Pre and post-hospitalisation expenses in your health insurance policy

India is firmly in the grip of a second wave of the novel Coronavirus (COVID-19) pandemic. Maharashtra and its capital Mumbai are amongst the worst hit, much like the first wave. As hospitals overflow with patients, many are also grappling with the financial implications of doctor consultations and diagnostic test bills.

Moreover, as with any other major ailment, COVID-19 treatment also involves significant expenses beyond hospitalisation. There have been cases of COVID-19 patients requiring medical care beyond the 14-day treatment and quarantine period.

A regular health insurance policy typically settles the hospitalisation bill. But did you know that you can claim expenses incurred before admission and after discharge too? However, there are restrictions – not all expenses can be claimed, and settlement might not be cashless for you.

Will my health insurance policy pay for COVID-19 RT-PCR tests done before hospitalisation?

Yes. A health insurance policy foots the bill for diagnostic tests that are linked to the eventual hospitalisation. “All costs associated with an admissible hospitalisation including medical tests such as RT-PCR and investigations are covered as part of pre-hospitalisation expenses,” says Mahavir Chopra, Founder, Beshak.org, an independent platform for insurance buyers. An RT-PCR test is most commonly used to detect traces of Coronavirus in our bodies; it costs up to Rs 1,200.

If you have to be hospitalised for COVID-19 treatment, the costs of RT-PCR, blood tests and CT scan costs – incurred up to 30 days before hospitalisation - will be borne by the insurer. The condition is that it should be directly linked to the hospitalisation. “In COVID-19 positive cases, the cost of RT-PCR which gives a positive result prior to the hospitalisation will be covered,” says Bhaskar Nerurkar, Head–Health Claims, Bajaj Allianz General Insurance.

If the test results come negative, then you can only claim expenses of such diagnostic tests if your health insurance policy reimburses OPD (Out-Patient Department) charges.

Will my health policy pick up the tab for expenses post discharge?

Most health insurance policies cover certain expenses post of your discharge from the hospital. “The tests advised by physicians and follow-ups up to 60 days post hospitalisation are covered as per policy terms and conditions,” says Nerurkar. In fact, if you need to hire help at home to nurse your health, that will be covered too, as also physiotherapy sessions in case of, say, spine surgery. This will be covered up to your sum insured limit. Some premium products extend this coverage to 90 days. However, in case of standard Corona Kavach policies, these expenses will be covered for up to 30 days after discharge.

What documents do I need to submit to file the claim?

Your diagnostic test receipts will be your key documents for making the pre-hospitalisation claim. Ensure that you preserve all the bills and receipts – better still, ask the diagnostic centres to email them to you or download through the app. In times of stress, it will be easier to access these documents digitally rather than physically safeguarding the copies.

In case of post-hospitalisation expenses, your discharge summary will be the crucial document, as it contains details of medicines and follow-ups. It will have to filed as a reimbursement claim – that is, you will have to make the payment and your insurance company will reimburse the expenses later. Remember, this will be in addition to your regular hospitalisation claim – you can file it separately, taking into account your follow-up and medication expenses during the 60-90-day period. It will not be settled as a cashless claim, unlike your hospitalisation bill, but you will have to submit your documents to make the claim. Typically, insurers provide a window of 7-15 days to initiate this claim and submit the documents.