For most health insurance buyers — a mediclaim policy is equated to a cover for hospitalisation costs. Few know that health insurance covers are designed to cover pre- and post-hospitalisation expenses as well. Many, therefore, fail to retain bills or fail to claim such expenses in time and end up spending a large sum out of pocket.
Health covers also offer to reimburse the money spent by the insured while undergoing treatments or tests that act as precursors to the hospitalisation. The rider here is that the expenses must be linked to the illness that led to hospitalisation, and the same should have been incurred up to 30 days prior to the insured being hospitalised. For instance, if an insured is diagnosed with appendicitis and is required to undergo tests in connection with the impending surgery, the cost of such medical tests will be reimbursed by the insurance company. Any medicines that s/he is required to take during the days leading to hospitalisation will also be treated as part of the claim.
Moreover, any follow-up treatment or medication prescribed after the policyholder is discharged from the hospital is also covered under health insurance policies. Again, the condition is that these expenses must be arising out of the ailment that resulted in the surgery or hospitalisation. Here, in case of most policies, expenses incurred up to 60 days after the discharge will be admissible as part of the claim. This includes the medicines prescribed in the discharge summary, as well as the cost of enlisting the services of medical care professionals like physiotherapists, nurses or attendants during the recuperation period. Any follow-up visits to your doctor will also form part of the post-hospitalisation claim. This is particularly useful in case of major surgeries like bypass that necessitate extensive care, medication and check-ups, post surgery.
Understand the exclusions
One of the criteria deciding the validity of the claim states that the expenses would be admissible only if they are related to the main hospitalisation. Let’s say an insured, who happens to be on regular medication to keep his diabetes in check, suffers a fall and is hospitalised for the same. In such a case, the cost of the X-Ray and other scans conducted prior to hospitalisation to determine the extent of the damage caused will be paid by the insurer. During the same pre-hospitalisation period, the cost of diabetes-related medicines that he had been taking, however, will be excluded from the claim. However, all the expenses incurred — including the cost of medicines administered to control his diabetes — while he was in the hospital will be admissible.
However, if you are asked to undergo medical tests for diagnosing your condition and the results negate the possibility of the suspected illness, such expenses will not be reimbursed by the insurance company.
Another key exclusion is with regard to expenses concerning maternity (which is covered only by group mediclaim policies). Both pre- and post-hospitalisation costs related to pregnancy will not qualify for reimbursement under a health insurance policy.