Health Insurance Policies - Fine Prints - Pre and Post-Hospitalization Claims

Pre and Post-Hospitalization Claims

PRE-HOSPITALIZATION EXPENSES REIMURSEMENT: Medical expenses incurred for a period of up to 30 days prior to hospitalization on disease /illness /injury will be considered as part of claim.


Relevant and justified medical expenses pertaining to the current hospitalization only are applicable for re-imbursement as per the guidelines issued by IRDA. Expenses that are applicable for re-imbursement should not exceed the duration of 30 days before the date of admission in a hospital/nursing home. Expenses incurred on the medical treatment exceeding 30 days duration prior (before) to hospitalization are deducted irrespective of any relevant justification submitted by the policyholder or the medical fraternity. It should be borne in mind that pre-hospitalization expenses should be relevant in nature.

POST-HOSPITALISATION EXPENSES REIMURSEMENT: Relevant medical expenses incurred during period up to 60 days after hospitalization on disease/illness/injury sustained will be considered as part of claim as mentioned.

Relevant and justified medical expenses pertaining to the current hospitalization only are applicable for re-imbursement as per the guidelines issued by IRDA. These medical expenses applicable for re-imbursement should not exceed the duration of 60 days after the date of admission in a hospital/nursing home. Expenses incurred on the medical treatment exceeding 60 day duration subsequent (after) to hospitalization are deducted irrespective of any relevant justification submitted by the policyholder or the medical fraternity. It should be borne in mind that post-hospitalization expenses should be relevant in nature.

Reference

1. Best Health Insurance Policy in India - (https://www.apnapaisa.com/insurance/health-insurance-india/index.html)

Disclaimer: The contents of the article are in tune with the regulations in Insurance and TPAs (Third Party Administrators) since the past 2 years. The same rules are likely to prevail and be in force for the year 2009-10, unless changes/modifications/alterations/deletions/additions in existing regulations are made by the Insurance Companies, in tune with the guidelines issued by IRDA (Insurance Regulatory Development Authority). The author of this article does not take responsibility for changes made in the existing health insurance policy coverage which would occur with passage of time.

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