Circular on Health Insurance Business dated 29th May 2024

Pre- and Post-Hospitalisation Cover in Health Insurance

India +91✓

Understanding Health Insurance Coverage for Pre- and Post-Hospitalisation

 

With rising healthcare costs, it is difficult to get the recommended treatment you need without a proper health insurance plan. Some expenses, like pre- and post-hospitalisation expenses, further add up to the overall medical expenses of an ailment or surgery.


Pre- and post-hospitalisation coverage can shield the insured against his/ her savings from getting drained and makes it easier to settle their medical bills during emergencies. Thus, you can secure your family’s health and financial future.

 

What are Pre-Hospitalisation Expenses?


The medical expenses incurred before the insured gets admitted into the hospital for the ailments or surgery are the pre-hospitalisation expenses. Tests done for investigation purposes as per the doctor’s recommendation, and medicinal expenses are covered under the pre-hospitalisation expenses for a specified time limit as per the policy.


Pre-hospitalisation expenses include consultation fees, medicine bills, and investigation charges. The insured is required to submit the prescriptions and reports along with the original bills while making a claim for pre-hospitalisation.

 

Also Check: Health Insurance Plans for Parents

 

What are Post-Hospitalisation Expenses?


Upon discharge from the hospital, there are still some medical expenses left. For better financial support, you need to ensure that your health plan also covers the post-hospitalisation expenses.


Health Insurance Policy covers the post-hospitalisation expenses, then the insurance company shall compensate such incurred medical expenses related to the admissibility of hospitalisation requiring in-patient care for a certain period from the date of discharge from the hospital.


Post-hospitalisation expenses include the costs of medications after surgery, revisits or follow-up consultations, and tests that are performed after discharge from the hospital. Most Health Insurance plans cover these expenses for the specified number of days for the post-discharge period from the hospital.

 

Reasons to Buy Health Insurance With Pre and Post-hospitalisation Cover

 

Take a glance at a few reasons why you must purchase a health insurance policy with pre- and post-hospitalisation cover:

 

  • Enhanced Coverage: If you select pre- and post-hospitalisation cover, the scope of coverage of your health policy increases. It not only covers the medical expenses incurred during hospitalisation but also before being admitted and after being discharged. Thus, it can lower your out-of-pocket expenses significantly.
  • Reduces Financial Strain: Pre- and post-hospitalisation expenses can be really expensive. Sometimes, the money spent before and after hospitalisation is equal to the hospitalisation expenses. As a result, your savings can deplete in just one single medical bill. But if your health policy covers these expenses, your financial burden will be negligible.
  • Better Prepared for Medical Emergencies: If your health plan comes with pre- and post-hospitalisation cover, you are better prepared to deal with any medical emergency. No matter when you face a health emergency, your insurance company will pay for your hospitalisation and post-hospitalisation expenses.
  • Lowers Stress: A health plan with pre- and post-hospitalisation cover, you can avail treatment for a disease or medical condition without any stress. You can focus completely on getting fully cured and do not need to worry about arranging a large amount of funds to pay your pre- and post-hospitalisation expenses.
  • Cashless Coverage: Another benefit of purchasing a mediclaim policy with pre- and post-hospitalisation cover is that you get cashless coverage. You can undergo pre-hospitalisation tests and avail post-hospitalisation treatments at the tied-up hospitals of your insurers. You can get cashless treatment coverage and won’t have to pay any upfront costs for pre- and post-hospitalisation.

 

The Convenience of Network Hospitals

 

Multiple leading insurance providers collaborate with hospitals to facilitate the convenience of cashless treatments. Therefore, an insured person can select a network hospital anywhere in the country to utilise this advantage. This is why, when choosing an insurance provider, individuals must conduct in-depth research to clearly understand the policy terms and conditions. Furthermore, one needs to go through the list of inclusions and exclusions to make an informed decision. This is where it is crucial to select an insurer that offers not only extensive coverage but also a large network of hospitals.

