Does Health Insurance Cover Surgery?

Does Health Insurance Cover the Cost of a Surgery?

As the cost of private healthcare in India has skyrocketed over the past few years, having a health insurance plan has become a necessity. It is not just any other financial product and should be an integral aspect of your financial portfolio. If you’re someone who’s looking to buy insurance and wondering if health insurance covers the cost of surgeries, then we’ll help you out.

Fortunately, most health insurance plans provide coverage for a large variety of surgeries. However, the coverage will only be provided if these surgeries are life-saving or done for improving a patient’s health. Cosmetic surgeries not intended for health benefits will not be covered. Let’s take a deeper look at the topic of medical insurance for surgery.

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 expenses, 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. 

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