Before we talk of claiming pre and post hospitalization cover, let’s understand the terms themselves. As their names suggest, the expenses incurred before hospitalization are filed under pre-hospitalization and treatment expenses after discharge from the hospital are filed under post-hospitalization. Claiming these expenses is a facility provided by health insurance companies and can only be availed by the insured. These expenses include OPD medicines, prescriptions given by the doctor, lab tests etc. Then comes the matter of how many days before hospitalization or for how many days after discharge can one get coverage. Generally, insurance companies cover medical expenses up to 30-60 days before admission and 60 to 180 days after discharge from the hospital.

(Read more: myUpchar Bima Plus)

  • Pre-hospitalization expenses: Before a patient is admitted to the hospital, one or more tests may be required. Doctors and experts recommend getting tests done so that the disease or medical condition can be diagnosed and staged accurately and treatment can go in the right direction. Given the ever-increasing number of diseases, doctors do not take risks and prescribe tests even with minor or mild symptoms if there is room for doubt. Generally, under any regular health insurance policy, tests done before 30 days of hospitalization are covered under this policy. However, this duration can be more or less depending on the insurer. Pre-hospitalization also covers blood tests, urine tests, X-rays etc.
  • Post-hospitalization expenses: The expenses from the time of hospitalization until discharge are claimed under inpatient hospitalization. Post-hospitalization expenses are those expenses that are incurred after the insured person is discharged from the hospital. These include medication, follow-ups and tests, while treatments such as acupuncture are not covered. Some health insurance companies offer coverage up to 60 days after discharge from the hospital, while others may offer coverage for longer. It could also depend on the policy to some extent.

While buying a policy, it is important to keep some general things in mind so that you get the best coverage possible even if it ends up costing you a few extra bucks. If you take the myUpchar Bima Plus policy, you get 30 days pre-hospitalization and 60 days post-hospitalization coverage as well as free online doctor consultation.

(Read more: What is Top Up Health Insurance)

  1. Claiming pre and post hospitalization expenses
  2. Documents required for pre and post hospitalization claim
  3. Importance of pre and post hospitalization cover
  4. Benefits of pre and post hospitalization cover
  5. How does pre and post hospitalization cover work
  6. Rejection of pre and post hospitalization claims
  7. Ayurvedic treatment claims under post-hospitalization cover
  8. Things to remember

It is very important to keep in mind the time frame for claiming medical expenses before and after hospitalization. You can get information about this time from the policy bond. If you make a claim before or after this stipulated time, the insurance companies can reject it.

For example: Suppose you need to go to the hospital and see a doctor, then you will have to inform the insurance company at the time mentioned in the policy bond. If you want, you can also inform the TPA about this. TPA refers to a third-party administrator, who is contracted by some insurance companies to act as an intermediary. Currently, online services can be availed rapidly, that is, you can also file a claim on the company's website. Once the papers reach the insurance company, they will start the process of verification. The insurer will check that the expenses are related to the same medical condition for which the patient was admitted to the hospital. If the expenses are not related then the claim will be cancelled and if everything is in order then the claim will be accepted after verification as per the terms and conditions of the policy.

At present, for claiming both pre and post hospitalization, the most important are the original bills received from the hospital like the certificate given by the doctor for reimbursement, doctor’s prescription as well as fee receipt and pharmacy bills (drugs prescribed by the doctor). While taking a health insurance policy, applicants should go through the policy bond first to avail all the facilities easily in the future.

Insurance policies have a long list of related documents and it is advised to read them thoroughly so that the insured is clear about the terms and conditions.

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The following documents are generally required for pre and post hospitalization claims:

  • Discharge summary
  • Original bills, including cost break-up
  • Original receipts (doctor fees, X-ray film and report, blood test report and receipt)
  • Lab and test report
  • Copy of invoice/sticker/barcode, if implanted
  • Doctor's consultation letter
  • KYC Form
  • Hospital claim form which should be signed by the insured duly filled in.

Most of the time, people think that a mediclaim policy or a family floater health insurance policy only covers hospital expenses but that is not true. Due to this lack of awareness, people are unable to make the most of their mediclaim. As you may now know, pre and post hospitalization expenses are also a part of your health insurance policy.

