What are Pre & Post Hospitalization Expenses in Health Insurance Plans?
What are pre and post hospitalsiation expenses in health insurance

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

Max Bupa

02 November 2020

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.


Here are the differences between the pre and post hospitalization expenses -


1. 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. 


2. 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.


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. 


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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