Does Your Health Insurance Policy Cover Surgical Expenses?


Surgery is an important medical procedure for the treatment of certain illnesses. For a patient and the family members, it is natural to feel a bit nervous. In an event of a surgical operation, a lot of care is required. It hints at the need for getting quality treatment at the best hospital. 

Medical procedures, including surgeries, are getting advanced. However, their costs are quite high especially in private hospitals. Having a health cover or a mediclaim policy becomes absolutely essential in order to prevent one’s financial savings from draining out. 

Operation Insurance by Care Health Insurance (Formerly Religare Health Insurance) is a health cover for surgical expenses. 

What Does Surgical Expense Cover Include?

Health insurance products offer comprehensive cover for various medical expenses, including surgical expenses. Based on the policy, a number of surgeries may be covered, for instance, bypass surgery, knee replacement, and cataract operation. Hospitalisation costs, including room rent, ICU and operation theatre charges, get covered in the health insurance policy. 

Moreover, operation insurance plans also cover pre and post hospitalisation medical costs for the insured for certain specified number of days based on the policy terms. Before the surgery, the patient may have to go through numerous diagnostic tests such as electrocardiogram (ECG), ultrasound, blood tests, etc. In addition, post-operative care is also essential, which would include follow-up visits to the doctor. These expenses borne by an individual are reimbursed by the insurer, subject to policy terms and conditions.

There are some other benefits for the policyholders:

  • They can avail of the lifelong renewability feature so that an adequate sum insured is always available
  • For spending a claim-free year, they can get increased coverage under the ‘no claim bonus’ feature
  • Operation insurance plans are indemnity based plans which cover the actual expenses incurred due to the surgery

The best thing is health insurance for surgery comes at quite an affordable premium. There is a wide range of features and benefits, and the policyholder can avail coverage from Rs 10 Lakh to as high as Rs 2 crore.

Know the Exclusions

While you ensure you get the best insurance for surgery, do not forget to look at the exclusions mentioned in the policy documents. These are cases where the insured will not be eligible to obtain a claim for certain expenses. Cosmetic surgeries, plastic surgeries, and treatment for infertility are some types of surgeries that are generally not included in the policy cover. 

Important Tips to Avail Coverage for Surgery

  • Whether it is a planned hospitalisation or emergency hospitalisation, the policyholder should remember to inform the insurer as per the specified time. It is important so that there are no hassles in getting the claim.
  • The insured should be aware of the waiting period for specific diseases. In case an illness is diagnosed or a medical emergency occurs during that period, they should make prior preparation to avoid any major financial implications. 
  • While choosing the sum insured, one’s medical condition is an essential factor to keep in mind. 

In the case of certain non-communicable diseases, an individual may not show symptoms initially. The chances of medical emergencies may suddenly rise as the disease progresses. Any treatment involving medication and surgeries may cost up to lakhs of rupees. So, opting for comprehensive health insurance with various features and insurance cover for surgery is the best way to ensuring the welfare of the entire family.