For most of us, the objective of buying a Mediclaim policy is to meet any hospitalisation expenses. Not many, however, are aware of the full extent of succour that a health policy can offer.
Not only can they take care of your hospitalisation expenses, but also expenses incurred during the period prior to, and after, the stay in hospital.
That does not mean, of course, that you can claim reimbursement for any medical tests undertaken or routine visits to your family doctor. In other words, only those expenses that are linked to the illness which led to hospitalisation will be picked up by the health insurer.
Also, in case of pre-hospitalisation expenses, only those costs that have been incurred up to 30 days prior to the insured being hospitalised, are admissible. This includes diagnostic tests to confirm the ailment too, as also the medicines that the policyholder is required to take during the period leading up to hospitalisation.
Similarly, expenses incurred up to 60 days after being discharged will also be treated as part of the claim. This could include follow-up visits, medicines mentioned in discharge summary and fees payable to nurses or attendants.
However, if the claims arise out of an illness that is not related to the cause of hospitalisation, they are not approved. For instance, if an individual, who is on regular medication to control his diabetes, is hospitalised due to a fall, the cost of X-ray and other scans conducted prior to hospitalisation to determine the extent of the damage caused, will be paid by the insurer.
But, the diabetes-related medicines that the insured has been taking during the period will not be covered. When he is hospitalised, though, the cost of these medicines, too, will be admissible.
Since these expenses pertain to the period when the insured was not hospitalised, the cashless facility is not available. The relevant documents will have to be submitted to the insurer or the third party administrator (TPA) to get a reimbursement.
For making a pre-hospitalisation claim, documents like doctor’s recommendation for undergoing the medical tests and original bills for buying the prescribed medicines will have to be produced. Post-hospitalisation claim will necessitate the discharge summary, spelling out the medicines to be taken, post-surgical care required, as well as bills pertaining to follow-up visits.