Pre and Post Hospitalisation expenses covered by Health Insurance Policies

Insurance cover is a must and should be the top priority for all of us. However, unless and until we actually face some medical crisis, we do not realise how much cover is sufficient to protect us against the health or life related dangers. 

Second phase of Covid-19 in India has made it inevitable for many to get hospitalised. Patients with complications need more treatment and it could extend to days and months where they are forced to spend thousands of rupees for the upkeep of their health. 

This calls for a need to go through the particulars about your policy in detail before you go for it. Beyond the regular hospitalisation bills, a policy could cover a few expenses incurred prior to hospitalisation and post discharge from the hospital. When an individual is hospitalised several tests are done and the related expenses are covered by the health insurance policies. 

Looking at the ongoing Pandemic situation it is important to know what your policy covers and what not when it comes to Covid-19. Along With that other regular hospitalisation related policy matters too are explained here:

1. Pre hospitalisation expenses: RT-PCR Test which is the basic diagnostic test required to detect Covid-19 is covered as pre hospitalisation expenses. However if the result turns out to be negative then it will be reimbursed only if your policy covers the OPD expenses. 

Patients who are admitted to the hospital for the treatment of Covid-19 can claim the costs of RT-PCR, blood tests and CT scan costs incurred up to 30 days before hospitalisation.

For other ailments too the medical condition of a patient is diagonised with the help of a few tests. Usually charges incurred 30 days prior to admission of a patient are covered as a part of pre-hospitalisation expenses. 

2. Post hospitalisation costs:Normally as per the terms and conditions of the policy,the follow-up consultation charges of the physician and cost of tests is covered up to 60 days post hospitalisation. Cost of home-nursing and physiotherapy too are covered. A few premium plans allow this coverage for up to 90 days.

Documents required to file the claim:

• All the diagnostic reports,bills,receitps etc. are required to make the claim. If physical copies are not available with you, download them from your email or apps. These days usually all hospitals and labs provide soft copies of the test reports. 

• Hospitalisation bills could be covered by a cashless facility. Yet you have to preserve all the detailed bills while taking the discharge from the hospital. Other than this, the cost of medication, follow-ups and other treatments after hospitalisation incurred within a time period of 60-90 days shall be reimbursed by the insurance company. Submission of all such details can be done in the window provided by the insurer for this purpose. 

As a policy holder one should know what’s included in their policies to get the maximum benefits from them. 

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Krishna Rath is a SEBI Registered Investment Adviser, and since 2015 has been educating netizens on investments and insurance. Krishna is a fee only SEBI RIA and is Odisha's first SEBI RIA. With background in IT, Krishna is changing the advisory space with new innovations in AdvisoryTech.

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