People often wonder what an ideal health insurance premium is. Earlier, having a medical insurance plan worth Rs. 10 Lakh was more than enough, but now, an upsurge in surgery costs has made this premium amount an average.
12 years ago, kidney transplants used to cost around Rs 5 lakhs. However, now the same costs more than Rs. 18 lakhs. As you do not have control over the rising medical costs, you have full authority to get reliable health insurance that could cover the cost of surgery on your behalf.
Explore how you can cover surgery costs using health insurance in this blog.
How Much Coverage Do You Get for Surgery with Health Insurance?
A comprehensive medical insurance plan provides the widest coverage, making it ideal during surgeries. The following are some insights on comprehensive policy coverage:
- Pre- and Post-Hospitalisation Cover
Robust health insurance plans not only cover the cost of surgery but also the pre- and post-hospitalisation expenses, including doctor consultations and pathological and medicinal expenses.
- Day Care Procedures
Thanks to technological advancements, most surgeries are completed swiftly. In addition, these take no longer than 24 hours for initial recovery. Comprehensive health plans cover these procedures.
- Emergency Ambulance Services
Emergency ambulance services offer both road and air ambulance services. This coverage helps patients while being transferred from one hospital to another or during emergency evacuation.
- Modern Treatment Cover
Based on the policy clause, modern treatments such as robotic surgeries, oral chemotherapy, and stem cell therapy are payable with health insurance.
- Hospital Cash
Some insurers offer a fixed daily allowance as a cash benefit for every single day spent at the hospital. The hospital cash amount limit depends on the policy terms.
- Alternative Care
If a patient is interested in alternative care such as Umami, homoeopathy, and Ayurveda, a comprehensive plan will provide coverage. The coverage amount gets decided at the time of premium purchase and can be updated accordingly.
- Outpatient Cover
This type of coverage allows policyholders to access quality outpatient care without an extra financial burden. For example, during a minor surgery of LASIK, you can use this to cover the cost of surgery.
- Organ Donor Expenses
A comprehensive insurance plan covers both the recipient’s and donor’s medical costs during organ donation. It includes organ removal, storage and all interrelated tests.
Factors that Influence Health Insurance Surgery Coverage
The following are some significant factors that influence the surgery costs:
- Gender and age of the policyholder
- Location of policyholder
- Family health history
- Lifestyle and habits like smoking, drinking, etc.
- Policy type and its coverage
Things to Keep in Mind Before Choosing Health Insurance Surgery Coverage
Before buying a health insurance surgery coverage policy, it’s important to understand health insurance kya hota hai. You need to keep in mind the following things:
- High Sum Insured Amount
Since surgery expenses are difficult to determine beforehand, policyholders need to be prepared. A high sum insured amount helps the policyholder receive high financial coverage during surgery.
For example, if you need to go for a complex surgery with high expenses, choosing an insurance with a high insured sum could be beneficial.
- Policy Premium
Factors such as inflation and technological advancements impact surgery costs. Therefore, it is a smart option to choose a policy with a higher premium, as this will enable you to obtain more coverage.
For example, if you are undergoing heart surgery, you can cover the costs of hospitalisation, medications, and pre- and post-operative care with your health insurance plan.
- Waiting period
The waiting period varies depending on the surgery. For example, a bariatric surgery or a metabolic surgery might have a 36-month waiting period, or a knee replacement surgery could have a 2-year waiting period.
So, choosing a plan early enough to avoid the waiting period is a good option to cover the cost of surgery seamlessly.
- Knowing Policy Exclusions
Policy exclusions refer to the conditions or diseases that insurance does not cover. Usually, there are two types of policy exclusions: first, the exclusion is for a limited period, and second, permanent exclusion.
For example, cosmetic surgery, infertility treatments, and plastic surgery are not included in most medical insurance plans. Knowing the policy exclusions beforehand could save you from a lot of trouble in the future.
- Cashless Hospitalisation
Choosing an insurer that offers cashless health insurance benefits will allow a policyholder to go for surgery at a network hospital. At a network hospital, a policyholder can get quality treatment without paying a single penny.
- Simple Claim Process
A policy with a simple claim process reduces a lot of stress. Depending on the type of policy and the surgery, the claim process varies.
For a reimbursement claim, a policyholder must submit all necessary documents with a claim form. Whereas, for a cashless claim, the policyholder only needs to inform the insurer about the emergency, and the insurer takes care of the rest.
Bottom Line
A report from NITI Aayog states that around 30% of the total population in India do not have a health insurance plan. It could be because developing countries have not prioritised surgical care for the public.
If you are looking for a reliable, comprehensive health insurance plan to cover the cost of surgery, it is necessary to compare different quotes from different insurers. Conduct a check to know their claim settlement ratio and quality of customer support.