Pre & Post Hospitalisation Coverage in Group Health Insurance

In group health insurance, pre-hospitalisation refers to medical expenses incurred by the policyholder before hospital admission. These medical expenses are covered for a predefined number of days before the hospitalisation.

It generally covers the medical expenses for which the insured person needs hospitalisation. These expenses can include consultations, lab tests and more. By performing the tests, doctors can identify the severity of a medical condition and offer treatment based on that.

The pre-defined number of days for medical expenses prior to hospitalisation may vary from insurance provider to provider. For some insurance companies, it is 30 days, and for others, it can be 60 days prior to hospitalisation.

Post-hospitalisation expenses in group health insurance are the medical expenses that the policyholder incurs after the hospitalisation. These medical expenses are covered for a specified number of days after the policyholder's discharge from the hospital.

These medical expenses are for the same condition for which policyholders need hospitalisation. This generally includes doctor consultations, tests, medicines, etc., to identify whether the patient is recovering from the condition or not.

The number of predetermined days for post-hospitalisation in group health insurance may vary from insurance provider to provider.

Pre and post-hospitalisation in group health insurance offers various benefits to policyholders and their covered family members. Some of the benefits are listed below:

Wide Medical Coverage

One of the reasons for choosing group health insurance is the wide medical coverage against unforeseen medical emergencies.

With pre and post-hospitalisation in group health insurance, you will get wide coverage from the diagnosis of the disease to treatment to the recovery of the disease. It means your insurance plan covers the full cycle of treatment, which may take several months.

Holistic Care

Another benefit of pre and post-hospitalisation in group health insurance is holistic care to employees during medical crises. It ensures that employees receive comprehensive medical attention throughout their health crisis, from the initial diagnosis through treatment and recovery.

This continuous support improves the chances of full recovery and reduces the burden on employees, ensuring that their health is managed with care at every stage, not just during hospitalisation.

Easier Claim Process

The easier claim process is a key benefit of group health insurance that adds great value for employees. Due to the organisation's status as a significant client, insurance providers often prioritise and expedite the claim process.

Employees benefit from quicker claim settlements and enhanced service during medical emergencies. This smooth and hassle-free process provides peace of mind, ensuring employees get timely support when they need it the most.

Cashless Hospitalisation

Another notable benefit of group health insurance is the cashless hospitalisation facility. This means that if an employee needs hospitalisation at an authorised network hospital, they can avail themselves of treatment without worrying about upfront payments.

The policyholder is provided with a health card or e-card, which they can present to the hospital for quick verification and direct billing.

This eliminates the need to arrange funds during emergencies, allowing employees to focus solely on their recovery while the insurance provider settles the medical expenses directly with the hospital.

Pre-existing Disease Coverage

Another important benefit of group health insurance is the immediate coverage for pre-existing diseases from day one.

Unlike individual health insurance policies, where policyholders often have to wait through a specified waiting period for coverage of pre-existing conditions, group health insurance covers these conditions immediately.

This immediate coverage ensures that employees with chronic conditions or ongoing medical issues receive the treatment they need right away, without delay, providing immediate financial protection and access to care, making you feel relieved and cared for.

Also Read: Benefits of Group Health Insurance Policy for Employees

Let us take an example to understand how pre- and post-hospitalisation coverage in group health insurance works. Suppose a person X who works in an ABC organisation falls sick. He is covered by the ABC company's group health insurance.

On 24th August 2024, person X went to the doctor for a consultation. The doctor suggested some tests to identify the health issues.

On 25th August, person X got the result back, and after examining the result, the doctor suggested that the patient need to be admitted to the hospital.

The patient was admitted the same day. On 26th August, the patient received treatment in the hospital. After receiving treatment, person X was discharged from the hospital on 30th August.

He again went to the hospital for follow-up treatment on 2nd September 2024. The doctor prescribed some medications to the patient. After that, the patient again went to the doctor for a final check-up after the 3-day medication course on 5th September 2024..

In this scenario, the medical expenses incurred from 24th August 2024 to 25th August 2024 are pre-hospitalisation expenses. The medical expenses from 26th August 2024 to 30th August 2024 are hospitalisation expenses since the person was admitted to the hospital.

The expenses incurred from 2nd September 2024 to 5th September 2024 are identified as post-hospitalisation expenses incurred by person X.

Understanding the process to claim pre and post-hospitalisation in group health insurance is crucial. Let us explore the process in detail so you can feel informed and prepared when the need arises.

Pre Hospitalisation Expenses

Step 1: When you anticipate a hospitalisation, inform the insurance provider about the admission within the stipulated time frame.

Step 2: Keep all the medical bills, lab test results, etc., handy at the time of filing pre-hospitalisation medical expenses.

Step 3: Submit all the documents at the time of filing the claim.

Post Hospitalisation Expenses

Step 1: Once you are discharged from the hospital, collect the medical bills for follow-up consultations, post-hospitalisation treatments, medications and more.

Step 2: Submit these documents to the insurance provider for the claim settlement within the stipulated time frame.

TATA AIG group health insurance policy offers coverage for pre- and post-hospitalisation expenses. Under pre-hospitalisation expenses, we offer coverage for medical consultations, appointments, diagnoses, tests and medications incurred up to the number of days specified in the policy or document issued by us.

This benefit is payable if we have a claim admitted under the domiciliary treatment or in-patient treatment.

Under post-hospitalisation expenses, we offer coverage for expenses like consultations, medicines, etc., after discharge from the hospital up to a specified number of days, as mentioned in the policy document.

Like pre-hospitalisation expenses, this benefit can also be claimed under domiciliary treatment day daycare procedures or in-patient treatment.

• The medical expenses for pre and post-hospitalisation should be for the medical condition for which the patient has been admitted to the hospital.

• The policyholder must submit all the necessary documents for pre and post-hospitalisation expenses to the insurance provider or TPA when raising claims.

• To claim the pre and post-hospitalisation expenses in group health insurance, you need to raise a claim request within the stipulated time frame mentioned in the policy documents.

In India, business insurance, such as group health insurance, is available to help organisations and companies. These products offer financial security to businesses and organisations against unforeseen emergencies and help businesses maintain continuity and build a strong workforce.

One such product is a group health insurance policy that offers security to employees and their family members. TATA AIG offers corporate health insurance policies tailored to the needs of employers and businesses.

• What is the time limit for post-hospitalisation?

  The time limit for post-hospitalisation in group health insurance may vary from insurance company to company. For some, it is 30 days, and for some, it can be up to 60 days. The insurance provider accepts the claim submitted during this time frame.

• Can I file for post-hospitalisation with group health insurance after the time limit?

  If you file a claim for post-hospitalisation after a stipulated time frame, then it will be rejected by the insurance provider.

• What expenses are covered under the pre-hospitalisation in group health insurance?

  The medical expenses that are covered under the pre-hospitalisation in group health insurance are doctor consultations, lab tests, medicines, etc. In simple words, the patient pays the medical expenses to diagnose the disease before admission into the hospital.