Heres what you need to know about pre-& post-hospitalisation cover!

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12 Jun 2023

Mastering Pre- & Post-Hospitalisation Coverage: Vital Insights

Having a health insurance plan helps you overcome financial issues that might occur during your bad health days. Remember, a good health insurance policy does not only offer aid during medical emergencies but also covers pre and post-hospitalisation costs. Let's understand in detail.

What is the pre-hospitalisation cost in terms of health insurance?

Pre-hospitalisation covers the cost that incurs due to the test and diagnosis that happens before getting hospitalized. Doctors conduct several tests to confirm the disease or condition before prescribing medicines and treatments. The tests carried out within 30 days of the pre-hospitalisation period are often covered under any ordinary health insurance coverage. Yet, the amount could change depending on the insurance type and add-ons. Blood tests, urine tests, X-rays, MRIs, and other tests are included in the pre-hospitalisation expenditures category.

What is the post-hospitalisation cost of health insurance?

Post-hospitalisation costs are those that are paid for following the insured's release from the hospital. The post-hospitalisation charges include costs for things like medication, check-ups, and testing after a patient is discharged. People are covered by the insurance company for up to 60 days following discharge. Nevertheless, the coverage does not extend to treatments like acupuncture, etc. Again, the type of policy chosen will determine the length of post-hospitalisation coverage.

Claiming pre and post-hospitalisation costs in health insurance?

When claiming pre and post-hospitalisation costs, timing is extremely important. Insurance providers adhere to a certain timeline for handling such claims. During the allotted time after receiving treatment, the claim application and document submission process for post-hospitalisation costs must be finished. Alternatively, it may be disregarded due to non-compliance. Because of this, you must be aware of the deadline for filing such claims and follow it while settling a claim.

What are the documents required to claim pre and post-hospitalisation?

The following are the documents required to claim pre and post hospitalisation -

  • Original hospital bills

  • Medical certificates

  • Original prescription

  • Medicines and drugs bills

  • Other documents as requested by the insurer.

When the documents are sent in, the claim verification procedure gets started. The insurer will determine whether the costs are connected to the same medical issue that led to the patient's admission or not. If the costs are unrelated, the claim may be rejected. The claim amount will be paid out in accordance with the policy's terms and conditions after verification.

What are the things to consider regarding pre and post-hospitalisation insurance coverage?

Below are the things to consider about pre-hospitalisation and post-hospitalisation coverage -

  • The patient's admitted condition should be the same as the cost of treatment, both pre and post-hospitalisation.

  • Only if the expenditures were incurred within a certain time frame will they be considered for the post-hospitalisation claim (for example, 45 to 90 days). Beyond the specified time period, the insurer will not pay any costs incurred.

  • Make sure you include all the required documentation when making a claim, as specified by the insurer or TPA (third-party administrator).

Conclusion

Frequently, medical expenses exceed what you need to pay for your hospital stay. Except in situations of accidents, if you need to be hospitalised, you would have had a number of tests beforehand, and you could still need more tests, medicine, or therapy afterward.

But, given the escalating cost of healthcare, these fees might wind up being quite significant and deplete all of your savings. As a result, it's critical that you opt for a health insurance plan that covers pre and post-hospitalisation costs.

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Team Kotak GIC

The content of this blog has been created and carefully reviewed by the esteemed team at Kotak General Insurance, with the sole purpose of providing valuable guidance and sharing insights on the importance of general insurance. Our objective is to assist users in making informed decisions when purchasing or renewing insurance policies for their cars, bikes, and health. Our expertly curated information aims to empower our readers with the knowledge they need to protect their valuable assets and financial interests.