What is Covered Under Operation Health Insurance Plan?
An operation insurance plan offers financial protection against various surgical expenses incurred by the policyholder. Medical insurance for surgery is an indemnity-based plan that provides the following benefits to the insured:
- Cover for Defined Surgical Procedures - Our plan makes it easy for you if you have to undergo a surgical procedure. With our best insurance for surgery, you will not have to pay anything out of your pocket. However, make sure the procedure is covered under pur defined surgical procedures.
- Pre-hospitalisation Expenses - We cover the medically necessary expenses such as examination, tests and medication up to Sum Insured for a period of 30 days immediately before the date of your hospitalisation.
- Post-hospitalisation Expenses - We cover the medically necessary expenses up to the sum insured incurred by You for a period of 60 days immediately after your discharge from the hospital and you go back home for recovery.
- In-Patient Care - We will pay for the medical expenses, through Cashless or Reimbursement Facility up to Sum Insured– from room charges, nursing expenses, ICU charges, surgeon’s fee, doctor’s fee, anaesthesia, blood, oxygen, OT charges, etc., subjected to terms and conditions.
- Day Care Treatment - We will pay through Cashless or Reimbursement Facility for all such listed day care treatments that need hospitalisation for less than 24 hours, maximum up to Sum Insured.
- Organ Donor Cover - We care about those who help you as much as we care for you. So, beyond ensuring that Your medical needs are met, we will pay you through cashless or reimbursement Facility up to a specified amount/limit for medical expenses that are incurred by You towards Your organ donor, while undergoing the organ transplant surgery, if the donation confirms to the applicable laws and rules and You have already claimed for the same Covered Condition under Hospitalisation Expenses.
- Second Opinion - We take Your illnesses as seriously as You do. If You are diagnosed with or have undergone/are undergoing any of the Covered Conditions and feel uncertain about Your diagnosis/treatment or wish to get a second opinion within India from a doctor on Your medical reports for any other reason, We arrange one for you, without any impact on Sum Insured amount. This second opinion is available to every Insured Person, once for each Illness / Surgery per Policy year.
- Annual Health Check-up - Our prime concern is your good health. We provide an annual health check-up from the second policy year on continuous coverage at our network provider/ empanelled provider in India for all the insured persons covered under the policy, on a cashless basis. This Benefit shall be available only once during a policy year per insured person.
- No claim bonus - If no claim has been paid by us in the expiring policy year, we raise a cheer to your good health in the form of a bonus for you. At the end of 1st claim free policy year, we will enhance the Sum Insured by 50%, at the end of 2nd claim free policy year by 25% and at the end of 3rd Claim free policy year by 25%.
Optional Benefits of Buying Health Insurance for Surgery
You also have an option of choosing optional benefits while buying surgery insurance cover. Below listed are a few optional benefits that you can choose from
Co-payment Option
By choosing this optional benefit, you will bear a co-payment of 20% per claim and our liability shall be restricted to the balance amount payable, subject to terms and conditions.
Unlimited Automatic Recharge
If, you ever exhaust your health cover, we reinstate the entire sum insured unlimited times in a policy year provided you use the recharge amount only under hospitalisation expenses.
Air Ambulance Cover
We will pay you up to the amount specified in the Policy for availing Air Ambulance in India for your transportation from the place of occurrence of a medical emergency to the nearest Hospital.
Room Rent Modification
Your Room Rent/Category and ICU Charges should not have any restrictions or limits. In this optional benefit, you will have no limit on room rent/room category during Hospital accommodation.
What is Not Covered Under Operation Insurance?
The operation insurance policy has an initial waiting period of 90 days and 48 months for pre-existing diseases. The insured persons cannot get a claim if they undergo a diagnosis of illness or any surgical procedure during this period.
When buying a health insurance policy, it is essential to check the list of exclusions. It will give you an idea of the various scenarios where you will not be eligible to get a claim.
We list below some of the permanent exclusions of the policy:-
- Act of self-inflicted injury attempted suicide or suicide
- Any illness related directly to the consumption of Alcohol/Tobacco/Cigarettes etc.
