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Does your health insurance cover all your medical expenses?

Does your health insurance cover all your medical expenses?

Do you think only hospitalization burns a hole in your pockets? What about the exorbitant costs incurred on tests and consultations before you are hospitalized? Or, for that matter, the monitoring expenses after you are discharged? Anubhav was none the wiser. He had a persistent fever for which he spent tens of thousands on diagnosis. After a stint in hospital (he had cerebral malaria), expenses continued as the infection was regularly monitored from recurrence. He knew that his health plan would cover his hospitalization expenses. But what about the expenses incurred before and after hospitalization? Would they be covered?

A health insurance policy covers almost all types of medical expenses if they are not incurred for a treatment which is otherwise excluded from coverage. Hospitalization expenses, Day Care treatments, domiciliary treatments, organ donor expenses, ambulance expenses, etc. are all covered in every health insurance plan. Among these coverage features pre and post-hospitalization expenses are also included. Do you know what such expenses are?

Besides covering the expenses which are incurred while you are hospitalized, your health insurance policy also covers expenses incurred both before and after such hospitalization. These medical expenses which are incurred before and after hospitalization are called pre and post hospitalization medical expenses. Let us understand them in details:

Pre-hospitalization medical expenses                                                                                  

When you fall sick what do you do? You visit a physician and get consultation for your sickness. The physician might then ask you for diagnostic tests to diagnose your condition and also prescribe you medicines. If, after diagnosis, your physician advises on hospitalization then the expenses which you have incurred prior to such hospitalization are called pre-hospitalization expenses. These expenses include the consultation fees paid to the physician, the cost of medicines and cost of diagnostic tests done for investigative purposes. In short, all such costs leading up to actual hospitalization are termed as pre-hospitalization costs.

Post-hospitalization expenses

After you are discharged from a hospital do your medical expenses stop? No they don’t. Such medical expenses are called post-hospitalization expenses. These expenses relate to medical consultations, medicines and other tests which are done for monitoring your health after you are discharged from the hospital.

Some important points

Both pre and post-hospitalization expenses are covered by your health plan. However, there are some points which should be kept in mind. Here are the points:

  • Both pre and post hospitalization expenses are covered for a specified number of days both before and after hospitalization. Pre-hospitalization expenses are covered for either 30 days or 60 days before hospitalization. Post-hospitalization expenses are covered for 60 or 90 days after being discharged from the hospital. The actual number of days for which pre and post-hospitalization expenses are covered depends on the plan.
  • Pre-hospitalization expenses are covered only if they are incurred for the disease or ailment for which hospitalization subsequently occurs. Similarly, post-hospitalization expenses are also covered if they are incurred for the disease for which hospital treatment was taken.

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

Convalescence or recovery allowance is a lump sum benefit which is allowed if you stay in a hospital for more than a specified period. This period might be 7 days or 10 days depending on the policy. Pre and post-hospitalization are, therefore, completely different from recovery benefits. Let us see how:



Thus, both these terms are different and cannot be used interchangeably.

By now you must have had a very good idea of what pre and post-hospitalization means. Your health plan provides you an exhaustive coverage option and pre and post-hospitalization expenses are also a part of it.

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