 

Process to Claim Pre-Hospitalisation and Post-Hospitalisation Expenses

 

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

 

  • Pre-Hospitalisation Expenses: When you plan a hospitalisation, ensure to keep all medical bills, authorised prescriptions, and diagnostic reports, as all mentioned documents may be essential for reimbursement.
  • Post-Hospitalisation Expenses: After being discharged from the clinic, continue to collect bills for follow-up consultations, medications and post-hospitalisation treatments. Submit these expenses to your insurance provider along with the necessary documents like discharge summary, medical bills, doctor’s prescription, etc.

 

Things To Remember While Buying Health Insurance with Pre- And Post-Hospitalisation Benefits

 

Here are a few important aspects that you must keep in mind while purchasing a health insurance plan with pre- and post-hospitalisation coverage:

 

  • Fixed Coverage Period: Pre-hospitalisation and post-hospitalisation expenses are covered only for a fixed time period, generally ranging from 30 to 90 days before and 60 to 180 days after discharge, depending on the specific policy.
  • Medical Condition: The insurance provider will cover pre- and post-hospitalisation expenses only for that medical condition for which you were admitted to the hospital. Any expenses incurred beyond this time period will not be covered under the particular policy.
  • Hospitalisation is required: The coverage for pre-hospitalisation and post-hospitalisation expenses gets activated only if you get admitted to the hospital. You cannot claim these expenses if you were not hospitalised.
  • Submit Bills and Invoices: When raising a claim for pre- and post-hospitalisation expenses, make sure to submit the bills and receipts for all pre- and post-hospitalisation expenses to your insurance provider.

 

Also Read: Maternity Health Insurance

 

Health Insurance safeguards your family in case of unplanned medical emergencies. The skyrocketing medical costs quickly evaporate your savings if you are inadequately covered under a health insurance policy. So, before getting a health plan, look for extensive coverage for pre- and post-hospitalisation expenses in the policy.

FAQs

Pre-hospitalisation in health insurance refers to the medical expenses incurred before a patient is admitted to the hospital. These may include consultation fees, diagnostic tests, and prescribed medicines.

Pre-hospitalisation coverage means that your health insurance policy will reimburse the medical costs you incur before hospitalisation, provided they are directly related to the illness or condition that requires admission.

Pre-hospitalisation expenses typically cover doctor consultations, diagnostic tests, prescribed medicines, and investigation charges. The exact coverage depends on the terms of your health insurance plan.

In health insurance, pre- and post-hospitalization expenses define the medical costs incurred before and after a hospital stay, which are often covered by the health insurance policy. Costs for Doctor visits, tests, and diagnostic procedures before admission are pre-hospitalization expenses. Meanwhile, post-hospitalization expenses include follow-up care, medication, and extra tests after discharge.   

Yes. Considering the expenses incurred for pre and post-hospitalisation, most Health Insurance policies cover them. Such expenses are covered if they are related to the in-patient hospitalisation for specific days mentioned in the policy clause.

These are expenses incurred after discharge, like medicines or follow‑up tests, within policy limits. For e.g. Follow‑up visits, medicines, or tests prescribed after discharge (within a defined number of days) may be covered as post‑hospitalization expenses. 

These are medical expenses incurred before admission, such as tests or consultations, covered for a defined period. For e.g. If you were admitted on 10th June and had diagnostic tests or doctor consultations on 1st June related to the same condition, those expenses may be covered as pre‑hospitalization.

Hospitalization expenses are covered as per your sum insured and policy limits. Some expenses may have caps or sub‑limits, which are clearly mentioned in your policy.

Expenses incurred immediately before or after hospitalization may be covered, depending on the pre‑ and post‑hospitalization limits in your policy.

Pre- and Post-Hospitalisation Cover in Health Insurance
Disclaimer:

Health Insurance Coverage for pre-existing medical conditions is subject to underwriting review and may involve additional requirements, loadings, or exclusions. Please disclose your medical history in the proposal form for a personalised assessment. 
The information provided on this page is for general informational purposes only. Availability and terms of health insurance plans may vary based on geographic location and other factors. Consult a licensed insurance agent or professional for specific advice. T&C Apply. For further detailed information or inquiries, feel free to reach out via email at marketing.d2c@starhealth.in