Pre & Post Hospitalisation Coverage – Understand the Importance
3 min read
・Jul 05, 2024
Faisal got into a terrible road accident. While his insurance policy had covered the weeks-long hospitalisation cost, the post-hospitalisation medications and checkups left a huge financial burden.
In the last five years, treatment costs in India have increased 2X. When considering health insurance, people tend to focus more on medical bills related to hospitalisation. Charges like room rent, medication, operation theatre charges, surgeons’ fees, medicines, injections, etc., pile up, increasing the medical bill that you hope your insurance will cover.
However, when it comes to treatment, you should look beyond the hospitalisation expenses at the time you stay in the hospital. You might need follow-up treatments for complete recovery.
Policies that cover pre and post-hospitalisation expenses cover beyond the medical bills incurred during your hospital stay.
Let’s dive deep into these expenses to understand how to get maximum financial support during medical emergencies.
Pre Hospitalisation Expenses Meaning
All medical bills incurred before getting hospitalised for an illness are termed pre-hospitalisation expenses. Unless there is an accident, your doctor would recommend hospitalisation based on your medical condition. They evaluate your health based on several types of scans and tests needed for the diagnosis. The pre-hospitalisation expenses include the cost of these tests like CT scans, blood tests, X-rays, MRIs, angiography, etc.
In case you expect probable hospitalisation, collect all prescriptions, bills and diagnostic reports, which might prove essential to claim your expenses. Get in touch with your insurer and submit all medical records as asked. If your plan covers these expenses, you can claim with the insurance company for all bills 30 days before hospitalisation.
However, the insurer may choose to cover only parts of those bills covering tests that are related to your hospitalisation.
Post Hospitalisation Expenses Meaning
Post-hospitalisation expenses include charges incurred after you are discharged from the hospital. It includes follow-up treatment and support costs.
For example, if you need physiotherapy or assistance for a few weeks after your hospitalisation, your insurance policy could cover those with post-hospitalisation expenses coverage. Generally, many insurers cover these expenses for 45 to 90 days after hospitalisation. Make sure to organise all documents related to check-ups, medications, and tests post-discharge.
If you prefer to receive alternative treatments like acupuncture to speed up recovery, it may not be covered under post-hospitalisation expenses. Some insurers, however, extend coverage for ayurvedic treatments, but this depends on the type of policy coverage.
Comparison of Pre and Post-Hospitalisation Coverage
The average medical cost for treating infectious diseases has increased to Rs. 1.7 lakh from Rs. 80,000. As treatment costs are higher due to medical inflation, buying insurance plans with extensive coverage is crucial. Certain parts of pre and post-hospitalisation charges will be covered depending on the policy provider. Understanding the importance of these expenses will help you stay prepared for medical emergencies.
| Feature | Pre-hospitalisation expenses | Post-hospitalisation expenses |
| Covered expenses | Diagnostic tests, expert consultations, medications | Follow-up visits, medication refills, rehab, dialysis, physiotherapy, domiciliary care (if needed) |
| Benefits | Timely diagnosis, reduced stress, and reduced financial burden | Complete recovery with financial support, reduced risk of readmission, minimal dependency on others |
| Limitations | A limited number of days before hospitalisation, exclusions, sub-limits or caps | Limited number of days after hospitalisation, exclusions, condition-specific coverage, sub-limits or caps |
| Approval | May require pre-authorisation | May require approval |
| Exclusions | Non-medical expenses, cosmetic treatments | Non-medical expenses, preventive treatments |
Both pre and post-hospitalisation coverage varies with every insurance provider. To avail of these benefits, you must submit numerous documents such as:
- medical bills
- diagnostic reports
- prescriptions
- discharge summaries
- follow-up reports
Also, the timeframe for coverage varies from one insurer to another. Ideally, you must find an insurance policy that covers these expenses for a more extended period without many exclusions.
Factors Affecting Choice
Premium affordability plays a huge role when choosing pre- and post-hospitalisation coverage.
For example, if Rohan decides on a Rs. 5 lakh policy with basic coverage like hospitalisation expenses (room rent, doctor fees, surgery costs, etc.), the annual premium will be between Rs. 8000 and Rs. 12,000. However, if Rohan wants extensive coverage, including pre- and post-hospitalisation expenses coverage, his premium would go up from Rs. 10,000 to Rs. 15,000.
Also, your pre and post-hospitalisation coverage will only apply if the expenses incurred are related to the in-patient treatment you received. Sometimes, the doctor may suggest multiple tests to make a diagnosis. If those tests are not related to your hospitalisation treatment, the policy won’t cover them. When you wish to claim pre and post-hospitalisation expenses, ensure that you submit the claim within the timeframe with all necessary documents.
Key Takeaways
Pre- and post-hospitalisation coverage offers superior coverage, including treatment costs. Before getting your diagnosis and treatment, ensure that the hospital you go to is recognised in the network hospital list. Otherwise, your claim may be rejected. Extended coverage allows you to claim for all medical expenses related to the insured diseases. The insurer will verify your claim, and if found satisfactory, you will be reimbursed for all eligible expenses.
Additionally, you can consider platforms like PhonePe for a seamless and hassle-free insurance purchase experience.
Frequently Asked Questions
Do pre and post hospitalisation benefits need to be purchased separately in a health insurance plan ?
Can AYUSH treatment expenses be covered under post hospitalisation benefits ?
How do I know if my health insurance plan covers pre and post hospitalisation ?
Do the health insurers on PhonePe provide these benefits ?
How to raise a claim for pre and post hospitalisation ?
