All group health insurance plans cover pre-hospitalisation and post-hospitalisation expenses. Pre-hospitalisation refers to the medical costs of a patient before they are admitted to the hospital, and post-hospitalisation refers to the costs after the treatment is complete, for illnesses that require some minimum hospital stay.
What are Pre and Post-Hospitalisation Expenses?
Hospitalisation is just a one part of anyone's treatment. Pre-hospitalisation covers the diagnostic and consultation expenses that leads up to your hospitalisation. Post-hospitalisation covers the recovery and follow-up expenses after you leave the hospital. These both are add-on benefits of a main inpatient hospitalisation claim and not just a separate outpatient cover.
Here is proper list of what usually falls under each phase:
| Expense type | Pre-hospitalisation | Post-hospitalisation |
|---|---|---|
| Consultations | Consultations with doctors and specialists before admission. | Follow-up and review consultations after discharge |
| Tests and scans | Blood and urine tests, X-rays, MRI or CT scans, ultrasounds, ECG, biopsy or pathology charges | Repeat blood tests and scans if advised by your doctor. |
| Medicines | Prescribed medicines and injections before admission | Prescribed medicines and injections |
| Recovery care | Not applicable | Physiotherapy, dressings and wound care, suture removal, home nursing if advised, rehabilitation linked to the treated condition |
For example, you were admitted to the hospital for an appendicitis surgery. Before your admission, your doctor recommends blood tests and an ultrasound to confirm the diagnosis. This falls under Pre - Hospitalisation.
After you’re discharged, you visit the doctor for follow -up consultations, get your dressing changed, and buy prescribed medicine for recovery. These expenses are covered under Post-hospitalisation.
What is Not Covered Under Pre and Post-Hospitalisation?
As we know that pre and post-hospitalisation benefits are very useful but they do have few limits. It doesn't cover every medical expense you get outside the hospital. This don't turn a group plan into an outpatient cover which is OPD.
Medical Expenses that are not related to the specific illness or injury that causes the hospitalisation.
Bills that falls outside the pre and post-hospitalisation policy time limit.
Cases where the main hospitalisation claim itself is rejected: if the admission is not payable then the main hospitalisation claim related pre and post costs is also not payable.
Non-medical items such as toiletries, attendant charges, or administrative fees etc cannot be claimed.
Expenses that exceed your available sum insured.
Keep every bill and prescription
Pre and post-hospitalisation claims are always paid by reimbursement. Save all the original bills, pharmacy bills, diagnostic reports, and the doctor's prescriptions etc with dates. An insurer can reject the claims if it is without a dated prescription and is being related to a treatment. The documents should clearly show the treatment date and the doctor’s prescription which are linked to the expenses of your hospitalisation.
Complete the main hospitalisation claim first
The pre and post benefit is related to an accepted inpatient claim. If the hospitalisation itself is not covered, then these related expenses are usually not covered.
Collect dated bills and prescriptions
Make sure you have consultation receipts, diagnostic reports, pharmacy bills, and prescriptions of both pre and post-expenses of hospitalisation, each showing the date and the treating illness.
Fill the reimbursement claim form
To fill the reimbursement claim ask your insurer or TPA's for post-hospitalisation reimbursement form, which is also available through your HR or insurer's portal.
Submit within the deadline
After the last post-hospitalisation every insurer's requirement is that claims should be submitted within 15 to 30 days. It is always advisable to check the policy documents to confirm the exact duration.
Track and receive settlement
Once you have filled the form, the insurer will verify all the details like dates, relation and document. After verification if the claims is approved by the insurer, then the eligible amount will be reimbursed to your bank account, subjected to sum insured and sub-limits.
Key Takeaways
Pre and Post-hospitalisation expenses are covered in all types of Corporate Health Insurance Plans.
30 and 60 days is a common structure of pre and post-hospitalisation, which is 30 days before getting admission in a hospital and 60 days after getting discharged from hospital, although this window varies according to the policy.
Only those expenses which are related to the same illness, that caused a covered admission are qualified for pre and post benefit.
If the main hospitalisation claim is rejected, then all the linked pre and post expenses are also not covered.
These expenses are mostly reimbursed, so dated bills, prescriptions and other documents related to the hospitalisation are necessary.
Pre and post-hospitalisation costs share your main policy Sum Insured and few policy plans add a percentage sub-limit.
Frequently asked questions
Pre and post-hospitalisation and OPD are two different type of benefits.
If inpatient admission is accepted by the insurer within a set of time period then pre and post-hospitalisation will cover the hospitalisation related expenses.
OPD (outpatient department) covers only for consultations and tests with no hospitalisation. Group plans may offer OPD as a separate benefit, but the pre and post-hospitalisation is already a part of plan.
Generally no. Cashless settlement are applied to the hospital stay at a Network hospital. Pre and post-hospitalisation bills are usually claimed after the completion of treatment through reimbursement, so you can pay upfront at the hospital desk and submit documents after for the reimbursement.
If your main hospitalisation claim is rejected, then the related pre and post-hospitalisation expenses are also not accepted, because pre and post expenses depends over a valid and covered admission.
Generally, the exact coverage period is defined as part of the policy document. In case this is not available, policyholders can directly reach out to their respective HR point of contact.
About the authors
Neviya Laishram
Written by · Senior Editor – Health, Life and Group Health Insurance Content at ACKOWith a journalism background, she brings 9 years of experience in strategising and editing health, life, and group health insurance content. Having written for magazines and digital publications, she combines research and editorial expertise to create credible, useful content for readers.
Nitesh Kapur
Reviewed by · Senior Director – Underwriting & Claims, Group Health Insurance at ACKOWith over 15 years of experience in health insurance underwriting, he has led group health insurance strategy, risk assessment, and policy design. He has held leadership roles at leading insurers, building risk frameworks, evaluating complex health risks, and strengthening underwriting standards.
