Most of us think of health insurance as a safety net for surgeries, critical illnesses, or long hospital stays. But what about all the expenses before you’re even admitted to the hospital? There are things like consultations and lab tests which are extremely crucial for early detection and timely treatment, but they’re also quite costly. These are medical expenses that fall under pre-hospitalisation expenses.
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Pre-hospitalisation expenses in health insurance are the medical costs that arise before you are admitted to a hospital. These are expenses that are related to the diagnosis or initial treatment of a health condition that ultimately leads to hospitalisation. They are considered as part of your overall treatment plan and are eligible for reimbursement as long as it is mentioned in your health insurance plan. It is important to note that you can claim these expenses only if they are medically necessary and directly connected to the condition that you are hospitalised for.
Some of the common expenses include:
Just as it’s important to understand what's included, it’s also important to know what is not included in these expenses.
Most health insurance policies in India provide pre-hospitalisation coverage for a limited number of days before admission. This period usually ranges from 30 days in basic plans and up to 60 days or 90 days in comprehensive or premium plans.
For example, if you're admitted in the hospital on July 15th, and your health insurance company provides 30 days of pre-hospitalisation cover, then any relevant medical expenses that you bear from June 14th to July 14th may be reimbursed.
Also read: Pre-Hospitalisation and Post-Hospitalisation Expenses in Health Insurance
While this benefit sounds straightforward, there are a few conditions that are placed on pre-hospitalisation claims. They are as follows:
Pre-hospitalisation costs are only covered if your main hospitalisation or hospital admission claim is approved by the health insurance company.
The pre-hospitalisation expenses should relate to the same illness or medical condition for which you are admitted in the hospital.
All pre-hospitalisation expenses need to be within the eligible window according to your policy, that is, 30, 60, or 90 days.
You need to make sure that all the required and original documents like bills, prescriptions, test reports, and payment receipts are submitted as per the insurance company’s claim policy.
These expenses are typically reimbursed after the claim for the hospitalisation is approved. It is not covered under a cashless claim unless it is mentioned in your health insurance policy.
Let’s say you start experiencing extremely painful stomach pain. Before you even go to surgery or get admitted to the hospital you will.
Together, these can easily cost ₹10,000-₹20,000, or more. If your policy only covers the hospitalisation bill, then you’re left with paying for all the expenses before hospitalisation from your pocket.
That’s why pre-hospitalisation coverage in health insurance is important. It helps in making your treatment journey financially protected from start to finish, and not just the part where you’re in the hospital bed.
Pre-hospitalisation expenses may seem like a minor benefit, but they cover the phase where the diagnosis and decisions are made thus playing a big part in making your medical journey financially stress-free. So, when choosing a health insurance plan, don’t just look at the sum insured or the premium. Make sure to check pre-hospitalisation expenses to know what’s covered in your health plan.
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Reviewed by Dr. Harshita Dahiya 
Acko Technology & Services Private Limited
#36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Bengaluru, Karnataka 560102
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