When someone needs medical care, the expenses can stretch much beyond the stay in the hospital. Sometimes a major expenditure is done before as well as after the hospitalisation. It is therefore recommended that you opt for pre and post-hospitalisation in health insurance. In most cases, pre and post-hospitalisation in health insurance are covered for a specified number of days, mostly 30 and 60 days respectively. Pre-hospitalisation can include diagnostic investigations while post-hospitalisation can include medication, tests, and follow-ups. However, the coverage may vary from insurer to insurer.
Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.
The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918
The treatment cost incurred after being discharged from the hospital is termed as post-hospitalisation expense. Usually, you may incur some medical expenses for medications and follow-ups after your discharge. These medical consultations and prescriptions might be part of your recovery process and are covered under post-hospitalisation expenses.
Most insurance companies cover post-hospitalisation expenses for up to 60 days after being discharged. However, this coverage period shall vary from one insurer to another. It is recommended to check the terms and conditions associated with post-hospitalisation expenses.
How to Claim Pre & Post Hospitalisation Expenses
Raising a claim for pre and post-hospitalisation expenses should be completed within the stipulated time period without fail. If you do not intimate your insurance provider and submit the documents in time, your health insurance claim may be rejected due to non-compliance. So, make sure you are aware of the time frame set by your insurer for filing insurance claims. Let’s understand the steps to claim pre and post-hospitalisation expenses in health insurance:
Step 1
File an insurance claim within the stipulated period set by the insurance company. Furthermore, make sure your health insurance claim for pre and post hospitalisation is for the treatment of an ailment for which you were admitted.
Step 2
Fill out the claim application form with accurate details and attach all relevant documents. Submit this to your insurance provider and Third-Party Administrator (TPA).
Step 3
After submitting the documents, the insurer will verify the claim details and check if the information is accurate. If your insurance claim satisfies the terms and conditions of your policy, your claim will be accepted.
Now that you have understood what pre and post hospitalisation in health insurance is, you can easily make a successful claim! However if you still don’t have a health insurance plan, then we recommend you get one. With benefits like cashless claims, pre and post hospitalisation coverage and lucrative add-on covers, comprehensive health insurance is a prudent choice.
So, browse through the health insurance plans available on Bajaj Markets and get a backup against rising healthcare costs. You can now estimate the premium quote with our easy-to-use health insurance premium calculator!
FAQs on Pre and Post Hospitalisation in Health Insurance
What is the post-hospitalisation claim period?
The post-hospitalisation claim period is a duration during which you must raise a health insurance claim with your insurance provider. This may differ from insurer to insurer, thus, it is recommended to check the post-hospitalisation claim period applicable to your plan.
How long is the post-hospitalisation claim period?
The duration of the post-hospitalisation claim period depends on your insurance provider, and thus, it is advised to contact the insurer for the same.
What is covered under the pre-hospitalisation expenses in health insurance?
The pre-hospitalisation expenses include the cost of diagnostic tests, X-rays, angiograms, MRIs, CT scans, blood tests, etc.
What are the documents required for filing pre and post hospitalisation claims?
You can keep the following documents handy while raising a pre and post hospitalisation claim in health insurance: Original invoices, Bill receipts, Discharge summary, Prescription of medications, A medical certificate, if applicable, Other documents required by the insurance provider
Do I have to purchase pre and post hospitalisation coverage separately?
Your comprehensive health insurance plan should cover pre and post hospitalisation expenses. However, it is advised to go through your policy documents before concluding anything to ensure such expenses are covered.
