{"id":1222,"date":"2017-05-30T10:20:56","date_gmt":"2017-05-30T10:20:56","guid":{"rendered":"https:\/\/pamstaging.securenow.in\/insuropedia\/?p=1222"},"modified":"2026-03-18T07:29:48","modified_gmt":"2026-03-18T07:29:48","slug":"what-does-pre-and-post-hospitalization-expenses-cover","status":"publish","type":"post","link":"https:\/\/securenow.in\/insuropedia\/what-does-pre-and-post-hospitalization-expenses-cover\/","title":{"rendered":"Cover for pre-and post-hospitalization expenses"},"content":{"rendered":"<div id=\"bsf_rt_marker\"><\/div><h2><strong>Cover for pre-and post-hospitalization expenses<\/strong><\/h2>\n<p>Before a hospitalization, you might have to undergo a series of tests, and post-hospitalization care might also entail some expenses. If your employer offers group health insurance, the insurer might cover some or most of these expenses. This post attempts to offer some clarity on the expenses that may or may not be covered under a group mediclaim policy.<\/p>\n<h3 data-path-to-node=\"5\">Key Takeaways<\/h3>\n<ul data-path-to-node=\"6\">\n<li>\n<p data-path-to-node=\"6,0,0\"><b data-path-to-node=\"6,0,0\" data-index-in-node=\"0\">The Linkage Rule:<\/b> Expenses are only covered if they are directly related to the condition for which the patient was hospitalized. Unrelated chronic treatments (like medication for hypertension during an accident recovery) are excluded.<\/p>\n<\/li>\n<li>\n<p data-path-to-node=\"6,1,0\"><b data-path-to-node=\"6,1,0\" data-index-in-node=\"0\">In-Patient Requirement:<\/b> These benefits are usually only triggered if the insurer has already accepted the &#8220;In-Patient&#8221; hospitalization claim. If the main claim is rejected, the pre- and post-expenses are also rejected.<\/p>\n<\/li>\n<li>\n<p data-path-to-node=\"6,2,0\"><b data-path-to-node=\"6,2,0\" data-index-in-node=\"0\">Reimbursement Focus:<\/b> While the hospital stay might be &#8220;cashless,&#8221; pre- and post-hospitalization costs are typically paid out-of-pocket by the employee and claimed as a reimbursement later.<\/p>\n<\/li>\n<li>\n<p data-path-to-node=\"6,3,0\"><b data-path-to-node=\"6,3,0\" data-index-in-node=\"0\">Defined Windows:<\/b> Every policy has specific &#8220;windows&#8221; (e.g., 30 days before and 60 days after). Any test or medicine purchased outside these date ranges will not be covered.<\/p>\n<\/li>\n<li>\n<p data-path-to-node=\"6,4,0\"><b data-path-to-node=\"6,4,0\" data-index-in-node=\"0\">Exclusion of Domiciliary Care:<\/b> Generally, if a patient is treated entirely at home (domiciliary hospitalization), these specific pre- and post-period benefits may not apply in the same way they do for hospital admissions.<\/p>\n<\/li>\n<\/ul>\n<h2><strong>Pre-and post-hospitalization expenses<\/strong><\/h2>\n<p>You may incur expenses before you move to a hospital for in-patient treatment. A group health insurance policy typically identifies the following as pre-hospitalization expenses: medical tests, medicines, vaccinations, and doctor\u2019s\/medical practitioner\u2019s fees.<\/p>\n<p>Recuperation or post-hospitalization expenses refer to the medical expenses incurred by the insured to regain their pre-illness\/injury state of health.<\/p>\n<h2><strong>Insurance cover<\/strong><\/h2>\n<p>Insurers cover both pre-and post-hospitalization expenses if the following conditions are met:<\/p>\n<ul>\n<li>The insurer accepts the claim for hospitalization expenses<\/li>\n<li>The expenses arising from the same illness\/injury\/disease which necessitated hospitalization<\/li>\n<li>The expenses occurred within prescribed time limits:\n<ul>\n<li>For pre-hospitalization: 30 to 60 days before hospitalization<\/li>\n<li>For post-hospitalization: 60 to 90 days after hospitalization<\/li>\n<\/ul>\n<\/li>\n<li>Hospitalization was in-patient and not domiciliary.<\/li>\n<\/ul>\n<p>Read More: <strong><a href=\"https:\/\/securenow.in\/insuropedia\/benefits-of-group-health-insurance-for-indian-sme\/\"><u>What benefits are available under Employee Group Health Insurance?