Page 152 - IC38 GENERAL INSURANCE

Definition

IRDA Health Insurance Standardization guidelines define Pre-hospital expenses
as:

Medical expenses incurred immediately before the insured person is
hospitalized, provided that:

a) Such Medical Expenses are incurred for the same condition for which the
Insured Person‟s Hospitalization was required, and

b) The In-patient Hospitalization claim for such Hospitalization is admissible by
the Insurance Company.

Pre hospitalization expenses could be in the form of tests, medicines,
doctors‟ fees etc. Such expenses relevant and pertaining to the
hospitalization are covered under the health policies.

ii. Post hospitalization expenses

After stay in the hospital, in most cases there would be expenses related to
recovery and follow-up.

Definition

Medical Expenses incurred immediately after the Insured Person is dischared
from hospital, provided that:

a) Such Medical Expenses are incurred for the same condition for which the
Insured Person‟s Hospitalization was required, and

b) The In-patient Hospitalization claim for such Hospitalization is admissible by
the Insurance Company.

Post hospitalization expenses would be relevant medical expenses incurred
during period up to the defined number of days after hospitalization and will be
considered as part of claim.

Post hospitalization expenses could be in the form of medicines, drugs, review
by doctors etc. after discharge from hospital. Such expenses have to be related
to the treatment taken in hospital and are covered under the health policies.

Though the duration of cover for pre and post hospitalization expenses would
vary from insurer to insurer and is defined in the policy, the most common
cover is for thirty days pre and sixty days post hospitalization.

Pre and post-hospitalization expenses form part of the overall sum insured for
which cover is granted under the policy.

146