Pre & Post Hospitalization: How Does it Work in Health Insurance?

Pre and Post Hospitalization

Pre and post hospitalization are inclusive features of health insurance policy. Health insurance policy covers hospitalization expenses. However, it also covers the medical expense incurred before admission in the hospital and after the discharge from the hospitals. It is applicable only in inpatient hospitalization.

You can better understand with this example:

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One day Mr. Arvind was having abdominal pain. He Visited a doctor near to his house. The doctor prescribed some medicine to him. But after 10 days it becomes more serious and there was no improvement from the medicine.

Now the doctor prescribed him to have some medical tests. He has gone through medical tests. He again visited the doctor after getting the reports of his diagnostic tests. Now the doctor told him that its a serious matter of concern.

As per the medical report, Mr. Arvind’s liver is in damaged condition. The doctor suggest him for hospitalization and surgery of the liver.

Mr. Arvind hospitalized and gone through surgery and treatment. He discharged after 10 days of hospitalization. Hospital’s doctor prescribed him some medicine to take at least one month.

The doctor also advises him to come for a followup visit and some medical tests on some interval to check the progress report. Mr. Arvind followed all the things.

Pre and post Hospitalization in health insurance policy

In this case, Mr. Arvind has three kind of expenses:

  • Medical expense incurred before the admission of the insured person in the hospital
  • Expense incurred during the hospitalization
  • Medical expenses incurred after discharge from the hospital

Mr. Arvind is eligible to claim his all these expense from his health insurance policy.

What is Pre-Hospitalization in Health Insurance?

Pre-Hospitalization expenses are medical costs incurred before the admission of the insured person in the hospital. It is covered in case of inpatient hospitalization. It means the insured person was admitted min 24 hours in hospital.

In most of the illness/disease, some symptoms and or sign appears from the starting of it. Apart from the accident and some attacks, it is very rare that we don’t have any symptoms if suffering from any disease.

In the starting phase of the disease, we normally go to the doctor and have some prescribed medicine and medical test. We do expenditure on medicine, diagnostic test, and doctor consultation fees.

All these expenses, which incurred before hospitalization, called pre-hospitalization expenses. Normally, Following expenses are covered:

  • Expense for medicine
  • Expense for medical test – x-ray, blood test, ECG, Ultrasound, etc
  • Doctors fees
  • Vaccination
Pre hospitalization in health insurance

It is for the time period of 30 to 60 days before admission of the insured person to the hospital. However, it is depending on your health insurance plan and company.

What is Post-Hospitalization in Health Insurance?

Post-hospitalization expenses are medical costs incurred after the discharge of the insured person from the hospital. It is covered when the insured person was hospitalized for min 24 hours.

Normally, these expenses are inclusive in post-hospitalization

  • Medicine Expense
  • Diagnostics tests/Investigation cost
  • Doctors Visit, Consultation Fee
  • Vaccination
Post Hospitalization in health insurance

In most of the case, when anyone discharged from the hospital, he may need to take some medicine for a few days. The doctor may advise some medical tests and followup visits on some interval to monitor the progress.

Health insurance covers these costs as post-hospitalization expenses. Your company may provide a claim up to 60 to 90 days. In some plans, it is up to 180 days also. The time period depends on your health insurance plan and company.

What is not covered in Pre and Post Hospitalization?

Every health insurance policy has some exclusion list also. It has some terms and conditions related to pre and post-hospitalization also.

  • Expenditure should be directly related to the same illness/disease for which the insured person was hospitalized.
  • It is not covered when hospitalization is less than 24 hours. Means, pre and post hospitalization are covered only in case of inpatient hospitalization only.
  • Routine medical costs or check-up is not covered.
  • Alternative treatments like acupuncture etc are normally not covered.

Let’s see an example:

Mr. Sharma was suffering from liver problem. He was taking medicine on a regular basis as prescribed by his doctor. He used to go for some medical tests related to the liver also.

One day, he injured in a road accident. He hospitalized due to serious injury in his legs. After 3 days, the hospital discharged him.

The doctor prescribed him some medicine to eat. The doctor also advises him for a followup visit and one diagnostic test. After 20 days, he is recovered from the injury.

In this case, he is not eligible to get the claim of medicine, doctor fees, and tests related to the liver. Because he was hospitalized for accidental injury. Treatment was not for liver treatment and expense is not related to accidental injury.

Claim Process for Pre and Post Hospitalization

Policyholders can claim it through the reimbursement process. There is a need to submit required documents and bills to the insurer.

Generally, company ask following documents to submit to process it:

  • Claim Form
  • Physician/Medical certificate
  • Original Bills of medicine, tests and other related bills
  • Investigation/Diagnostic reports
  • Discharge summary
  • Id Proof
  • Cancel Cheque and or bank details
  • Any other documents as per requirements

You should submit all the documents within the specified time limit of the insurance company.

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