Health Insurance Coverage with Pre & Post Hospitalisation

We all know that a health insurance policy provides reimbursement for your treatment or hospitalisation expenses when you incur them. However, many are under the misconception that a health insurance policy is only applicable for expenses incurred during the actual hospitalisation. This is not true. There is something called pre and post hospitalisation expenses that are also covered by health insurance policies. These are expenses that a person may incur before or after the actual hospitalisation.

A pre-hospitalisation expense or a post hospitalisation expense are costs incurred by a patient before they are hospitalised and after they’re discharged respectively.For eg., if Mr. Adevelops a symptom of chest pain, he may first go to his family physician or a cardiologist, who will then prescribe additional tests like an ECG or an Echocardiogram to diagnose the problem. If the reports of these tests show a possibility of heart disease, Mr. Ashok’s doctor will advise him to undergo hospitalisation followed by the required surgery. After successful treatment, Mr. Ashok is discharged and asked to take medication, follow up with the doctor and get some tests done in the coming weeks.Now if Mr. A has health insurance coverage, his policy will not only cover the hospitalisation expenses and surgery cost in his case, but also cover expenses incurred via doctor’s fees and tests up to 30 days prior to hospitalisation. The same is true for investigations and doctor’s fees upto 30 or 60 days after the hospitalisation.

- Pre-hospitalisation expenses are only covered if the policy holder is eventually hospitalised. After investigations and doctor’s consultation if the patient is not hospitalised and sent home, then pre-hospitalisation expenses cannot be claimed.- Expenses are only reimbursed if they are related to the particular disease or ailment for which the patient is hospitalised.- Expenses include doctor’s consulting fees, diagnostic tests like X-Ray, Blood Tests, Urine Tests etc.

- Again, to claim post-hospitalisation coverage, getting hospitalised in the first place is mandatory.- Expenses incurred after hospitalisation like medicines, doctor’s fees, tests and physiotherapy may be covered in post-hospitalisation expenses.

Any test, medicine or doctor’s consultation that has no relation to the ailment for which the person was hospitalised is not covered under pre or post-hospitalisation expenses.

Thus, a health insurance policy has a wider application than what many people believe. The pre and post hospitalisation coverage is an important factor when choosing your policy. You’d want a policy that covers any expenses incurred before or after you get admitted. This will ensure that most of your health expenses are taken care of and you do not have to shell out your own money for expensive diagnostic imaging and tests.

The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.