Pre-Hospitalisation and Post-Hospitalisation Expenses in Health Insurance

Medical costs do not only comprise treatment and hospitalisation costs, but also include diagnostic tests, doctor consultation, ER visits, etc. If your health insurance plans do not cover these, they lead to increased out-of-pocket expenses.

Pre-hospitalisation expenses are the medical costs incurred before the formal admission of a patient to a hospital. These expenses are directly related to the illness or injury that eventually requires hospitalisation and occur within a specific timeframe before admission, typically ranging from 30 to 60 days, depending on the insurance policy.

Now that you know the pre-hospitalisation meaning, consider this example: Ajay hospitalises his father for a heart procedure after complaints related to chest pain. However, before the actual hospitalisation, they visit a cardiologist for consultation, go for an ECG and other blood tests. The medical expenses incurred to come to a diagnosis and start with a treatment for Ajay’s father qualify as pre-hospitalisation costs.

Types of Expenses Covered Under Pre-Hospitalisation:

• Doctor consultation fees

• Diagnostic tests (X-rays, CT scans, MRI, blood tests)

• Prescription medications

• Emergency room visits

• Medical procedures performed on an outpatient basis

• Ambulance charges for emergency transport

• Physiotherapy sessions related to the condition

Post-hospitalisation expenses are medical costs that are for medical attention required for the same illness or injury after discharge from the hospital. These expenses are covered for a specified period after discharge, usually between 60 and 90 days, and are essential for the patient's complete recovery and follow-up care.

For instance, after undergoing knee replacement surgery, you may need regular physiotherapy sessions, follow-up consultations with the orthopaedic surgeon, prescription medications for pain management and diagnostic tests to monitor the healing progress. All these post-discharge expenses would fall under post-hospitalisation coverage under our Individual health insurance.

Types of Expenses Covered Under Post-Hospitalisation:

• Follow-up doctor consultations

• Prescription medications for continued treatment

• Physiotherapy and rehabilitation services

• Diagnostic tests to monitor recovery

• Medical equipment rentals (wheelchairs, crutches, oxygen cylinders)

• Home healthcare services

• Outpatient procedures related to the original condition

Here are some of the top reasons for opting for TATA AIG’s health insurance plans with pre-hospitalisation and post-hospitalisation covers –

Broad Coverage

TATA AIG covers medical expenses not just during hospitalisation, but also for diagnostic tests, doctor consultations and medications, 30 to 60 days before and 60 to 90 days after hospital stay. This ensures end-to-end support across the treatment journey.

Reduces Out-of-Pocket Expenses (OOPE)

Medical costs for initial tests or long-term follow-ups can add to your own pocket expenses, especially if your health insurance plan does not cover them. This cover reduces your financial burden by covering costs often excluded in basic plans.

Cashless Claims

Access cashless treatment at authorised hospitals, including for pre- and post-hospitalisation services. You do not need to worry about upfront payments for the entire treatment cost or reimbursement delays.

Convenient Access to Care

Choose from a wide network of 12,000+ hospitals across India and easily find one near you for timely treatment and follow-ups, without compromising on care or convenience.

Complete Treatment Support

Serious illnesses often require prolonged care. TATA AIG’s post-hospitalisation cover includes support for physiotherapy, medications and specialist consultations. This ensures that your recovery is smooth without worrying about the costs.

Reduces Stress

Medical treatments and their expenses can be overwhelming, especially during ongoing medical care. With TATA AIG’s extended coverage and simplified claims, you focus on recovery while we handle the finances.

TATA AIG allows you to claim medical expenses incurred before admission and after discharge. However, you must ensure that both fall within the eligible period (typically 30–60 days before and 60–90 days after hospitalisation, as per the plan). Additionally, timely submission of documents is essential for a smooth claim process.

Claim Process for Pre-Hospitalisation Expenses

Get Treated and Maintain Records: Visit a doctor, undergo tests or get prescribed medicines before hospital admission.

Hospitalisation is a Must: Pre-hospitalisation expenses are valid only if the insured is subsequently hospitalised for the same condition.

File the Main Hospitalisation Claim First: Pre-hospitalisation bills can only be claimed after your primary hospitalisation claim is accepted.

Submit Required Documents: Upload prescriptions, diagnostic reports, medical bills, and consultation records through our website, app or claim desk within the allowed period.

Claim Process for Post-Hospitalisation Expenses

Complete Follow-up Treatments: Continue medications, tests, or consultations as advised after discharge.

Track the Coverage Window: Ensure all post-hospitalisation expenses fall within the covered period (e.g., 60–90 days post-discharge).

Collect All Supporting Documents: This includes discharge summary, post-discharge consultation notes, pharmacy bills, and test results.

Submit Within Claim Window: File the post-hospitalisation claim within the specified time after treatment. Delay or missed deadlines may lead to claim rejection.

Documents Required

• Consultation papers and doctor’s prescriptions

• Diagnostic reports and medical bills

• Pharmacy bills with prescriptions

• Discharge summary

• Original payment receipts

• Follow-up treatment notes

Check Exclusions: Before you buy health insurance online, be sure to check the list of procedures and other medical costs covered under pre- and post-hospitalisation. These may vary from one plan to another; thus, check your policy documents or contact our customer care.

Check Coverage for PED: Health insurance plans offer coverage for pre-existing diseases (PED) only after you complete the applicable waiting period. Thus, ensure you check and complete the waiting period and disclose your PEDs accurately.

Coverage Duration: Check the coverage period when buying a plan with pre- and post-hospitalisation expenses (30 days for pre and 60 days for post-hospitalisation), as the costs are only covered if they fall within the specified period.

Mandatory Hospitalisation: These expenses are covered when they are associated with inpatient treatment, i.e., treatments that require admission to a hospital. Ensure that you file a claim for the right type of expenses.

TATA AIG’s mediclaim policies with pre- and post-hospitalisation cover are designed to support your complete recovery journey, before admission and after discharge. These benefits extend beyond the basics, helping manage everyday expenses that often get overlooked in standard plans.

With TATA AIG, you can avail of an easy and hassle-free claiming procedure online. Once our team verifies your application and documents, we will reimburse the money into your account as per the terms of the policy you have chosen.

In addition to smooth claim processing, TATA AIG offers a wide network of over 12,000+ hospitals for cashless treatment, an intuitive digital platform for tracking and managing claims, and 24x7 customer assistance. You also benefit from a high claim settlement track record and transparent service.

From diagnosis to recovery, TATA AIG ensures that your health journey is financially supported and stress-free, making us a trusted partner in every step of your care.