What surgeries are covered by health insurance?

The word ‘surgery’ can easily cause worry and stress. Worry about the procedure, the pain, the recovery period, and the costs involved. Those who have health insurance may be in a better position to meet the expenses. However, it is essential to understand the surgery-related coverage provided by different health insurance plans.

Let’s understand all about surgeries and health insurance coverage.

Surgery cover varies from insurer to insurance

Health insurance policies differ from each other vastly. To know the types of surgery expenses included in a policy would require knowing the clauses mentioned in the policy. 

Here’s what a policyholder can do: ask your doctor/surgeon/hospital to share a detailed plan of what surgeries would be required. You could even get a rough estimate of the cost of the surgeries. Next, read your health insurance policy document clauses section. Policy documents list costs that are covered and excluded in the plan. This should give you the basic information about the surgery costs covered by your insurer. For clarifying doubts and concerns, it is best to contact your insurance agent or the health insurance company representative.

 Related blog: How Health Insurance Works

Day care procedures and surgery

Surgeries are of various kinds. Some may require hospitalization of a few days to a long duration, while some may be completed within a few hours and not require hospitalization. This is where day care procedures coverage for surgeries comes in. 

Here’s a list of some day care procedures including surgeries that are covered by different insurance plans.

  •     Certain surgeries related to the ear – stapedotomy, surgeries of the auditory ossicles, and reconstruction of the middle ear, among others.
  •     Certain surgeries related to the nose – sinus, nasal concha, foreign body removal, among others.
  •     Surgical treatments for eyes – cataract, corneal incision, eyelid incision, removal of foreign body, among others.
  •     Neurological surgery
  •     Oncology
  •     Chemotherapy

Alongside, let’s also look at surgeries and procedures that are not included in health insurance plans.

  •     Cosmetic surgeries
  •     Dental surgeries
  •     Non-essential surgeries
  •     Experimental surgeries

  

Non-essential or experimental surgeries

Most health insurance plans that provide coverage for day care procedures would cover surgeries. However, this may vary depending on the policy clauses. Medical technology is advancing fast, but po may take time to catch up. Certain new technology-based surgeries may not be included or mentioned in the health insurance policy and hence, there are chances of such treatments not being covered.

 

Costs related to surgeries

Some surgeries can require extensive procedures, pre and post the actual operation. It is important to understand whether or not your health insurance plan covers these costs. Medical treatment costs are on the rise. Hi-tech medical procedures cost lakhs and it is important to keep the cost factor in mind when buying the insurance policy. It is better to have a high sum insured if surgery costs are to be claimed. Experts advise that a sum insured of Rs 10 lakh to Rs 25 lakh is a good start in case surgeries are required.

Know more about surgeries that are covered by health insurance plans with this infographic.

 

Important practices to avail coverage for surgery from health insurance

  • Remember and consider the waiting period to avail coverage for surgery. You cannot buy a new health insurance plan today and go into surgery the next day thinking that the insurer will pay the claims. Typically, health insurance policies have a waiting period. The insurer would pay claims only after the waiting period is over.
  • Whether you had to go in for an emergency surgery or it was a planned factor in your medical treatment plan, it is essential to inform your insurer on time. In order to claim the expenses from the insurance company, follow the guidelines and rules of the company.

  

Health insurance plans with surgery coverage

If you’re looking to buy health insurance that provides surgery coverage, here are some health plans that you could consider.

Aditya Birla Activ Diamond Plan:a comprehensive general health insurance plan, this plan also offers additional cover for critical illness and reduction of pre-existing diseases waiting period. Its key features are:

  • 150%reload of sum insured, for subsequent claims due to unrelated illness, maximum up to Rs 50 lakh
  • Coverage for 586 daycare procedures
  • International and domestic medical emergency services
  • HealthReturns worth up to 30% of the premium amount  

Bajaj Allianz Health Guard Plan:A comprehensive plan, both for individuals and family, it offers coverage for pregnancy as well as newborn baby. Here are its key features:

  • Two variants available: Silver (up to 2 lakh sum insured) and Gold (up to 50 lakh sum insured
  • Entry age: 3 months to 65 years
  • Renewability: lifelong
  • Includes comprehensive coverage: pre and post hospitalization, critical illness, organ donor expenses, AYUSH treatment, maternity and more.

Star Health Family Health Optima: this super saver family health insurance plan is available for the age group of 18 years to 65 years. It includes members- spouse, dependent children (16 days to 25 years), and parents. Its key features are:

  • Sum insured up to Rs 25 lakh
  • Coverage for newborn baby
  • Air ambulance cover up to 10% of the basic sum insured
  • Bonus and additional sum insured

 Bharti AXA Senior Citizen Health Insurance: health insurance specially designed to safeguard senior citizens of 65 years and above, this is currently one of the most recommended senior citizens’ health insurance plans. Here are its key features.

  • Offers additional cover for critical illness
  • Cashless hospitalization
  • Sum insured: 5 lakh to 1 crore
  • Special dedicated customer care support for senior citizens

HDFC Ergo Health Insurance for Senior Citizens: with no age limit, this here is one of the best plans for senior citizens’ healthcare needs. Its key features are:

  • Day care treatment coverage: all treatments
  • Critical illness coverage: ad-on available
  • Additional coverage: AYUSH treatments

Surgery can cause concern, not only about health and wellness, but also about finances. It is important to be financially prepared for such health needs. Hence health insurance experts often urge policyholders to maintain a high sum insured. With rising medical treatment and operation costs, it is only wise to have an insurance policy that covers surgery and one with a high sum insured. 

 

FAQs: Health Insurance To Cover Surgery

How do I know what surgeries are covered by my health insurance plan?

Health insurance policies differ from each other vastly. To know the types of surgery expenses included in a policy would require knowing the clauses mentioned in the policy. Hence, go through your health insurance policy document in detail. Ask your health insurance age or the insurance company representative to share a detailed list of what surgeries would be included.

Are surgeries covered from day 1 of buying a policy?

No. Typically, health insurance plans have a waiting period. It is only after the completion of the waiting period that you would be able to claim for the surgery expenses.

What surgeries are included in health insurance plans?

Here’s a list of some day care procedures including surgeries that are covered by different insurance plans.
· Certain surgeries related to the ear – stapedotomy, surgeries of the auditory ossicles, and reconstruction of the middle ear, among others.
· Certain surgeries related to the nose – sinus, nasal concha, foreign body removal, among others.
· Surgical treatments for eyes – cataract, corneal incision, eyelid incision, removal of foreign body, among others.
· Neurological surgery
· Oncology
· Chemotherapy

Click to rate this post!
[Total: 0 Average: 0]