Does Health Insurance Cover Surgery?

Does Health Insurance Cover Surgery?

Over the past few years, there has been a notable increase in the number of people opting to invest in health insurance. While this growing trend is indicative of heightened awareness among the public regarding the significance of securing healthcare coverage, understanding the nuances of health insurance coverage is equally vital. When you invest your hard-earned money in insurance, you need to be sure that when the time comes, your policy will help you cover the expenses. The inclusions and exclusions can differ not only from insurer to insurer but also from plan to plan.

One common question that may come to your mind is, ‘Does medicare cover surgery?’ However, it can not be answered with a simple yes or no. To find the answer to this question, we’ll have to keep in mind a few things and several factors. Read on to understand the coverage of health insurance for surgery.

Changing Trends in Health Insurance Coverage

Post-COVID, the Insurance Regulatory and Development Authority of India issued several guidelines for health insurance providers. The insurers were instructed to standardise and clarify the exclusions so that policyholders did not face any problems understanding them. Companies were also directed to give special emphasis on explaining coverage, which was offered up to sub-limits only.

While health insurance companies are quite transparent when it comes to inclusions and exclusions, the onus of knowing these features lies more on you. You need to go through the policy documents thoroughly so that you do not miss any crucial information.

Does Health Insurance Cover Surgery?

If you are thinking, I need surgery but have no insurance, then maybe it is high time that you invest in a suitable plan. When you are on the lookout for the right plan, you may come across a number of plan options that offer you the promise of being the best health insurance for surgery. However, what may be best for someone might not be the best for you. This is because health insurance needs may differ for different people. Therefore, understanding the coverage is essential. Let us now come to the question, ‘does insurance cover top surgery?’ To answer this question, we’ll have to explore the different aspects individually:

The Coverage Depends on the Plan Option

While a large number of surgical procedures are covered by health insurance providers, it is crucial to understand that the coverage depends entirely on the plan option that you have chosen. For instance, health insurance with ₹3 lakhs as the sum insured will offer coverage up to this limit only. Any amount that exceeds this amount will have to be borne by you.

Every health insurance plan also comes with its own set of sub-limits, and the coverage can be decided as per the caps in your plan.

Robotic Surgeries are Covered 

Robotic surgeries are a technological marvel that has significantly transformed various surgical fields. This modern approach utilises robotic systems to assist surgeons in performing minimally invasive procedures with enhanced precision. The use of robotic arms and instruments allows for greater control, smaller incisions, and faster recovery times for patients. While some health insurance plans may cover robotic surgeries, it's important to note that coverage can vary widely among different insurance providers and plans.

With Care Advantage Health Insurance, you can get coverage for such advanced surgeries that come with a sum insured as high as ₹6 crores.

Daycare Procedures are Covered

Certain surgical procedures do not require long hospitalisation, and you can go home within 24 hours of admission. Such procedures, called daycare procedures, are covered. With Care Health Insurance, you can get coverage for a long list of procedures, and that’s not all; a lot of plans allow coverage up to your sum insured. Some of the common surgeries under daycare are:

  • Angioplasty
  • Balloon Valvotomy
  • Heary Valve Replacement, etc.

Cosmetic Surgeries are Generally Excluded

Typically, cosmetic surgeries that are aimed at enhancing a person’s appearance are not covered by health insurance. For example, if you're considering a rhinoplasty to refine the appearance of your nose and make it appear more slender and are wondering can I get health insurance before surgery, it's important to note that even if you have a health insurance policy, it may not provide coverage for this elective cosmetic procedure.

At the same time, keep in mind that certain surgeries, such as bariatric surgery and breast reduction surgery, are covered when medically required. Also, if someone has been in an accident and requires some kind of reconstruction surgery, their health insurance may cover the expenses, as per the policy coverage.

A Waiting Period has to be Served

As a policyholder, you should surely know that there are different waiting periods that you need to serve when you purchase a health insurance plan. For example, there is typically a waiting period of 30 days after the date of policy purchase, during which a claim cannot be raised, even if it is for a covered treatment.

However, accidental injuries are an exception. So, in case surgical intervention is required after an injury, you might get the coverage as per the plan option.

There are certain illnesses and surgical treatments where the waiting period can be anywhere between 2 years to 4 or sometimes even 6 years.

>> Also Read: Things You Must Know About Pre-existing Disease Waiting Period

Child Birth-related Expenses are Excluded in Regular Health Plans

Most health insurance plans do not offer coverage for maternity-related expenses, including abortions and C-section deliveries. Plans such as Care Joy offer you coverage for maternity benefits. Depending on the plan option you choose, you can avail coverage for normal as well as Caesarean deliveries.

The Bottom Line

The surge in health insurance reflects a broader shift towards prioritising personal well-being and financial preparedness. The increasing number also underlines the increasing recognition of health insurance as a crucial component in safeguarding one's overall financial stability. While it is good to see that people understand the unpredictable nature of medical expenses and the potential financial strain they can cause. But at the same time, buying any health insurance plan might not be the way ahead. Choosing a plan that suits your needs and your budget is equally essential.

Care Health Insurance comes with a long list of plans that offer you customised coverage, which makes our health plans the best insurance for surgery. At the same time, we urge you to carefully read and understand the policy document, including terms and conditions, waiting periods, and sub-limits, when buying a health plan. Regularly reviewing your health insurance plan ensures you have adequate coverage for your needs and helps avoid any unpleasant surprises. If you have any doubts or concerns, like ‘can I get health insurance before surgery’, it's advisable to consult our  insurance experts and avoid any unpleasant surprises. This proactive approach not only averts heartburn when making a claim but ensures that your health plan aligns seamlessly with your needs.

Disclaimer: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.


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