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Disclaimer: The above plans and premiums are for 1 Lakh sum per life per month covering Health and Wellness needs of 7 Employees, 5 Spouse & 2 Kids below 35 years of age. The premium is inclusive of GST and do not cover PEDs & Maternity. Standard T&C Apply PolicyBazaar does not rate, endorse or recommend any particular insurer or insurance product offered by the insurer.
Pre & Post Hospitalisation Cover in Group Health Insurance
Pre and post-hospitalisation cover in group health insurance is one of the inclusions that provide coverage for the expenses incurred before and after the insured hospitalisation of the insured employee. Since these expenses can empty your pockets, pre and post-hospitalisation cover works like a shield over your pockets by protecting you from the expenses incurred out of the hospital expenses.
Medical expenses incurred before admission to a hospital are known as pre-hospitalisation expenses. There is a generic procedure that is when a person feels sick he consults with a doctor. After that, if required the doctor suggests the person get some tests or scans done to get the exact idea about the medical condition. If the diagnosis comes out severe then the insured patient has to be admitted to a hospital.
It is common sense as the patient has to get medical tests and scans done to diagnose the severity of the medical condition. These tests include CT Scan, X-rays, MRIs, Blood-sugar, etc. which determines the severity of the medical condition and the cost of these expenses are covered under pre-hospitalisation.
Most insurance companies offer pre-hospitalisation cover that taken place before 30 days of the hospitalisation. However, this varies from insurer to insurer and it can go up to 60 days prior hospitalisation of the insured patient.
Expenses incurred after the patient is discharged from the hospital as known as post-hospitalisation expenses in the group health insurance policy. There are several cases in which the treatment does not end immediately after the patient is discharged.
The patient has to take medicines after being discharged from the hospital. Apart from this, the patient has to keep on consulting with the doctor who has treated him/her to make sure that he/she is recovering from the medical condition until they or fully recovers.
The duration for coverage varies from insurer to insurer as some insurance companies offer post-hospitalisation coverage for up to 60 days whereas some insurer offers coverage for up to 90 days after the discharge of the patient.
Reasons to Opt for Pre & Post-hospitalisation in Group Health Insurance
Here are some of the reasons to opt for pre and post hospitalisation coverage in the group health insurance online:
Easier to Getting Claim
When a company provides group insurance scheme to the employees, the insurance company has to take their employee's claims as a priority and settle them as quickly as possible. It is because the company is a bigger client for the insurance company and if would not provide them better and quick service then they might have to lose the company at the time of renewal. Hence the insurer has to make sure that they do not upset the company’s employees in any kind of service related to the insurance plan.
As an employee of the company, you get an e-card that you can utilize to get a cashless claim in case you have to get hospitalised. You do not have to hassle to get your claim settled as the insurance claim desk in the hospital gets it done.
Coverage from Day 1 & No Test for Pre-existing Diseases
In the individual health insurance policy, the insured has to go through a waiting period for several medical conditions. However, under group health insurance, the insured employees get coverage from day one as well as they do not have to get any tests done for pre-existing diseases.
How Do Pre & Post Hospitalisation Work?
To make it easier for you to understand, let us tell you how pre and post hospitalisation works with an example:
- On 1st July, the employee feels sick and goes to a doctor for consultation and the doctor suggests some tests (Pre-hospitalisation expense)
- On 2nd July, the employee gets the tests done.
- On 3rd July, the doctor examines the test results(Pre-hospitalisation expense) and suggests the patient get admitted to a hospital.
- On 4th July, the patient gets admitted to the hospital (Hospitalisation expenses).
- On 8th july, the patient goes through treatment in the hospital (Hospitalisation expense).
- On 11th July, the patient gets discharged (Hospitalisation expense).
- On 15th July, the patient goes to the doctor for follow-up treatment and the doctor asks him to do a 3 days medication course (Post-hospitalisation expense).
- On 18th July, after doing 3 days medication course, the patient goes to the doctor for a final check-up (Post hospitalisation expense).
Key Points to Remember
Here are some of the key points to remember related to pre and post-hospitalisation cover:
- The treatment of the medical condition before and after the hospitalisation must be for the same condition for which the insurer employee was admitted to the hospital.
- To raise a claim for pre and post-hospitalisation expenses, the insured has to make sure to submit the required documents to the insurer or TPA.
- The expenses for the pre and post-hospitalisation claim will be entertained only when they are raised within the specified days in the insurance policy documents.
The companies that opt for pre and post-hospitalisation cover in group health insurance plans help their employees by taking off the expenses incurred in medical tests, medicines, doctor’s fees, etc. This is one of the best features of a group health insurance policy and it is recommended to every employer offer it to their employees.
Written By: PolicyBazaar - Updated: 21 July 2022