<\/u><\/a><\/strong><\/p>\n<h3><strong>Case study: Cover for pre-and post-hospitalization expenses <\/strong><\/h3>\n<p>Karan Dumra had an intermittent fever over three days. He thought it was a simple viral fever that could be suppressed with generic anti-viral medication. On the fourth day, he experienced shivering and a very high fever. So, he decided to consult a doctor. Since Karan was too ill to travel, the doctor came home. After preliminary checks, the doctor advised blood tests and an ultrasound to check his liver.<\/p>\n<p>See: <a href=\"https:\/\/securenow.in\/insuropedia\/general-exclusions-under-group-health-insurance\/\"><strong>What Is Covered Under Group Health Insurance?<\/strong><\/a><\/p>\n<p>It took two days for the test reports to come in. Meanwhile, Karan\u2019s situation worsened. He vomited a couple of times, and his worried family decided to admit him to a hospital for treatment.<\/p>\n<p>They had already spent about Rs 12,000 on medical tests and doctor\u2019s fees. Karan spent three days in the hospital. The hospital was one his insurance provider had listed as a network hospital. So, the insurer directly paid all the in-patient treatment bills.<\/p>\n<p>Karan was discharged but he had not fully recovered. He spent another five days on medication at home. The doctor asked for more medical tests to ensure that Karan had improved and to determine when to stop the medication. Two more physician\u2019s visits occurred in this period. While recuperating, Karan spent another Rs 15,000.<\/p>\n<p>Karan\u2019s group health insurer covered pre-and post-hospitalization expenses for up to 30 days before and 60 days after hospitalization. Thus, Karan was able to file a <a href=\"https:\/\/securenow.in\/insuropedia\/filing-a-claim-under-group-health-insurance-policy\/\">claim<\/a> for these expenses with the insurer. Since the insurer did not apply a co-pay clause, it reimbursed 100% of the cost of medicines, medical tests, and physician\u2019s fees.<\/p>\n<h3 data-path-to-node=\"2\">Summary Table: Pre- and Post-Hospitalization Cover<\/h3>\n<div class=\"horizontal-scroll-wrapper\">\n<div class=\"table-block-component\">\n<div class=\"table-block has-export-button new-table-style is-at-scroll-start is-at-scroll-end\">\n<div class=\"table-content not-end-of-paragraph\" data-hveid=\"0\" data-ved=\"0CAAQ3ecQahcKEwjkwYSn46aTAxUAAAAAHQAAAAAQRQ\">\n<table data-path-to-node=\"3\">\n<thead>\n<tr>\n<td><strong>Feature<\/strong><\/td>\n<td><strong>Pre-Hospitalization<\/strong><\/td>\n<td><strong>Post-Hospitalization<\/strong><\/td>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><span data-path-to-node=\"3,1,0,0\"><b data-path-to-node=\"3,1,0,0\" data-index-in-node=\"0\">Definition<\/b><\/span><\/td>\n<td><span data-path-to-node=\"3,1,1,0\">Medical costs incurred before being admitted to the hospital.<\/span><\/td>\n<td><span data-path-to-node=\"3,1,2,0\">Medical costs incurred after being discharged for recovery.<\/span><\/td>\n<\/tr>\n<tr>\n<td><span data-path-to-node=\"3,2,0,0\"><b data-path-to-node=\"3,2,0,0\" data-index-in-node=\"0\">Common Timeline<\/b><\/span><\/td>\n<td><span data-path-to-node=\"3,2,1,0\">Typically <b data-path-to-node=\"3,2,1,0\" data-index-in-node=\"10\">30 to 60 days<\/b> prior to admission.<\/span><\/td>\n<td><span data-path-to-node=\"3,2,2,0\">Typically <b data-path-to-node=\"3,2,2,0\" data-index-in-node=\"10\">60 to 90 days<\/b> after discharge.<\/span><\/td>\n<\/tr>\n<tr>\n<td><span data-path-to-node=\"3,3,0,0\"><b data-path-to-node=\"3,3,0,0\" data-index-in-node=\"0\">Eligible Expenses<\/b><\/span><\/td>\n<td><span data-path-to-node=\"3,3,1,0\">Diagnostic tests (X-rays, blood work), consultations, and medicines.<\/span><\/td>\n<td><span data-path-to-node=\"3,3,2,0\">Follow-up visits, diagnostic tests, and rehabilitation\/medication.<\/span><\/td>\n<\/tr>\n<tr>\n<td><span data-path-to-node=\"3,4,0,0\"><b data-path-to-node=\"3,4,0,0\" data-index-in-node=\"0\">Core Requirement<\/b><\/span><\/td>\n<td><span data-path-to-node=\"3,4,1,0\">Must be related to the specific illness that led to hospitalization.<\/span><\/td>\n<td><span data-path-to-node=\"3,4,2,0\">Must be part of the recuperation process for the same illness.<\/span><\/td>\n<\/tr>\n<tr>\n<td><span data-path-to-node=\"3,5,0,0\"><b data-path-to-node=\"3,5,0,0\" data-index-in-node=\"0\">Claim Type<\/b><\/span><\/td>\n<td><span data-path-to-node=\"3,5,1,0\">Almost always handled via <b data-path-to-node=\"3,5,1,0\" data-index-in-node=\"26\">reimbursement<\/b>.