How to Claim Pre and Post-Hospitalisation Expenses under Tata AIG Medicare Select Cover?

Pre Hospitalisation Expenses

Pre-hospitalisation expenses are those medical expenses that you may incur 90 days prior to being admitted to the hospital for treatment (TATA AIG Medicare Select Plan). However, the expenses must be in connection with the medical treatment that is covered under the insurance policy.

For example, all expenses related to the investigation, consultation, and medicines incurred specified number of days before admission to the hospital are considered pre-hospitalisation expenses.

List of pre-hospitalisation expenses:

Post Hospitalisation Expenses

Post-hospitalisation expenses are those medical charges that an insured may incur up to 90 days after being discharged from the hospital. All expenses that are connected with the treatment or hospitalisation and are incurred during the specified duration after discharge will be admissible.

List of Post-Hospitalisation Expenses

While you can claim treatment and hospitalisation charges under reimbursement or cashless claim methods, when it comes to pre- and post-hospitalisation expenses, the case is slightly different. If you have the TATA AIG Medicare Select plan, these expenses can be claimed only under the reimbursement method.

So, if you have opted for a cashless method, the inpatient and treatment charges will be paid directly to the hospital. If you also want to make a claim for pre- and post-hospitalisation charges, you can raise a separate reimbursement claim with us.

Here are the steps that you can follow to claim the pre- and post-hospitalisation charges.

• Step 1: Fill the Form - First, you must fill out the claim form with all the necessary information, such as the cause of hospitalisation, details of the pre-and post-hospitalisation charges, etc.

• Step 2: Documentation - Ensure that your claim is backed by all the relevant documents, such as a doctor’s letter, prescriptions, bills, medical certificates, etc.

• Step 3: Claim Submission - Once you have the claim form and the documents in place, you can submit the claim to us using our online portal or email.

• Step 4: Review and Verification - Once we receive your claim request, we shall review and verify it for accuracy. And if the claim is appropriate, the amount will be approved and reimbursed to you.

As you have seen, the claim procedure for pre- and post-hospitalisation expenses is a straightforward one. However, to make the claim a success and receive the claim amount, a few considerations need your attention.

• Time Frame - When submitting a claim, it is necessary to be mindful of the time frame for filing the claim. The claim for pre-and post-hospitalisation charges must be filed with TATA AIG within the stipulated time to avoid claim rejection.

• Policy Coverage - You must also know that the pre-and post-hospitalisation charges incurred 90 days prior and 90 days after discharge from the hospital are admissible and covered under the policy. Thus, include the expenses incurred during the specified time to avoid claim rejection.

• Relevance - You must also be aware of the expenditure relevance while claiming the pre- and post-hospitalisation charges. Under the TATA AIG Medicare Select insurance policy, only those pre- and post-charges are covered that are directly related to the hospitalisation or treatment. For instance, if the treatment or hospitalisation is for an orthopaedic issue, the pre- and post-expenses must also be in connection with the same illness.

• Exclusions - Not all the pre-and post-hospitalisation expenses can be claimed, as some of them may be excluded from the scope. For example, expenses related to pre-existing diseases may only be covered after the specified waiting period is over. Thus, when you want to make a claim, make sure you do not include the expenses that are explicitly excluded from the coverage.

To get the reimbursement of the pre and post-hospitalisation expenses, it is necessary to preserve the bills and documents before and after the treatment. Submitting all the required documents is crucial to ensure that your claim is accepted. Here are the documents that you must submit:

1.Claim Form - The claim form is the most crucial document that you must fill out and submit to register the claim successfully.

2.Diagnostic Test Reports - If you have undergone medical tests, such as blood tests, X-rays, MRI scans, etc., before and after hospitalisation, you must submit reports of the same for approval.

3.Medical Bills - Medical bills and receipts, such as pharmacy expenses, lab test charges, etc., serve as proof of the expenses you have incurred before and after hospitalisation.

4.Medical Certificates and Prescriptions - You can support the claim by providing medical certificates and doctor prescriptions along with the other documents.

5.Discharge Summary Report - It is necessary to submit the discharge summary, stating the reason for hospitalisation, treatment given at the hospital and the post-discharge care and diagnostics to be carried out.

6.Follow-Up Treatment Proofs - You may also attach all the follow-up treatment proofs and bills, such as therapy charges and bills, invoices for the purchase of medical equipment, etc.

