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What are Pre & Post Hospitalization Expenses in Health Insurance Plans?

Posted On : 20 July 2023, 8 Months Ago. Blog Total Read 6138

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With the growing demand for health plans, insurance providers are offering a slew of options for buyers to choose from — be it individual health insurance plans or family health insurance plans. Beyond the different types of health insurance plans offered, insurers are also offering specialized benefits like covering pre hospitalization expenses, post hospitalization expenses, critical illnesses, and more.

Consumers are now spoilt for choice when it comes to buying health insurance. Learning the vocabulary around health insurance is essential in finding a policy suited to your needs. Comparing policies is more important than ever as competition in the market is fierce. Some terms that revolve around health insurance are ‘pre-hospitalization expenses’ and ‘post hospitalization expenses.’ Here’s what they mean.

What are the hospitalization expenses in health insurance?

When buying health insurance, your goal is to find a policy that will cover expenditures like that of hospitalization, diagnostic testing, surgery costs, and more associated with an unforeseen illness or accident. All these expenses fall under the blanket term of ‘hospitalization expenses.’ However, there are costs associated with being ill before one is even admitted as a patient into a hospital. These costs can be divided into post and pre- hospitalization expenses. Typically, most comprehensive individual health insurance plans and family health insurance plans provide coverage against such expenses.

Pre-Hospitalisation Expenses in Health Insurance

These costs refer to any medical expenditures that are incurred by the policyholder before they are admitted into a hospital as a patient. This limit ranges from any medical expenses between 30 days to 60 days before the person is admitted into the hospital. Once in the hospital, the person is eligible for in-patient treatment. Listed below are some expenses which are considered as pre-hospitalization expenses in health insurance policies:

Medical Tests for diagnosis of one’s condition.
Prescription medication by one’s doctor/medical practitioner in the lead up to hospitalisation for which inpatient claim has been accepted.
Fees paid towards a doctor/medical practitioner.

Post Hospitalisation Expenses in Health Insurance

These costs refer to any medical expenditures that are incurred by the policyholder for anywhere between 30 days to 60 days after they have been released from the hospital for out-patient care. Post hospitalization expenses are referred to as ‘recuperation expenses.’ Keep in mind that one may not necessarily be prescribed ‘outpatient care’ for their illness and may still be eligible for a post hospitalization expenses cover. This is because this covers medical cost that the policyholder can take to regain their pre-illness condition after they have been released from hospital care. Expenses include:

Medical care in the form of prescribed drugs or tools that the patient has to follow through with at home after hospital care.
Scheduled medical check-ups with a practitioner/vaccinations/diagnostic tests to assess one’s condition after hospitalization.

Why is it Important to have Healthcare Insurance that covers Pre and Post-hospitalisation Charges?

There are various reasons why you need to buy a health policy which includes pre and post-hospitalisation coverage.

Extensive Coverage

A medical aid policy caters to all your healthcare needs in time of an emergency. However, it is important to have coverage that not only assists in the time of an emergency but also before and after it. Pre and post-hospitalisation coverage ensures complete safety for you and your dear ones.

Coverage of Treatment Cost

It is often noticed that more than hospitalisation charges, it is the treatment and medication charges that are heavier and need more coverage. For instance, a person who was admitted to the hospital for just one week might need to go through treatment for months. Post-hospitalisation expenses include the cost of treatment, dialysis etc. and hence are essential.

Network Hospitals

If you get your treatment done in one of the hospitals listed in the network list of your insurer, then you are in luck. You would have hassle-free treatment, and cashless payment will be insured for pre and post-hospitalisation.

How to Claim the Pre and Post-hospitalisation Expenses?

To claim the pre and post-hospitalisation expenses, you need to be very particular about the timing. The insurers keep a specific time frame for wherein you can claim for pre and post-hospitalisation claims. The claims might very much be denied if they aren't filed in due time.

An important fact to keep in mind is that pre and post-hospitalisation expenses work on a reimbursement basis if you do not avail it from hospitals in the hospital network list.

Here are a few important documents that are required:

Hospital Bills (original)
Medical certificates
Prescription documents
Bills of the medication
Health card
Any other important documents if asked by the insurer

When are pre and post hospitalization claims not accepted?

To reap all of the benefits of health insurance, it is important to be aware of the times the insurance provider is likely to accept your health insurance claims. Keep in mind that there are certain conditions in which your pre-hospitalization and post hospitalization expense claims may not be accepted by your insurance provider. One common instance of this is if the cause for being in the hospital is completely different from the pre or post hospitalization expenses you are claiming your insurance cover for. These causes must be linked to the same condition for your health insurance claims to be accepted. Ensure you seek out an insurance policy with a provider that has a good claim settlement ratio as this signals reliability and efficiency from your provider.

Conclusion

Buying health insurance is one of the best ways to secure yourself in 2020. Individuals appear to be growing more aware of its importance and, so, health insurance plans appear to be penetrating the market more strongly than ever before. The importance of getting good pre and post hospitalization coverage is paramount considering the sheer amount of health insurance policies available on the market today.

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