<\/span><\/td>\n<td><span data-path-to-node=\"3,5,2,0\">Almost always handled via <b data-path-to-node=\"3,5,2,0\" data-index-in-node=\"26\">reimbursement<\/b>.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<h3><strong>Case study: No cover for unrelated expenses<\/strong><\/h3>\n<p>Ranjeet had been under medication for hypertension for 20 days when he met with an accident. Owing to his condition, Ranjeet\u2019s subsequent hospital bill and tenure of treatment both exceeded the normal average for accident victims.<\/p>\n<p>After his discharge from the hospital, Ranjeet was housebound for another 30 days. The hypertension medication continued during this period. His company\u2019s family floater health policy took care of all the expenses incurred on in-patient treatment, except hypertension medication. Later, Ranjeet filed a claim for pre-and post-hospitalization expenses and included the costs of the hypertension medicine as well.<\/p>\n<p>The insurer rejected his claim for pre-hospitalization expenses as it was not related to the cause of hospitalization. It also deducted the amount spent on hypertension medicines from the post-hospitalization claim (again because it was not related to the cause of hospitalization and because the insurer never covered hypertension medicines even during in-patient treatment).<\/p>\n<h3 data-path-to-node=\"8\">Frequently Asked Questions (FAQs)<\/h3>\n<h4 data-path-to-node=\"9\"><b data-path-to-node=\"9\" data-index-in-node=\"0\">1. Can I claim for a diagnostic test done 2 months before I was hospitalized?<\/b><\/h4>\n<p data-path-to-node=\"9\"><strong>A)<\/strong> It depends on your policy&#8217;s &#8220;Pre-hospitalization&#8221; window. If your policy specifies a 30-day limit, a test done 60 days (2 months) prior will be rejected. Most standard corporate policies offer a 30-day pre-hospitalization window.<\/p>\n<h4 data-path-to-node=\"10\"><b data-path-to-node=\"10\" data-index-in-node=\"0\">2. Why was my claim for post-hospitalization medicines rejected even though I have the bills?<\/b><\/h4>\n<p data-path-to-node=\"10\"><strong>A)<\/strong> The most common reason is that the medicines were unrelated to the illness that caused the hospitalization. For example, if you were hospitalized for a fracture but claimed for cough syrup or diabetes medication, the insurer will exclude those specific costs.<\/p>\n<h4 data-path-to-node=\"11\"><b data-path-to-node=\"11\" data-index-in-node=\"0\">3. Do I need to keep the original doctor&#8217;s prescriptions for these claims?<\/b><\/h4>\n<p data-path-to-node=\"11\"><strong>A)<\/strong> Yes. For reimbursement of pre- and post-hospitalization expenses, insurers require the original bills and the doctor&#8217;s prescriptions that recommended those specific tests or medicines. Without the prescription, the insurer cannot verify that the expense was medically necessary.<\/p>\n<h4 data-path-to-node=\"12\"><b data-path-to-node=\"12\" data-index-in-node=\"0\">4. Is there a &#8220;Cashless&#8221; option for pre-hospitalization tests?<\/b><\/h4>\n<p data-path-to-node=\"12\"><strong>A)<\/strong> Usually, no. Because these tests happen before the insurance company has officially &#8220;authorized&#8221; the hospitalization, you must pay for them yourself and submit them as part of your final reimbursement file after you are discharged.<\/p>\n<h4><b data-path-to-node=\"13\" data-index-in-node=\"0\">5. Does post-hospitalization cover include things like physiotherapy?<\/b><\/h4>\n<p data-path-to-node=\"13\"><strong>A)<\/strong> Yes, if the doctor has officially prescribed physiotherapy as part of the recovery process for the specific injury or surgery you were hospitalized for, it is typically covered under the post-hospitalization benefit up to the specified time limit.<\/p>\n<p><script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@type\": \"FAQPage\",\n  \"mainEntity\": [\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Can I claim for a diagnostic test done 2 months before I was hospitalized?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"It depends on your policy's \\\"Pre-hospitalization\\\" window. If your policy specifies a 30-day limit, a test done 60 days (2 months) prior will be rejected. Most standard corporate policies offer a 30-day pre-hospitalization window.