Health Insurance For Surgery

Yes, most health plans offer medical insurance for surgery. While the terms and conditions of the coverage and the limits may vary from policy to policy, the surgical procedure that is deemed necessary by a doctor is generally covered. The expenses, however, may come with a sub-limit and the company may cover them only up to a predefined percentage of the sum insured. Also, there are various additional costs that are attached and medical insurance for surgery may not cover 100% of the expenses. 

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

The amount of coverage you will get for surgery will mainly depend on factors like your hospitalisation costs, Pre and post hospitalisation, deductibles, etc. In general, the coverage you are liable to get from your insurance company will depend on the type of insurance plan chosen and the amount of maximum sum insured. Every individual health insurance plan will have its own level of coverage which will determine the price of its premiums.

In simple terms, the maximum coverage you may get for surgeries will not exceed the ‘maximum sum insured’ on your health insurance plan. It is recommended that people living in urban areas have health insurance that provides coverage of at least 50% of their annual income. Given the rising inflation, you should have a plan with a cover of at least ₹20-₹25 Lakhs with a top-up health plan providing similar coverage.

Now that you understand how coverage for surgery in health insurance works, you can make an educated decision on which policy to purchase based on what the plan offers and your specific needs. You should also compare health insurance plans available online by different companies to find the most economically beneficial plan with the best features. Try to buy a plan with a higher sum insured so you will be financially prepared for any surgeries or medical emergencies. You can take a look at the health insurance plans available at Bajaj Markets and pick one that you like.