Brain Surgery Cover In Health Insurance

Many brain-related medical conditions can be treated with medicines. However, there are also some diseases or illnesses that require brain surgery. Brain surgeries are very complex medical procedures that can cost lakhs of rupees in India and put a dent in your savings. If the operation is being conducted in metropolitan cities like Mumbai or Bangalore, the cost can go even higher. There are also additional costs associated with surgery like tests, scans, hospitalisation, medicine, and more. If you wish to keep  yourself financially covered against these expenses, you should consider getting a health insurance plan that covers brain surgery. 

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

• Most health insurance plans offered by reputed insurers in India cover the cost of brain surgery. 

• Health insurance plans cover the cost of medical expenses like ICU costs, hospitalisation, treatment expenses, Pre and post hospitalisation, room rent, etc. 

• The coverage for the brain surgery and related expenses will only be provided till the maximum sum insured in your health plan. 

If the total cost of your surgery is ₹12 Lakhs and your health insurance provides a maximum sum insured of ₹10 lakh, you will have to pay for the remaining ₹2 Lakhs out of pocket. So, when you are buying your health plan, make sure that you buy a policy with a high enough sum insured to take care of all your potential medical expenses in the future. You can also try to get a critical illness cover on top of your health insurance that will provide you with a large amount of money if you are diagnosed with a critical illness like cancer, lung disease, heart attack, etc. 

If you have any pre-existing conditions at the time of health insurance plans, a mandatory waiting period of around 2-4 years will be applicable. While this waiting period is active, you will not be eligible for any coverage for your pre-existing medical conditions including your brain-related issues.

However, once the waiting period in health insurance is over, the coverage will continue and you can seek treatment for your brain-related conditions including brain surgery. In case you are suffering from a pre-existing condition, try to look for a policy that offers the lowest waiting period among all available options. On the other hand, if you do not have any pre-existing conditions, a basic 30-day waiting period will apply to your policy. 

Brain related medical conditions must be taken extremely seriously. If you end up needing brain surgery in the future and do not have health insurance, it can drain all of your savings and disrupt your financial planning. In case of brain surgeries that require prolonged hospitalisation, you may even have to go into serious debt to pay off your medical bills. You can protect yourself against the immense medical costs of brain surgery and other treatments by getting a good health insurance policy. If you do not yet have a plan, you can check out the various health insurance policies available at Bajaj Markets and buy the one that best fits your requirements.