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Why was my claim for post-hospitalization medicines rejected even though I have the bills?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"The most common reason is that the medicines were unrelated to the illness that caused the hospitalization. For example, if you were hospitalized for a fracture but claimed for cough syrup or diabetes medication, the insurer will exclude those specific costs.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Do I need to keep the original doctor's prescriptions for these claims?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"Yes. For reimbursement of pre- and post-hospitalization expenses, insurers require the original bills and the doctor's prescriptions that recommended those specific tests or medicines. Without the prescription, the insurer cannot verify that the expense was medically necessary.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Is there a \\\"Cashless\\\" option for pre-hospitalization tests?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"Usually, no. Because these tests happen before the insurance company has officially \\\"authorized\\\" the hospitalization, you must pay for them yourself and submit them as part of your final reimbursement file after you are discharged.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Does post-hospitalization cover include things like physiotherapy?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"Yes, if the doctor has officially prescribed physiotherapy as part of the recovery process for the specific injury or surgery you were hospitalized for, it is typically covered under the post-hospitalization benefit up to the specified time limit.\"\n      }\n    }\n  ]\n}\n<\/script><\/p>\n<h4><b>About The Author<\/b><\/h4>\n<p><strong>Mayank Sharma\u00a0<\/strong><\/p>\n<p><strong>MBA Finance<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">He is a professional who brings extensive knowledge and expertise to the field of group health insurance. He has dedicated 7years to helping individuals and businesses navigate the complexities of insurance. Having worked closely with numerous clients and insurance providers, he deeply understands the nuances of group health insurance policies. With a reputation for providing insightful and informative content, he leverages his industry experience to educate readers about the importance of group health insurance and its benefits. Through their articles, Mayank Sharma aims to empower individuals and businesses to make informed decisions about their healthcare coverage, ultimately promoting healthier and more secure communities.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Cover for pre-and post-hospitalization expenses Before a hospitalization, you might have to undergo a series of tests, and post-hospitalization care might also entail some expenses. If your employer offers group health insurance, the insurer might cover some or most of these expenses. This post attempts to offer some clarity on the expenses that may or [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"om_disable_all_campaigns":false,"_lmt_disableupdate":"no","_lmt_disable":"no","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[1,292],"tags":[48],"class_list":["post-1222","post","type-post","status-publish","format-standard","hentry","category-group-health-insurance","category-product-features-group-health-insurance","tag-group-health-insurance"],"acf":[],"modified_by":"SecureNow","_links":{"self":[{"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/posts\/1222","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/comments?post=1222"}],"version-history":[{"count":21,"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/posts\/1222\/revisions"}],"predecessor-version":[{"id":35705,"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/posts\/1222\/revisions\/35705"}],"wp:attachment":[{"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/media?parent=1222"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/categories?post=1222"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/securenow.in\/insuropedia\/wp-json\/wp\/v2\/tags?post=1222"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}