For a few reasons, medical expenses in India are getting more expensive over time. One significant factor is that medical technology and treatment options are improving. Although this is a good thing, it also means that the costs are going up.
Inflation, which plays a significant role in the general increase in prices, is another reason.
The prevalence of lifestyle diseases and chronic conditions necessitates long-term medical care, further contributing to the escalating expenses. The surge in demand for quality healthcare services has also led to increased private healthcare costs.
All these things place a significant financial burden on individuals and families. And that is why having health insurance covering both pre- and post-hospitalisation expenses become essential. It provides a safety net, so you don't have to be stressed about paying massive amounts for medical treatments.
It is imperative to understand the pre-hospitalisation meaning in insurance to know why you need coverage for it. Pre-hospitalisation expenses are the medical costs you must pay when you fall ill before getting admitted to the hospital. These expenses include consultation charges, medical screenings, and medicines needed for diagnosis. The good news is if you have health insurance, you do not have to pay for these expenses yourself. However, your health insurer has specific requirements to claim these expenses. The expenses you incur must be for the same illness for which you need hospitalisation. You may also have to share some of the costs under the co-payment or deductible clause.
If you have medical insurance, your insurer will cover pre-hospitalisation expenses for up to 60 days before your hospital admission.
Now let’s understand post-hospitalisation expenses meaning. After you leave the hospital, there are still medical costs you might have to deal with. These are called post-hospitalisation expenses. They include follow-up doctor visits, medications, medical tests, physiotherapy sessions, and other treatments to get better. These expenses are necessary for ongoing care and support to ensure you heal well. Health insurance often covers these expenses, usually between 30 and 90 days. Different insurance providers offer various terms of coverage.
Most insurance providers cover these expenses for up to 30 days after release from the hospital. Review your policy documents carefully, as this can vary from insurer to insurer. But remember, these expenses must be for the illness you were admitted for. If you opted for a co-payment or deductible, you have to share the costs in the agreed-upon percentage.
To understand how this policy works, let’s consider an example:
Suppose Mr Amit is suffering from severe kidney pain. On the 2nd of July, he visited a nephrologist who recommended a series of tests to diagnose the problem. On the 4th of July, Amit underwent the medical screenings and received the results the next day. He revisited his doctor on the 6th of July with all the reports, and the doctor diagnosed him with chronic kidney disease.
Following the doctor’s advice on the 8th of July, he got admitted to the hospital and received treatment for ten days, getting discharged on the 18th of July.
From the 19th of July to the 25th of August, Amit visited his doctor multiple times for follow-up check-ups, prescription changes, and therapy related to his condition.
Once he was declared fit, he submitted the entire bill to his insurer, including pre-hospitalisation expenses of about Rs 10,000, Rs 35,000 for treatment during a hospital stay, and Rs 12,000 for post-hospitalisation costs.
After submitting the bill, the claim department reviews and verifies the details. If found satisfactory, the claim will be processed, and the amount will get disbursed.
Buying this hospital cover provides the following list of benefits.
It covers hospitalisation charges and related expenses before and after hospitalisation.
It covers the cost of treatment necessary after discharge from the hospital, such as physiotherapy.
You can avail of cashless medical care at any of the network hospitals of your insurer and avoid paying out-of-pocket expenses.
Pre- and post-hospitalisation coverage encourages a more holistic approach to healthcare. It ensures that all aspects of treatment and recovery are adequately covered.
With this coverage, policyholders are more likely to seek timely medical attention, as they don't have to bear the full burden of expenses themselves.
Pre-and post-hospitalisation coverage acts like a cushion and keeps you prepared for any unexpected medical emergency. As your treatment expenses are covered even after you get discharged from the hospital, you can focus on recuperating without worrying about the financial implications.
You might have to undergo several diagnostic tests and multiple consultations with your doctor before and after hospitalisation; this coverage could help prevent the drainage of your savings.
You can consider reviewing the features of various health insurance policies offered by HDFC Ergo. We offer many policies with hospital covers for an average duration of 45 to 90 days. The coverage will pay for expenditures relating to doctor visits, medication, treatment, diagnostic tests, and aftercare (i.e., physiotherapy and other treatment options). Some policies offered by us include coverage for pre-hospitalisation expenses for up to 60 days and 180 days for post-hospitalisation expenses. You can look up various policies online or get in touch with our consultants, who will guide you through the process and help you find the right plan that matches your needs.
In order to claim these expenses, follow the steps below.
Inform your health insurance company about your hospitalisation immediately or within 24 hours of admission. Provide your policy number, name, hospital name, diagnosis, and expected stay duration.
If you are obtaining cashless treatment at a network hospital, submit the pre-authorisation form and the required documents to the hospital or the insurer's representative. If you are paying for the treatment at a non-network hospital, safely keep all the original bills, receipts, prescriptions, and reports.
Collect the hospital’s final bill and discharge summary. If you have obtained cashless treatment, the insurer will clear the invoice directly with the hospital after deducting any co-payment or non-payable expenses. If you have paid for the treatment, you must file a reimbursement claim with the insurer within the stipulated time limit.
To claim pre-hospitalisation expenses and post-hospitalisation costs, you will need to submit the following documents along with your reimbursement claim form:
- Original bills, receipts, and prescriptions for medicines, tests, consultations, etc., incurred before and after hospitalisation.
- Original reports and certificates for diagnosis and treatment
- A copy of your health insurance policy
- A copy of your identity proof
After verifying your claim and documents, the insurer will process and transfer the claim sum to your bank account within 30 days, as per IRDAI norms. If rejected, you will get a letter with the reason and the appeal procedure.
Consider the following things before opting for this coverage or raising a claim under it.
• Check the time limit for the pre- and post-hospitalisation coverage. Depending on the policy and the insurer, it may vary from 30 to 180 days.
• Claims are admissible only if you, as insured, are hospitalised.
• Compare the coverage scope and benefits of different plans with pre- and post-hospitalisation coverage. Go for a policy that meets your requirements and budget.
• Read the policy terms and conditions carefully before buying the health insurance plan. Know the exclusions, limitations, sub-limits, co-payments, deductibles, etc., that may affect your claim settlement.
• Choose a policy that has a wide scope of coverage, particularly f you have pre-existing diseases.
• Check the waiting period of your chosen policy so that you make full use of the coverage in times of need. Usually, one must wait for 30 days before the coverage starts. Talk to your insurer to get clarity on the duration of your coverage.
Pre-hospitalisation expenses include X-rays, CT scans, MRIs, blood tests, consultations, medications, etc., done before hospital admission. In contrast, some post-hospitalisation expenses include follow-up visits, prescriptions, physiotherapy, and diagnostic tests.
Several health insurance policies include it within their scope of coverage but read the documents carefully to understand the exact terms and conditions.
To claim post-hospitalisation expenses, submit the relevant medical bills, prescriptions, and receipts to your health insurance provider. The insurer will review the documents and process your claim accordingly.
The insurer rejects the claim if it is made before or after the stipulated time limit specified by the policy terms and conditions. Rejection also happens if the claim is for an unrelated illness or injury that is not covered by the policy or has no connection with the hospitalisation of the insured person.
Health insurance typically includes coverage for in-patient treatment under AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) at government-recognised hospitals and/or accredited by the Quality Council of India or the National Accreditation Board on Health (NABH). However, checking with your insurer to confirm whether they also cover post-hospitalisation expenses is essential.
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