Picture this – you have been sick for quite some time. You had to visit multiple doctors and undergo various tests to find out what the problem was. Turns out that you have to undergo a minor surgery. At this point in time, you’re worried about paying the hefty medical bill. Suddenly, you remember that you have a health insurance policy to cover the surgery!
While you’re relieved you have a health insurance policy to cover the surgery, you’re concerned about the costs you incurred before and after the hospitalisation. This is where pre-and-post-hospitalisation expense coverage comes into play in your health insurance policy.
In this article, let’s explore what this means in detail.
Best Health Insurance Policies with Pre-and-Post-Hospitalisation Expense Coverage
| Policy | Pre Hospitalisation | Post Hospitalisation | Other Features |
|---|---|---|---|
| Aditya Birla Activ One Max | 90 days | 180 days | PED WP: 3 years NCB: 100% PA up to 500% Restoration: 100% unlimited times |
| HDFC ERGO Optima Secure | 60 days | 180 days | PED WP: 3 years NCB: 50% PA up to 100% Restoration: 100% once a year |
| Care Supreme | 60 days | 180 days | PED WP: 4* years NCB: 50% PA up to 100%** Restoration: 100% unlimited times |
| Niva Bupa ReAssure 2.0 | 60 days | 180 days | PED WP: 3 years NCB: Unclaimed amount transferred to the following year.# Restoration: ReAssure Forever – if you make a claim once, the entire base amount will be added to your policy forever. |
*Can be reduced with add-ons
**Can be increased with an add-on
#Limit varies depending on the policy variants.
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What are Pre-and-Post-Hospitalisation Expenses in Health Insurance?
When you’re hospitalised, the costs are not only limited to what you spend during the hospitalisation. There are other costs involved, too – Some are before the hospitalisation, and some are after.
Pre-and-post-hospitalisation expenses are these medical costs incurred before you are admitted to the hospital and after you are discharged, respectively. More often than not, since medical treatments usually extend beyond the hospital stay, these costs also add up to a significant amount.
Let’s take a look at these in detail now.
Pre-Hospitalisation Expenses in Health Insurance Policies
As the name suggests, pre-hospitalisation expenses are the costs related to medical consultations, diagnostic tests, medications, and any other treatments required before being admitted to the hospital. These include consultations with doctors and specialists, diagnostic tests such as blood tests, x-rays, MRIs, and medications prescribed to manage your condition before the treatment.
Post-Hospitalisation Expenses in Health Insurance Policies
Post-hospitalisation expenses are the costs incurred after you are discharged from the hospital. These include the costs of follow-up consultations, medications, physiotherapy, and other treatments needed to ensure complete recovery after discharge from the hospital.
What are the Advantages and Disadvantages of Pre-and-Post-Hospitalisation Expense Coverage in Health Insurance?
When it comes to financial instruments, however beneficial a feature may seem, there’s always a flip side to it. To make it easy for you when purchasing a health insurance policy, here are some common pros and cons of pre-and post-hospitalisation expense coverage:
- Advantages of Pre-and-Post-Hospitalisation Coverage in Health Insurance
- Comprehensive Coverage: The Health Insurance Plan covers tests, medications, and consultations before and after the hospitalisation and shields you from significant out-of-pocket expenses.
- Superior Healthcare: Having health insurance coverage for follow-up treatments and consultations encourages you to seek better healthcare post-discharge. This ultimately reduces the risk of complications and remission.
- Peace of Mind: Knowing that your health insurance will cover pre- and post-hospitalisation, too, allows you to focus on getting better rather than worrying about the bills.
2. Disadvantages of Pre-and-Post-Hospitalisation Coverage in Health Insurance
Despite the benefits, there are some limitations to consider, such as:
- Networks Hospitals: Sometimes, insurers ask you to get tests done only at network hospitals or test centres. If you do not have a facility that is in the insurer’s network nearby, it may become a hassle, especially if you need to do it frequently.
- Reimbursement: Pre-hospitalisation expenses are always on a reimbursement basis. This is because you may or may not be hospitalised after the tests. It will be treated as a pre-hospitalisation expense only if you are hospitalised after the tests. Regarding post-hospitalisation expenses, unless they are at a network facility, they may most likely be on a reimbursement basis.
- Sub-limits: Insurers may impose sub-limits on pre- and Post-hospitalisation expenses. The best policies that we recommend at Ditto do not have this limitation. However, it is prudent to be aware that this limitation exists with certain other policies in the market.
- Coverage for Domiciliary & Home-Care Treatments: Sometimes, if you need to undergo treatment without being physically admitted to a hospital, such as daycare or domiciliary treatments, insurers may be reluctant to cover anything other than the actual treatment costs. Sometimes, these treatments may also have sub-limits and deductibles. Feel free to go through this article on domiciliary treatments for more information.
Best Health Insurance Policies with the longest Pre-and-Post-Hospitalisation Expense Coverage
- Aditya Birla Activ One
Aditya Birla Activ One offers extensive pre- and post-hospitalisation coverage, up to 90 and 180 days, respectively. There is also no limit on this amount, which ensures that you are covered up to the sum insured. This policy also provides extra wellness benefits, such as discounts on gym memberships and health check-ups, making it a comprehensive option to consider.
Drawbacks: Being one of the newest insurers in the market, we feel that their operational metrics can be slightly improved
2. HDFC ERGO Optima Secure
The policy that usually tops the charts comes in second this time — HDFC ERGO Optima Secure offers pre- and post-hospitalisation coverage of 60 and 180 days, respectively. This plan also features unlimited partial restoration and a good no-claim bonus of 50% per annum (up to 100% of the sum insured).
Drawbacks: Optima Secure has a slightly higher premium compared to its peers, which offer similar features and coverage.
3. Care Supreme
Care Supreme is an affordable and comprehensive policy that covers up to 60 days of pre-hospitalisation and 180 days of post-hospitalisation expenses. It doesn’t have co-payments, room rent restrictions, or disease-wise sub-limits. The policy also covers daycare, domiciliary, AYUSH treatments and even air ambulance. Overall, this is a good policy worth considering.
Drawbacks: Care Supreme is a good health insurance plan, but like any other policy, there are some disadvantages. As an insurer, one of the major drawbacks is that Care has a slightly higher complaint volume than its competitors. Another drawback is that the PED waiting period for Care Supreme is 4 years, which is slightly longer. However, this can be reduced with an add-on.
4. Niva Bupa ReAssure 2.0
Niva Bupa ReAssure 2.0 offers comprehensive pre-and-post-hospitalisation coverage, with 60 days of pre-hospitalisation and 180 days of post-hospitalisation expenses covered. The policy also features a unique feature called Booster Plus instead of a traditional no-claim bonus. This carries forward the unclaimed amount of the current policy year to the next year, up to a certain limit depending on the policy variant. Apart from this, there are several other features and add-ons you can opt for to customise the policy as per your needs.
Drawbacks: Niva Bupa’s complaint volume is significantly higher than that of its competitors. We also feel that the other operational metrics could be slightly better. This could be because of the company's recent management changes. However, if you’re looking for a health insurance policy with a great set of features and are okay with the higher complaint volume, this policy is worth considering.
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Conclusion
Pre and post-hospitalisation expenses are an important part of a good health insurance policy. This is because, more often than not, these expenses can account for a significant part of your treatment.
While policies with such coverage may come with higher premiums, the benefits outweigh the cons and give you peace of mind, making them a valuable investment.
If you are considering purchasing a health insurance policy and still need help, book a free call with us for honest, spam-free health insurance advice.
