You were hospitalized for dengue or a surgery. After 5 days, you got discharged.
The insurance company paid the ₹1 Lakh hospital bill via "Cashless" settlement. You are happy.
For the next two months, you visit the doctor for check-ups and buy medicines worth ₹20,000 from your local pharmacy. You pay this from your own pocket.
Stop! You are losing money.
Most health insurance policies in India cover not just the "In-Patient" bill, but also the expenses incurred before you were admitted and after you came home. This is called Pre & Post Hospitalization Coverage.
Disclaimer: Time limits (30/60 days or 60/90 days) vary by insurer (HDFC Ergo, Niva Bupa, Star Health). Check your policy wording.
Paid the Hospital Bill? Don't Throw Away Your Pharmacy Receipts!
1. What Exactly Is Covered?
Insurance isn't just for the hospital bed. It covers the entire journey of the illness.
A. Pre-Hospitalization (Before Admission)
Usually covers expenses 30 to 60 days before admission.
- Includes: Doctor consultations, diagnostic tests (Blood tests, X-Rays, MRI) that led to the diagnosis requiring hospitalization.
- Example: You had a fever, saw a doctor, and got a blood test that confirmed Dengue. These costs are claimable.
B. Post-Hospitalization (After Discharge)
Usually covers expenses 60 to 180 days after discharge.
- Includes: Follow-up doctor visits, medicines, physiotherapy, and further diagnostic tests to monitor recovery.
- Example: After knee surgery, you need 3 months of physiotherapy. The insurance pays for it.
2. The "Related Line of Treatment" Rule
There is one catch. You can only claim expenses that are directly related to the illness for which you were hospitalized.
- Approved: Buying heart medicines after Heart Surgery.
- Rejected: Buying cough syrup or getting a dental check-up after Heart Surgery.
3. Why Is It Not Cashless?
While the main hospital bill is often cashless, Pre & Post expenses are almost always on a Reimbursement Basis.
How it works:
- You pay the chemist or lab from your pocket.
- You collect all original invoices and prescriptions.
- You submit a claim form to the insurer/TPA after your treatment ends.
4. The Document Checklist (Don't Miss One!)
To get your money back without rejection, you need a perfect paper trail. Missing one piece of paper leads to a query.
📄 Required Documents
- Claim Form: Part A (filled by you).
- Discharge Summary: Copy of the hospital discharge paper.
- Original Bills: Pharmacy and Lab invoices (with GST number).
- Original Prescriptions: The doctor must have written the medicines/tests on a letterhead.
- Cancelled Cheque: For the insurer to transfer money to your bank account.
5. Timing Is Key
Insurers have strict deadlines. Typically, you must submit the Post-Hospitalization claim within 7 to 15 days after the post-care period ends.
Pro Tip: You don't have to wait for 60 days. You can submit claims in batches (e.g., every 15 days) if the amount is large.
Don't Leave ₹50,000 on the Table
Medicines and tests have become expensive. In a serious illness, post-care costs can equal 20-30% of the hospitalization bill.
Stop treating pharmacy bills as trash. Treat them like cash. File that reimbursement claim and get your money back.
Action Plan:
- Open your policy document and search for "Pre-Hospitalization Days" (e.g., 60 days).
- Gather all bills from 2 months before admission until today.
- Download the "Reimbursement Claim Form" from your insurer's website and submit it this weekend.
Helpful Resources:
PolicyBazaar: Pre & Post Hospitalization Guide
Star Health: Reimbursement Claims Process
0 Comments