Being wheeled into the Operation Theatre can be quite unnerving. Even though your doctor would have spent a lot of time to put you at ease, it is quite natural to worry about the outcome. Your return to good health depends, in no small part, on the skill of the doctor and divine providence. However, choosing the right health insurance plan that covers the cost of surgery and post-operative recovery is something that is entirely in your hands.

Welcome surgical health insurance

A surgical health insurance plan absorbs the increasing costs of healthcare, putting surgical treatment at a top or middle tier hospital within reach for most Indians. If you are about to go under the surgeon’s knife, here are a few things that will make the experience less intimidating, financially at least.

Nature of surgery

Surgical procedures that do not directly contribute to your health are excluded from health insurance coverage. For example, liposuction and bariatric surgery both address weight loss. However, the former is considered cosmetic as it is not prescribed by a medical practitioner.

Bariatric surgery, on the other hand, is advised to patients who are morbidly obese or have other medical complications that affect normal bodily functions. Having a clear understanding of whether the surgery is lifesaving or non-essential can help you avoid out-of-pocket expenses.

Pre and post procedure costs

A surgery is never a standalone procedure. Diagnostic tests such as MRIs, medication and post-operative care including home therapy services constitute a significant chunk of the overall cost. Contact your insurer to get any clarifications you need relating to any medical services that may be excluded from coverage.

Know your healthcare network

While your insurer may have the best hospitals in your neighbourhood on its rolls, service providers such as pathology labs and diagnostic centres may not be affiliated. This would directly contribute to out-of-pocket expenses, unless you confirm the same beforehand with your insurer.

Dissect your final bill

On getting the doctor’s nod for discharge, you might think that the worst is over. However, you may be in for a surprise on seeing your final bill. Seek clarification from your insurer to understand how the bill was processed. Total charges, adjustments and discounts are the sections to watch with particular interest.

Understand the terms and conditions

As with all other insurance plans, health insurance coverage depends upon a set of pre-defined terms and conditions which are fundamental to the policy. The interpretation of these terms and conditions, laid down in the Policy Wordings, may differ from insurer to insurer.

Spend time understanding the inclusions and exclusions of your health policy and any additional coverage that you may have opted for. This will minimise any disappointment over the terms of service when filing a claim.

The pay-out in a surgical health insurance plan is not related to the actual cost of the surgery. Rather, your insurer will pay you a fixed, pre-determined amount for the surgery (if it is covered under the policy). By keeping in mind the above-mentioned points, you can get the most from your surgical cover under your health insurance plan.

Learn more about different Health Insurance Plans here.


The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.

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