With the rapid growth in medical technology and the advent of advanced treatment options, India’s average life expectancy has increased significantly. At the same time, the cost of medical treatment has gone up, which has made the treatment unaffordable for a few. Today, the treatment cost of critical illnesses like cancer or major surgery can run into several lakhs.
The best way to get coverage against the hefty medical bills and keeping your savings intact is by buying a robust health insurance policy. But, you may have heard many stories about the insurer denying payment of the full medical bills. While it is true that the health insurance policy helps you get compensation for the expenses incurred while you are hospitalised, does it cover 100% of the medical costs?
Typically, a health insurance policy covers all medical expenses as per the terms and conditions mentioned in the policy documents. Today, most health insurance plans cover hospitalisation expenses and pre-hospitalisation and post-hospitalisation treatment costs, including daycare treatment, medical tests, ambulance charges, bed fees, specialist consultation charges, etc.
What are Pre-hospitalisation medical expenses?
When you fall sick, you may visit a local physician and get a consultation for your condition. The doctor may then ask you to take a few diagnostic tests, including blood tests, urine tests, etc. to further diagnose your condition and prescribe you a few medications.
If the physician advises you to get hospitalised after the initial assessment, then the expenses you incur before getting admitted is called pre-hospitalisation expenses.
What are Post-hospitalisation medical expenses?
After you get discharged from the hospital, do the medical expenses stop? In most cases, it does not. The costs incurred after discharge is called post-hospitalisation expenses. It generally includes medications, therapy, and medical tests to monitor your health and recovery.
However, you must know that while most health insurance plans cover the pre-hospitalisation and post-hospitalisation expenses, they are limited to a specified number of days. For example, insurers cover pre-hospitalisation expenses for 30 days and post-hospitalisation expenses for up to 90 days (the duration may vary from insurer to insurer).
Additionally, the pre-hospitalisation expenses are covered only if incurred for the diseases or the ailment for which you get hospitalised. Similarly, the insurance company compensates for the post-hospitalisation costs if they are incurred for further treatment of the condition for which you were hospitalised.
In the purview of the COVID-19 pandemic, many insurance companies in India have extended the COVID-19 cove to their existing customers and introduced special COVID-19 protection plans. These plans typically cover the in-hospital treatment costs and cover other costs, including PPE kits, oxygen cylinders, and expenses incurred on post-discharge care.
Thus, it is evident that health insurance policies cover most medical expenses as per the terms and conditions. Only the costs that are exclusively listed as exclusions in the policy documents will not be covered. For example, most health insurance policies in India do not cover beauty enhancement treatments.
So, make sure that you are aware of the policy’s inclusions and exclusions to avoid filing false claims and get maximum coverage.
Disclaimer: This content is distributed by HDFC ERGO. No TNIE Group journalist is involved in the creation of this content.
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