Things You Should Know About Health Insurance for Knee Replacement Surgeries


As we age, we become weaker and continuing with our daily activities becomes more difficult. Most people, especially old ones, complain of pains in their muscles, joints, even knees. In many cases, their knees become very weak and they have to undergo a surgery. Thanks to insurance companies in India that offer health insurance covers for knee replacement surgeries.

Here are a few things you should know about health insurance for knee replacement surgery.

Knee Replacement Cost

There are many insurers in India that have designed insurance plans to cover expensive costs of knee replacement. No doubt, knee surgery can be a life-changing decision because it puts physical and mental pain. Also, the procedure is one of the most expensive. A single surgery could cost you anywhere between Rs 500,000 to Rs800,000. However, surgery costs may vary depending on several factors such as city and implant used in the surgery. Therefore, having a health insurance plan is necessary because it can save you hard earned money by covering the entire medical procedure costs. It prevent financial difficulties

Coverage Benefits

In general, a health plan covers costs such as hospital and surgeon fees and the taxes levied on importing the implants.

  • Treatment Cover: The policy provides coverage for in-patient hospitalization costs, like surgeon fee, room charges, medical tests, pre and post hospitalization and more.
  • Cashless Treatment: The health insurance also offers a cashless treatment facility which allows you to get all your hospital bills settled by your insurer. For this, you need to select a network hospital for the surgery.

Special Health Plans for Knee Surgery

Many insurance companies are providing special knee replacement insurance coverage. Earlier, knee surgery would come under cosmetic procedures so were not covered under health insurance plans. The number of claims filed for knee replacement has increased dramatically in the last decade. In the light of this, many governments as well as private insurance companies are offering health insurance plans for knee replacement surgeries.

Coverage under Your Existing Insurance Plan

Just go back a decade ago, and you will find that the claim rejection ratio for knee surgeries was very low. But, today many top health insurance companies have started approving claims for knee replacement surgery. You are allowed to use your existing health insurance for knee replacement. If you have a health insurance policy, it is advisable to contact your insurance provider before you undergo surgery. However, some insurers pay only a part, generally 50% of the total expenses of the surgery, especially in the case of an old insurance plan that did not cover this surgery.

Waiting Period for Knee Replacement Surgery

It is important to note that health insurance policies come with a specific waiting period. During this period, you cannot encash your insurance policy or file a claim. When it comes to general health insurance, the waiting period can be 3 to 4 months. In case of special plan like medical policies for pre-existing ailments, the waiting period can last between 2-4 years. The same is applicable for knee replacement insurance cover in India.

Filing a Claim For Knee Surgery

Filing a claim for knee surgery using your general insurance plan is a little tricky. Despite that fact your general insurance can offer you a high sum insured, chances are that your insurer can increase the premium amount once the policy is encashed. You will also lose your no claim bonus. It is also imperative to know that even if you are seeking surgery on a general insurance policy, you can get cover for knee replacement surgery only after completing the minimum 2- 4 years waiting period.

Final Thoughts

While it is hardly possible to change the course of nature, staying active throughout your life should be a part of your interests. Getting engaged in certain activities will keep your bones and muscles healthy. Since knees are the most vital part of your body and they are vulnerable to weakening during old age, it is good to buy health insurance for senior citizens today so that they can sit out the waiting period and encash the policy when required in future. This will prevent you from any obstruction in your road to recovery caused by expensive medical treatment.

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