Understanding and Claiming Pre and Post-Hospitalisation Expenses in Health Insurance

Introduction

A health insurance policy covers much more than your hospitalisation expenses, for the treatments covered under your health insurance. It covers the costs of consultations and tests before hospitalisation. Also, it covers monitoring expenses after hospitalisation. These medical expenses incurred before and after hospitalisation are called pre-hospitalisation expenses and post-hospitalisation expenses. Pre and post-hospitalisation expenses are also a part of the treatment cost. Hence your health insurance should cover these expenses.

In this blog, we will discuss pre and post-hospitalisation coverage in health insurance in detail.

Pre-Hospitalisation and Post-Hospitalisation Expenses

The coverage for pre-hospitalisation expenses and post-hospitalisation expenses is one of the significant benefits of health insurance.

Pre-Hospitalisation Expenses

Pre-hospitalisation is the period before hospitalisation, during which medical tests and scans are carried out for diagnosis. If the diagnosis leads to the hospitalisation of the insured as per the doctor's advice, the expenses incurred before hospitalisation are called pre-hospitalisation expenses. These expenses include:

• Doctor's consultation charges.
• Investigation charges include the costs of diagnostic tests and scans as prescribed by the doctor.
• Cost of medicines.

Post-Hospitalisation Expenses

Post-hospitalisation is the period after the discharge from the hospital, during which follow-up treatments and medical tests are carried out to monitor the progress of the insured after the treatment. These expenses include,

• Cost of care and medicines required for recovery after discharge from the hospital.
• Follow-up consultation charges.
• Cost of dialysis, chemotherapy, daycare treatments, etc.

Points to Note about Pre and Post-Hospitalisation Expenses

Here are some points to keep in mind regarding pre and post-hospitalisation expenses.

• Pre and post-hospitalisation expenses are covered for 30 to 180 days depending upon your health insurance plan. Aditya Birla Activ Fit health insurance plan covers pre-hospitalisation expenses for 90 days before hospitalisation. Post-hospitalisation expenses are covered for 180 days after hospitalisation.
• Pre and post-hospitalisation expenses are covered only for the ailment for which the insured was hospitalised. No other treatment or medication is covered. Note that, pre and post-hospitalisation expenses are not covered if there is no hospitalisation.
• Pre and post-hospitalisation expenses also do not cover any alternative treatments such as ayurvedic treatments, acupuncture, naturopathy, etc.
• The policyholder can claim pre and post-hospitalisation expenses both, provided he furnishes all the original medical bills and doctor's consultation paper referring to the treatment covered.

Benefits of Including Pre and Post-Hospitalisation Expenses in Health Insurance

Including pre and post-hospitalisation expenses in health insurance brings down the treatment cost to a great extent. It also ensures fast recovery of the patient. Let us look at the benefits you can avail yourself with pre and post-hospitalisation cover.

1. Financial Support

Pre and post-hospitalisation coverage in your health insurance plan can greatly reduce your financial burden. Recovery care expenses after hospitalisation are usually high because post-hospitalisation recovery may take a longer time than hospitalisation. These expenses can drain your finances, hence including them in health insurance coverage provides financial support to the patient and his family.

2. Better Medical Coverage

Health insurance covering pre and post-hospitalisation expenses will provide better coverage. Such a plan will cover all the medical expenses from diagnosis till recovery. Aditya Birla health insurance offers Activ Health Platinum Enhanced insurance plan with enhanced coverage. This plan not only covers pre and post-hospitalisation expenses but also provides a chronic disease management program for managing lifestyle diseases through wellness and nutritional coaching.

3. Helpful during Medical Emergencies

Having comprehensive coverage with pre and post-hospitalisation expenses included makes you better equipped to deal with any kind of medical emergency. You can seek the best medical care without worrying about finances.

4. Protects your Savings

When you have all the medical expenses covered from diagnostic costs to recovery costs, you need not worry about your savings. All your savings and investments are secured against any unforeseen situation. Activ Assure Diamond health insurance plan by Aditya Birla is one such plan offering a sum insured of up to ₹ 2 crores with a range of benefits to help cover all your medical needs.

Claiming Pre and Post-Hospitalisation Expenses

Pre and post-hospitalisation expense claims are settled on a reimbursement basis. Health insurance companies have a defined time frame for claim settlement. To avoid claim rejection, the insured should initiate a claim and provide all the required documents within this time frame. Check with your health insurer about the time frame to claim a reimbursement beforehand. Once you are aware of the time limit to claim reimbursement, you need to fill out a reimbursement claim form and provide the following documents for your claim request to get approved.

• Original medical bills,
• Doctor's consultation papers and prescription,
• Hospital discharge summary,
• Medical test bills and reports,
• Any other relevant documents as required by the insurer.

After receiving all the documents, the insurer verifies the claim request. Once approved, the claim amount is reimbursed directly to your bank account.

Conclusion

Medical treatment involves much more expenses than just hospitalisation costs. A patient undergoes a series of tests and consultations before diagnosis. Similarly, constant monitoring is again required for recovery after the treatment. Hence, including all these pre-hospitalisation expenses as well as post-hospitalisation expenses in your health insurance coverage makes sense.

If you think your existing health insurance coverage is insufficient, add top-up health insurance to enhance your coverage. A Super Top-Up health insurance plan from Aditya Birla Health Insurance provides coverage beyond your base health insurance coverage. Aditya Birla Health Insurance plans cover pre and post-hospitalisation expenses to suit all kinds of requirements. For more details on health insurance coverage and major health insurance products, click here.