Explained: Post-hospitalisation expenses covered by health insurance policies

The novel Corona Virus Disease’s (COVID-19) debilitating effects on health are fairly well-known. However, emerging evidence suggests that the pandemic can take its toll on patients’ vital organs such as heart and lungs even after they recover.

This could mean visits to the doctor or hospitals even after discharge, besides having to consume medicines for a longer period of time. These expenses can severely strain your finances, already reeling under humungous hospitalisation bills as also out-of-pocket expenses due to ongoing disputes between hospitals and general insurance companies.

However, you need not shoulder the entire burden on your own – you can tap your health insurance cover, which is not confined to hospitalisation expenses – for costs incurred after you return home.

Will my health insurance policy pay for medical expenses after I am discharged from the hospital?

Yes, these will be covered as part of post-hospitalisation expenses, up to your sum insured limit. In the case of standard Corona Kavach and Arogya Sanjeevani policies, these expenses will be covered for up to 30 days after discharge.

Insurance policies will pay for such expenses incurred up to 60 days after discharge. Some premium variants reimburse such amounts for up to 90 days. This would include medicines prescribed in the discharge summary, follow-up visits to your doctor or the hospital and even diagnostic tests during the period. If you need to take nursing care at home, that will be reimbursed too. Similarly, if you have undergone a spine surgery that necessitates post-operative physiotherapy sessions, you can claim the expenses under the post-hospitalisation cover.

If I get treated at home for COVID-19 after consulting a doctor at the hospital, will the expenses be reimbursed?

Such expenses will not be treated as part of post-hospitalisation costs. Only post-discharge expenses that are directly linked to the hospitalisation episode will fall in this category. However, if your policy covers domiciliary hospitalisation, or treatment taken at home under certain exceptional circumstances, your claim will be settled, as COVID-19-induced shortage of beds is a reality in many cities. These expenses will also be paid for if your insurer has explicitly taken the call to cover home treatment, given the extraordinary situation humanity is facing at present.

How should I go about making the claim?

Ensure that you preserve all your bills and receipts related to medicines, follow-up visits, diagnostic tests and so on carefully. Submit physical copies to the insurer soon after 60-90 days are over or as soon as the prescribed follow-ups come to an end. Usually, your insurer will give you a window of 7-15 days to submit these documents. However, some will consider the claim even in case of a delay as long as you can provide a justifiable reason. Unlike hospitalisation claims, this cannot be settled on a cashless basis. You will have to make the payment, which will then be reimbursed by your insurer.