7.Identity Proof - Attach an identity document, such as your Aadhar card, PAN card, etc., to establish your identity.

8.Policy Document - Provide a copy of the insurance policy document or card under which you are claiming the pre-and post-hospitalisation charges.

• Financial Assistance - The best mediclaim policy from TATA AIG covers pre- and post-hospitalisation charges, providing financial assistance to the insured. It reduces the financial burden and allows you to tackle medical situations smoothly.

• Extensive Coverage - The inclusion of medical expenses incurred before and after hospitalisation enhances the coverage of the insurance plan. It brings in more expenses under the insurance blanket, providing you coverage for additional expenses.

• Supports Recovery - Since the post-hospitalisation charges are included, it supports recovery, as you don’t have to worry about the follow-up charges, therapy treatments post-surgery, diagnostic tests, etc. Thus, you can follow all the post-hospitalisation recommendations without worrying about the finances.

• Enables Illness Detection - The coverage of pre-hospitalisation charges enables you to undergo diagnostic tests and doctor consultations without thinking about the financial implications. It helps to detect any health problems so you can get the required treatment on time.

• Facilitates Continuous Treatment - Since the pre- and post-hospitalisation charges are covered under TATA AIG’s Medicare Select insurance plan, you can continue the treatment without any worry about the financial implications.

• Helps to Protect your Savings - When the pre and post-hospitalisation and actual hospitalisation charges are covered under the insurance plan, it can help to secure your savings. You can get access to the treatments, tests, therapies and all other necessary medical services while having sufficient savings for the future.

• Includes AYUSH Treatment - If you decide to opt for AYUSH (Ayurveda, Yoga, Unani, Siddha, Homeopathy) treatment for your diseases, the Medicare Select plan also provides coverage for any pre- and post-expenses incurred for the same.

• You can maximise your reimbursement of medical expenses by claiming the pre-and post-hospitalisation charges. Thus, you must read the policy document carefully or enquire with the insurer about the reimbursement of pre-and post-hospitalisation charges.

• Ensure that you include all the necessary documents and also attach supporting documents to make your reimbursement claim stronger.

• Find out the duration for which you can claim the pre-and post-hospitalisation charges.

• Refrain from providing any false information or fake documents, as it can lead to rejection of the claim and, in some cases, the policy may be cancelled by the insurer.

• Preserve the original copies of bills, reports, prescriptions, etc., for submission.

• Pre-and post-hospitalisation expenses can be claimed under individual and family floater plans under the TATA AIG Medicare Select policy.

The TATA AIG Medicare Select individual health insurance plan is among the top-most affordable and comprehensive health insurance plans that offer maximum benefits to the policyholder. Investing in this health plan allows you to save a significant amount, as you can claim reimbursement of hospitalisation charges as well as pre-and post-hospitalisation expenses.

Moreover, the pre-and post-hospitalisation claim process is simple and can be completed in a few steps. All you must do is have all the documents ready and follow the process and guidelines diligently. The coverage for pre and post-hospitalisation expenses takes the financial load off your shoulders, allowing you to save for the future.

With the TATA AIG mediclaim policy, you are adequately prepared for facing medical emergencies.

What are some of the exclusions of the pre- and post-hospitalisation charges?

Some exclusions of the pre-and post-hospitalisation are as follows:

• Pre-existing diseases (before the waiting period)
• Cosmetic procedures
• Expenses not related to the hospitalisation and treatment.
• Expenses incurred for changes in gender treatments, etc.

What is the claim limit for post-hospitalisation expenses?

You can claim post-hospitalisation expenses up to the limit of the sum insured by your TATA AIG Medicare Select plan. The expenses incurred up to 90 days from the date of discharge from the hospital can be claimed.

Can I purchase pre- and post-hospitalisation expenses as a separate policy or add-on?

In most cases, pre- and post-hospitalisation expenses are included in the coverage of the base plan. Not many insurers offer it as a standalone policy or add-on cover. However, you can enquire and find out if any such offering is available.

When can a pre-or post-hospitalisation expense claim be rejected?

Your pre-or post-hospitalisation expenses claim may be rejected for a few reasons:

• Late submission of the claim
• If the tests or expenses are medically unnecessary
• Documents/proofs submitted are insufficient.
• Expenses are excluded from the policy’s coverage.

To avoid claim rejection, you must read the policy documents carefully and if there are any doubts, you can get them clarified from the insurance company.