Pre and Post hospitalization are inclusive features of the health insurance policy. The health insurance policy covers hospitalization expenses. However, it also covers the medical expense incurred before admission to the hospital and after discharge from the hospital. It is applicable only in inpatient hospitalization.
Pre and Post hospitalization are very important parts of a health insurance policy and you should know about them while buying a health insurance policy. It is quite normal that if someone is admitted for more than 24 hours in the hospital for any treatment/surgery, there may be some need for medication after discharge also. And same is possible before hospitalization also.
Apart from accidents and some other sudden attacks, normally a patient starts taking some medication with the advice of a doctor before the hospitalization. There are different health insurance plans available in the market, and you should know what is your pre and post hospitalization limits or terms in the policy.
Let me explain with this example:
One day Mr. Arvind was having abdominal pain. He Visited a doctor near his residence. 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 it’s a serious matter of concern and he should go for a liver surgery
Mr. Arvind was hospitalized and went through surgery and treatment. He was discharged after 10 days of hospitalization. The hospital’s doctor prescribed him some medicine to take for at least one month.
The doctor also advises him to come for a follow-up visit and some medical tests at some intervals to check the progress report. Mr. Arvind followed all the things.
In this case, Mr. Arvind has three kinds of expenses:
- The medical expense incurred before the admission to the hospital (Pre Hospitalization)
- Expenses incurred during the hospitalization
- Medical expenses incurred after discharge from the hospital (Post Hospitalization)
I hope now you got my point. And you know what is the difference between pre-hospitalization and post hospitalization. Now let’s understand each in detail.
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 has been admitted for a minimum of 24 hours in the hospital.
In most, illness/disease, some symptoms and sign appear 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 expenditures on medicine, diagnostic test, and doctor consultation fees.
All these expenses, incurred before hospitalization, are called pre-hospitalization expenses. Normally, the following expenses are covered:
- Expense for medicine
- The expense for medical tests – x-ray, blood test, ECG, Ultrasound, etc
- Doctors fees
Generally, pre hospitalization is for the time period of 30 to 60 days in a health insurance policy. 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 included in post hospitalization
- Medicine Expense
- Diagnostics tests/Investigation cost
- Doctors Visit, Consultation Fee
In most cases, when anyone is discharged from the hospital, he may need to take some medicine for a few days. The doctor may advise some medical tests and follow-up visits at some intervals to monitor the progress.
Health insurance covers these costs as post hospitalization expenses. Your company may provide a claim for up to 60 to 180 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. This means pre and post hospitalization is covered only in the case of inpatient hospitalization only.
- Routine medical costs or check-up is not covered.
- Alternative treatments like acupuncture etc are normally not covered.
However, I would suggest you should read your policy documents, its features, and benefits, and terms and conditions. So that you be aware what is covered in your policy and what is not.
Claim Process for Pre and Post Hospitalization
Policyholders can claim it through the reimbursement process. There is a need to submit the required documents and bills to the insurer.
Generally, the company asks 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.
Mostly you will get the benefits of pre and post hospitalization. However, the number of days covered for pre and post hospitalization may be different and as per the plan. While buying a health insurance policy you should ask to explain the pre and post hospitalization benefits.