- HIV/AIDS or any other sexually transmitted disease
- Cosmetic or plastic surgeries or related treatment
- Pregnancy, miscarriage, childbirth, maternity including C- section, abortion or complications of any of these
- All the hazardous activities
- Damage caused by a nuclear, chemical or biological attack or weapons
- Illness or injuries caused due to any breach of law by the insured with any criminal intent
List of Surgeries Covered Under Operation Insurance Plans
Care Health Insurance covers almost all surgical procedures, subject to terms and conditions. A list of some common surgical procedures are as follows-
- Cardiomyopathy
- Angioplasty
- Balloon Valvotomy/Valvuloplasty
- Pericardectomy
- Surgery to Place Ventricular Assist Devices or Total Artificial Hearts
- Surgery of Aorta
- Implantation of Pacemaker of Heart
- Heart Valve Replacement/repair
- Implantable Cardioverter Defibrillator
Why Do You Need Health Insurance for Surgery?
Surgery may become inevitable for a person suffering from an illness or having a specific medical condition. Surgeries are performed effectively and quickly owing to the technological advancements in healthcare, thus benefiting the patients. A surgical operation demands great care, and therefore it becomes crucial to avail quality treatment at the best hospital. This policy will protect you against a host of medical costs besides hospital bills. It would offer cover for expenses such as:
- In-patient Hospitalisation including room rent, operation theatre, and ICU charges
- Day-care treatment including day-care surgeries
- Pre-hospitalisation Medical Expenses incurred for 30 days before admission
- Post-hospitalisation Medical Expenses incurred for a period up to 60 days after discharge
How to Select Operation Health Insurance Online?
Buying operation health insurance online is a simple process that does not involve any paperwork. In a few clicks, you can get the best health cover for your medical expenses. Before proceeding, make sure you have made a clear assessment of your medical needs and estimated your costs.
Now, visit the official website of Care Health Insurance, where you will find the best operation insurance policy. You have the option to pick the sum insured based on your financial requirements. Moreover, you can calculate the premium and pay the amount online.
How to Claim Health Insurance for Surgery?
Below is the process you can follow to file cashless or reimbursement claim under your surgery insurance coverage-
| Cashless Claim Process |
Reimbursement Claim Process |
| Step 1: Go to a listed in-network hospital. |
Step 1: Submit your claim form along with other required documents. |
| Step 2: Fill out the proper forms at the insurance desk. |
Step 2: You'll get an approval letter when your claim is verified. |
| Step 3: Send the completed form to our claim management team. |
Step 3: Respond to queries raised by the claim management team. |
| Step 4: You'll get an approval letter when your claim is verified. |
Step 4: Get approval from the claim management team. |
| Step 5: Respond to queries from the claim management team and you will soon know whether your cashless claim is approved or rejected. |
Step 5: You will be contacted by our claims team if there are specific reasons for rejecting your claim. |
Key Factors to Keep in Mind While Opting for an Operation Insurance Policy
Choosing the right health insurance cover is of utmost importance so that you can stay worry-free about possible out-of-pocket expenditures. Here are some essential factors you must remember when selecting health insurance for surgery:
- Make sure you check the list of surgical procedures which are covered under the policy
- Find out the network hospitals where you could avail of cashless hospitalisation facility
- Decide the coverage amount which would be suitable for your estimated medical expenses
- Remember to take into account the waiting period clause, sub-limits, and exclusions
- Make sure the policy you have selected has features like lifelong renewability
- Check if there is an option of equated installments for premium payment
Difference Operation Insurance vs Health Insurance
Many people are gradually realising the importance of buying a health insurance plan, which will safeguard them during medical emergencies. A health plan offers numerous benefits and covers those medical expenses that are not just restricted to hospitalisation.
While this is true, it is also essential to have a specific health cover for surgery. It could be possible that your existing health policy becomes insufficient to cover all the expenses you are incurring due to an illness. Choosing an operation insurance cover is a wise decision as it will provide an additional cushion by covering the surgical procedures as defined in the policy document.
Kindly refer the prospectus for a complete list of procedures covered
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