How to Make the Most of Pre and Post Hospitalization Expenses Cover with Your Health Insurance Plan

  • postauthorRaj
  • postdateMarch 3, 2023
  • postreadtime4 min read
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Hospitalization is very rarely planned, which means you cannot always plan your expenses for it. With rising costs of medical expenses, it is almost impossible to get the treatment you need without a health insurance plan. Some costs, especially pre- and post-hospitalization expenses, can really add up without adequate health insurance. 

Getting a health insurance plan is one thing, but ensuring it covers all your needs is another. If you really want to save money, you should get a plan that does cover pre- and post-hospitalization expenses. That’s what we want to tell you about. That way, you can make the most of your health insurance plan to save on costs that would otherwise leave a hole in your pocket. 

Pre- and Post-Hospitalization Expenses Explained 

As the name suggests, these are expenses you incur before, and after hospitalization. Pre hospitalization expenses are usually costs that you incur prior to getting hospitalized. They can, but won’t always include, medication, investigative medical tests, and doctor consultation fees. To be sure what your insurance plan covers, be sure to read the terms & conditions (T&C) carefully. Generally, most plans tend to cover all these expenses.  

It is important to know that these expenses can be claimed only if it leads to hospitalization. If you are sent home, then it is considered an outpatient department (OPD) expense, which most insurance plans do not cover. You can read more about OPD expenses in our other blog.  

Post hospitalization expenses are costs you incur after getting discharged from the hospital. These costs can cover medical tests, vaccinations, lab reports and follow-up consultations. Again, these expenses can only be claimed if you have been hospitalized. If you haven’t, it is considered an OPD expense.  

The standard coverage for pre- and post-hospitalization expenses is limited to 30-60 days for pre, and 60-90 days for post hospitalization expenses. Again, be sure to read the terms and conditions of your policy to know what is covered.  

To understand how this works, let’s imagine Ashok has been having heart issues. He decides to get a checkup. After doing so and consulting the doctor, Ashok is told he needs a pacemaker. He is then hospitalized and undergoes surgery. Post the surgery, he is given medication and is told to check in with the doctor every week for two months. 

Ashok can claim all those expenses from the insurance company since he was hospitalized. However, if the doctor said that the issue was simply cholesterol, and put Ashok on medication, he would not be able to.  

pre and post hospitalization

Why You Need Them in Your Plan 

It is very easy to assume that you don’t need pre- and post-hospitalization cover in your insurance. However, that’s a very wrong assumption. At first, it may seem like these expenses aren’t much, but together, they can add up to quite a lot.  

According to India Today, “the average retail healthcare inflation for India was 7.14 percent for 2018-19.” That’s a 4.3% jump from the last year. The rise is predominantly in medication and consultation fees. If you have to visit a doctor weekly for even a month, the fees alone will be quite a lot. That’s not something everyone can, or should afford.  

That’s why you need a quality health insurance plan that covers these expenses. By doing so, you can save money for other things like your dream house or car.  

Claiming These Expenses 

If your insurance plan covers pre and posts hospitalization expenses, claiming them is pretty straightforward. Ensure you get all the medical certificates, original bill receipts, diagnostic test reports and all other documents requested by the insurance company. Contact them to ensure you have all the paperwork you need.  

If you want your claims to be approved, ensure that: 

  • The claims are for in-patient hospitalization rather than domiciliary treatment.  
  • The expenses and hospitalization are for the same condition that the patient was admitted for. 
  • The claims are all for the same insured individual only, and no one else. 
  • The claims are for all costs incurred within the timeframe specified by your insurance policy. 

If you want to make the most of your health insurance policy, ensure that you are aware of common exclusion in health insurance policies. It’s the smart way to take care of your health. As an employer, if you want a comprehensive employee healthcare plan with pre- and post-hospitalization expenses covered under the group health insurance for members then check out Onsurity. 

Onsurity’s plans offer complete access to healthcare package which include corporate group health insurance and other benefits like doctor teleconsultations, discounted medicines, access to fitness sessions and webinars.

If you are a team member and looking for affordable healthcare benefits, refer us to your company HR or if you are already an Employer/HR, you can subscribe to our plan today.

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