Health Insurance For Surgery

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Yes, most health plans offer medical insurance for surgery. While the terms and conditions of the coverage and the limits may vary from policy to policy, the surgical procedure that is deemed necessary by a doctor is generally covered. The expenses, however, may come with a sub-limit and the company may cover them only up to a predefined percentage of the sum insured. Also, there are various additional costs that are attached and medical insurance for surgery may not cover 100% of the expenses.

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

How Much Coverage Does Health Insurance Provide for Surgeries?

The amount of coverage you will get for surgery will mainly depend on factors like your hospitalisation costs, Pre and post hospitalisation, deductibles, etc. In general, the coverage you are liable to get from your insurance company will depend on the type of insurance plan chosen and the amount of maximum sum insured. Every individual health insurance plan will have its own level of coverage which will determine the price of its premiums.

In simple terms, the maximum coverage you may get for surgeries will not exceed the ‘maximum sum insured’ on your health insurance plan. It is recommended that people living in urban areas have health insurance that provides coverage of at least 50% of their annual income. Given the rising inflation, you should have a plan with a cover of at least ₹20-₹25 Lakhs with a top-up health plan providing similar coverage.

What are the Additional Costs of Surgery?

Alongside the cost of the surgery procedure, there are some other additional charges that may be applicable, such as:

Pre and Post Operative Tests

Blood tests, X-rays, and various diagnostic scans that need to be conducted before and after surgery.

Operation Theatre Costs

The cost of booking the operation theatre (OT) for the surgery is separate from surgery costs and usually charged on an hour-to-hour basis.

Surgeon(s) and Nurse(s) Fee

The fees for the surgeon who performs the surgery, as well as fees for any doctors or nurses that may be assisting them, are also charged separately.

Cost of Medicine

The cost of medicine needed before, during, or after the surgical procedure is also an extra cost (such as anaesthesia).

Medical Items

The cost of items used in a surgery such as plasters, crutches, bandages, stitches and other dressings, is also chargeable separately.

Recovery Expenses

Post-surgery recovery expenses will be the cost of your hospital room, food, fee for nurses and doctors who will check up on you, etc.

Please note that some or all of the above costs may be covered by your insurer under the health insurance plan or none may be covered, depending on the coverage terms of the policy. Thus, it is a good idea to read the full policy document before buying a health insurance plan.

Conclusion

Now that you understand how coverage for surgery in health insurance works, you can make an educated decision on which policy to purchase based on what the plan offers and your specific needs. You should also compare health insurance plans available online by different companies to find the most economically beneficial plan with the best features. Try to buy a plan with a higher sum insured so you will be financially prepared for any surgeries or medical emergencies. You can take a look at the health insurance plans available at Bajaj Markets and pick one that you like.

Does health insurance cover surgery?

Yes, most health insurance plans cover the cost of surgery as long as the procedure is life-saving or for improving the health of the patient, and prescribed by a doctor.

Does health insurance cover cosmetic surgery?

No, most health insurance plans do not provide coverage for cosmetic surgeries. However, coverage may be provided if a doctor deems the surgical procedure necessary (for instance, cosmetic reconstruction surgery after an accident, or Bariatric surgery).

Can I buy health insurance for surgery only?

Some insurers offer special health insurance targeted for covering surgeries only, that you can purchase. However, most general health insurance plans offer coverage for surgery, so you do not need to buy an additional plan.