 

Suppose, whenever you fall ill or find some abnormalities in your body, you immediately go to consult your doctor. The doctor does his usual check-up in the clinic and prescribes some medicines for relief. But, after completing the medication course, if your condition does not improve, the doctor may recommend hospitalization for further diagnosis and treatment. In such cases, all the expenses (like doctor visits, prescription medicines and tests) incurred before being admitted to the hospital can be covered by your policy. So while taking health insurance, remember to opt for the pre-hospitalization coverage option.

(Read more: Cashless Health Insurance)

A good health insurance plan should also cover pre and post hospitalization expenses. The advantages of pre and post hospitalization cover include:

  • Reduces financial burden: Pre and post hospitalization expenses can be reimbursed, thereby reducing the additional financial burden on you.
  • Freedom from medical expenses: With facilities like pre and post hospitalization, you can get treatment without worrying about the expenses.
  • Helps in an emergency: In cases of a health-related emergency, the biggest challenge can often be money. If your policy has facilities like pre and post hospitalization, then you will be worry-free even in an emergency and will not have to be in anyone’s debt.
  • Beneficial in savings: People often rush to big hospitals for good treatment, but the cost of treatment there is also huge - this can directly affect your savings. With facilities like pre and post hospitalization cover, your savings will not be exhausted. In case of reimbursement, you will get all the money spent on these expenses back (if the bill is not more than the sum insured).

(Read more: Difference between health insurance and life insurance)

Pre and post hospitalization cover in health insurance works on the reimbursement model. Let's understand with examples here:

  • Suppose someday you went to the doctor and they recommended some tests. After seeing the reports, the doctor advised you to be admitted to the hospital and you were admitted. In this case, the cost of doctor's fees, prescribed medicines and tests will all come under pre-hospitalization expenses.
  • Suppose the patient needs hospitalization, is undergoing treatment or is being discharged - then this will be called hospitalization cost. Insurance companies also settle such expenses through cashless mode with the hospitals in their network.
  • The follow-up treatment will come under the post-discharge cost from the hospital. Follow-up treatment is the care given to a patient over a period of time after the treatment of a disease is over. This includes regular medical checkups, which may include a physical test, blood tests and imaging tests.

The medical bills related to the illness for which the insured was hospitalized need to be conveyed to the insurance company or TPA in a timely manner. When the medical bill sent by you is verified, the insurer reimburses all the bills, meaning that the money is sent to the account provided by the insured. However, this does not happen immediately and may take a few days (usually 30 days or more).

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In order to avail the benefits of health insurance, it is important for the insurance provider to know about your health insurance claim at an appropriate time. Keep in mind that there are certain conditions in which a claim for pre-hospitalization and post-hospitalization medical expenses can be rejected. A common example of this is that if the insured is incurring medical expenses for a condition outside the terms covered under pre and post hospitalization coverage, he cannot claim for pre and post hospitalization. This is why it is important to know what is being covered in pre and post hospitalization.

On the other hand, you should also make sure that you are choosing an insurance policy with a provider that has a good claim ratio. A high claim ratio means that the insurance company has settled more claims and a lower ratio indicates a lower number of claims settled by the insurance company, which is not a good sign as a customer.

Buying health insurance is the best and easiest way to protect yourself in view of the rising healthcare expenses. People are now becoming more aware of health risks and their effect on your finances and hence, health insurance plans are entering the market more strongly than ever. With the large variety of health insurance policies available in the market today, the trend of getting good coverage before and after hospitalization is in full swing.

(Read more: What does health insurance cover)

Some insurers cover Ayurvedic treatment expenses, while some do not - it all depends on which insurance company you choose. If this is important to you, then you should go through the inclusion and exclusion of all the health insurance policies you’re considering before choosing the right one.

(Read more: What is Senior Citizen Health Insurance)

Here is a list of things to note about the expenses associated with pre and post hospitalization:

  • The cost of treatment before and after hospitalization should be linked to the condition for which the patient was admitted.
  • Post-discharge claims are generally considered only if they have been made during a specified period (for example, 45 to 90 days). These days may be different for different insurance companies. Any expenses incurred after the specified time limit will not be covered by the insurer.
  • To make a claim, ensure that you have submitted all the required documents to the insurer/TPA.
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