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You might often hear that purchasing health insurance or medical insurance for medical expenses is essential, and you probably have at least one insurance policy as you read this article as well! However, have you ever stopped to wonder what exactly these medical expenses are?  

 

Put simply, medical expenses are the costs incurred as a result of treatment or prevention of an illness or injury. However, medical expenses are not the only costs you incur when you go to a hospital for treatment. Factors such as pre and post hospitalisation charges also play a role. 

 

While these factors might seem like afterthoughts, they could land you with a huge out-of- pocket bill if you do not account for them, which beats the entire purpose of paying insurance premiums to have insurance for medical expenses all this while. 

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

 

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

Pre-hospitalisation medical expenses

When you purchase medical expenses insurance, you must not only account for the cost of medical treatment and the medicines that you have to use in order to carry out the treatment. In fact, there are a number of other costs that are involved that you should account for when you get insurance for medical expenses so that you do not have to bear a hefty out-of-the pocket bill in your time of need. Pre hospitalisation expenses in health insurance are one such subcategory. 

 

You go through a number of procedures and tests before you are actually hospitalised. Generally, this period is considered to be anywhere from 30 to 60 days before the hospitalisation period. These can include: 

  • Tests that have to be carried out in order to come to a diagnosis such as blood tests, MRI scans, sonographies, x rays, etc. 

  • Costs of any medication that you have to take before you are hospitalised. 

  • The doctor’s fees that are involved in the pre-hospitalisation process. 

Post-hospitalisation expenses

Similar to before you are hospitalised, your treatment does not completely cease to exist once your hospitalisation period is over. There are a number of post hospitalisation charges that are involved that you should account for when you account for the medical expenses insurance providers can cover for you. 

 

The cost of treatment after hospitalisation can include:

  • The cost of prescribed medicine

  • Physiotherapist appointments

  • Follow ups with your doctor 

  • Cost of follow up tests etc. 

Similar to pre-hospitalisation expenses in health insurance, the post-hospitalisation period is also considered to be anywhere between 30 to 60 days after you have been discharged from the hospital. 

Are pre and post-hospitalisation similar to convalescence/recovery allowance?

To answer this simply, pre and post-hospitalisation charges are not the same as convalescence/recovery charges. But let’s understand why. 

 

If you are hospitalised, it means you cannot go about your daily routine for that period. Sometimes, the injury that landed you in the hospital might result in you being in the hospital for an extended period of time, meaning your routine is disturbed, possibly causing a loss of income. It is this loss of income that a recovery allowance looks to supplement. 

 

Whereas pre and post-hospitalisation charges are costs of treatment, convalescence in health insurance is geared towards providing compensation for financial damage done due to an injury. 

Conclusion

We often underestimate the amount we will require if we are to be hospitalised or need medical treatment. Therefore, in order to be caught by surprise at the time of making a claim, it is important to consider not only cost of treatment, but factors such as pre and post hospitalisation charges as well while buying insurance for medical expenses. 


Now that you have gone through this article, you might have a better idea about hospitalisation expenses in health insurance and other charges. If you are looking to buy a health insurance policy, you can visit Bajaj Markets website to browse the extensive catalogue. The Bajaj Markets website has health insurance policies for all requirements and budgets, leaving you with an abundance of varied choices to secure your health.

Health Insurance Plans Available at Bajaj Markets

FAQs on Health Insurance For NRIs

Are pre and post-hospitalisation charges really essential?

Unlike a recovery allowance which allows you an added benefit in your time of need, pre and post-hospitalisation charges are essential, as both processes are essential to getting you into and out of the hospital. You are best advised to not try and skim costs here. 

Why is convalescence paid in lumpsum payments?

Since recovery allowances are not meant to cover medical charges but substitute lost income  (which can be used to cover medical charges), the payments can be given out as a lump sum to the policy holder. 

What costs are not covered by health insurance?

Generally, your health insurance won’t cover the costs of cosmetic surgeries etc, as they are not medically relevant. Additionally, if you have a pre-existing condition, this might not be covered as well. Any other miscellaneous charges by the hospital will also not be covered if they are not treatment-oriented, or outlined in the policy terms and conditions in advance.

What else does convalescence cover?

In addition to the costs of recovery, some health insurance policies might also provide compensation for the travel of family if they are coming from far away.

How can I reduce health insurance premiums?


The best ways to keep your health insurance premiums down is to get health insurance at an early age when you are most healthy, and to follow a healthy lifestyle there on out.

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