What Type of Surgeries Does Health Insurance Cover?

What Type of Surgeries Does Health Insurance Cover?

As the risk of lifestyle diseases and critical illnesses is rising, investing in a health insurance plan that provides coverage for a wide range of medical treatments is essential. It is essential to have a plan that provides coverage for surgeries and modern medical procedures so that you are adequately covered for maximum medical requirements in future. The coverage offered by a health insurance plan varies across the insurers. Let us discuss health insurance for surgeries and the common types of surgery covered.

Why is Health Insurance for Surgeries Necessary? 

A surgery is a medical procedure where surgeons operate on the human body or an organ to treat an ailment. It requires the patient to stay in the hospital for some time for recovery. However, with advancements in medical technology, many surgeries no longer require elaborate procedures or large incisions. As a result,  such procedures are now completed in just a few hours, and the patient is discharged within a day. Having health insurance for surgeries is important because it not only covers the cost of the surgery but also the other associated costs, as mentioned below:

Diagnostic Tests

Pre and post-operative diagnostic tests are required to assess the patient’s health. The cost of these tests is covered as per the policy terms and conditions, and the extent of coverage depends on the sum the insured amount opted for.

Operation Theatre and ICU Charges

Operation insurance also covers the operation theatre charges for the surgery. These rates are usually charged on an hourly basis.

Fees of Surgeon and Other Medical Staff

The cost of the medical team present during surgery, including doctors and nurses, is an additional expense associated with the procedure. Such fees are also covered by health insurance for surgeries.

Medical Equipment

A patient may need supportive equipment for recovery after surgery, such as a brace or crutches. Their costs are also covered up to a specified limit, as mentioned in the policy documents.

Inpatient Care or Recovery Room Rent

Sometimes, patients need some recovery time in the hospital after the surgery. In such cases, the cost of the hospital stay is also covered through a cashless or reimbursement facility up to the Sum Insured.


All types of medication required during and after the surgery, as prescribed by the doctor, are covered in operation insurance up to the limit specified in the policy documents.

Pre and Post-hospitalisation Expenses

Pre and post-hospitalisation expenses are also covered as part of operation mediclaim for 30 days before hospitalisation and for 60 days after the discharge.

Tips for Buying the Best Health Insurance for Surgeries

Having adequate health insurance coverage can help reduce your out-of-pocket medical expenses. Hence it is crucial to choose the right coverage using the following tips:

  1. Check the inclusions and exclusions of the policy before finalising a plan. The policy document lists all the surgical procedures covered under the plan. Check this list to find out what is covered and what is not.
  2. Check the list of network hospitals where you can get cashless hospitalisation. Look for nearby hospitals on the list. It will be easier to travel in case of an emergency.
  3. Select a sum insured option depending on your medical needs and the current costs of medical procedures. The cost of a procedure also depends on the hospital where you are seeking treatment.
  4. Check the waiting period, sub-limits and co-payment for various procedures to avoid claim rejection in future.
  5. Check the premium payment term, whether it is yearly, half-yearly, quarterly or monthly.
  6. Always select a policy that offers benefits like lifelong renewability, preventive health check-ups, No-claim bonus and other optional benefits.

Care Operation Mediclaim: Care Health Insurance for Surgeries

Care Operation Mediclaim plan is the best health insurance plan for surgeries, offering complete coverage for costs associated with the surgical procedures listed in the plan. The plan offers customisable indemnity-based coverage. Here is a list of different types of surgeries covered under the plan:

  • Angioplasty
  • Cardiomyopathy 
  • Balloon Valvotomy/Valvuloplasty
  • Surgery to place an artificial heart or ventricle assist device
  • Pericardectomy
  • Surgery of Aorta
  • Implantation of pacemaker
  • Heart valve replacement/repair
  • Implantable Cardioverter Defibrillator

Claim Process for Care Health Insurance for Surgeries

There are two ways to file a claim for surgeries: a Cashless claim and a Reimbursement claim. Let’s take a look at the claim filing process for both methods:

Cashless Claim Procedure

Get your surgery done in a network hospital to avail of a cashless claim. For planned surgery, inform the company before the surgery as per the timeline defined in the policy. For emergency surgery, inform the company within 24 hours. Given below is the process to file a cashless claim:

Step 1: Submit the completed claim form to the insurance desk at the hospital.

Step 2: Send the duly completed form to Care’s claim management team.

Step 3: After verifying the claim, you will know if it is approved or rejected. If the claim is approved, the insurance company will directly settle your hospital bill as per the limit defined in the policy.

Reimbursement Claim Procedure

When the treatment is taken at a non-network hospital, the claim request is submitted after the discharge from the hospital, along with the documents required by the company. Given below is the process to file a reimbursement claim:

Step 1: Submit the duly completed claim form along with supporting documents.

Step 2: You will get an approval letter once the claim is verified.

Step 3: Coordinate with the claim management team to address any doubts or additional queries.

Step 4: The claim management team will approve your claim.

In Summary

Health insurance for surgeries provides coverage for medically necessary surgeries. Hence, it is important to understand what types of surgeries are covered and the extent of coverage. It’s always recommended to contact your health insurance company to understand the plan coverage and exclusions before deciding. Care operation mediclaim offers comprehensive coverage for all listed surgical procedures with a wide range of benefits and sum insured options, considering the high costs of modern medical procedures.

>> Also Read: Does Medical Insurance Cover Cosmetic Surgery?

Disclaimers: The above information is for reference purposes only. Kindly consult your general physician for verified medical advice. The health insurance benefits are subject to policy terms and conditions. Refer to your policy documents for more information.

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