Health Insurance 939 views October 1, 2021

Life is uncertain and we don’t know when a medical issue may arise. And a surgery like knee replacement can impact your finances greatly if not insured against the same. If you undergo a knee replacement surgery, it can cost you INR 1.5 to 4 Lakh and you might not have such lump sum money at that moment. So, you need a health insurance plan to deal with the expenses arising out of a knee replacement surgery in the future. To help you find the right plan, we have brought to you a list of health insurance plans for knee replacement surgery. So, continue reading!

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Regular Health Insurance Plan vs Knee Replacement Surgery Cover Plans – Which is Better to Have?

If you buy a regular health insurance plan, you’ll get coverage for knee replacement surgery under day care treatment only. Day care treatments are those medical procedures that do not take 24 hours of hospitalization to complete. You’ll be eligible to avail of this benefit after a waiting period of 2-3 years based on your policy. Whereas, you’ll get coverage for the same from day one on buying a critical illness plan. If you already have a health insurance plan, check out the waiting period after which you’ll get coverage for knee replacement and terms and conditions applicable to the same. Because some insurers might not provide coverage for age-related knee replacement. In such cases, you can opt for a health insurance plan with the knee replacement cover.

List of Health Insurance Plans with Knee Replacement Surgery Coverage

The following are the health insurance plans for knee replacement surgery you may like to choose from.

Oriental Hope Health Insurance Plan

The policy is available to people aged 60 years and above. Here, you’ll get coverage against knee replacement up to 70% of the sum insured. The insurer shall pay the hospitalization expenses if it is for a minimum of 24 hours. However, this condition doesn’t apply if you receive treatment at a network hospital of Oriental Insurance.

Also, if the surgery is carried out in a Day Care Centre under the supervision of a registered and qualified medical practitioner, the time limit of 24 hours doesn’t apply. The day care centre needs to meet the following criteria for you to get the coverage.

  • The center must have qualified nursing staff, medical practitioners, equipped operation theatre
  • It should maintain daily records of patients and make them accessible to the insurance company’s authorized personnel

You will also get coverage for medical expenses incurred 30 days before the admission and within 60 days from the date of discharge.

The insurer provides you a No Claim Discount of 5% on the renewal premium after every claim-free year, subject to a maximum of 20%. Once a claim is made under the policy, the no claim discount will be ‘NIL’.

Oriental Insurance liability in respect of claims admitted during the policy period shall not exceed the sum insured as opted by you. The minimum sum insured is INR 1,00,000 and you can opt for a higher sum insured in multiples of INR 1,00,000, up to INR 5,00,000.

Liberty Group Hospi-Cash Connect Policy

The insurer shall provide you coverage against knee replacement surgery if you are hospitalized and incurred expenses are more than INR 2 Lakh. You can avail of this benefit if the treatment occurs due to any illness or accidental injury. The benefit amount shall be payable to you in addition to Daily Hospital Cash Benefit and any other lump sum amount, subject to the balance sum insured. You’ll get coverage against the following knee-related issues –

  • Total knee replacement (TKR) for post-traumatic arthritis
  • Septic arthritis
  • Severe irreparable knee injury

IFFCO TOKIO Swasthya Kavach (Family Health) Policy

IFFCO TOKIO Swasthya Kavach (Family Health) Policy provides you coverage against knee replacement surgery up to 50% of the Sum Insured, subject to a maximum of INR 2 Lakh. You can avail of this benefit after 24 months from the date of policy inception. The waiting period shall apply to this if the surgery arises due to something other than an accident.

Niva Bupa Health Pulse

You’ll get coverage against knee replacement surgery and other related complications under Niva Bupa Health Pulse. The expenses covered under day care treatments include –

  • Arthroscopic Knee Aspiration
  • Arthroscopic repair of ACL tear knee
  • Arthroscopic repair of PCL tear knee
  • Arthroscopic Meniscectomy
  • Haemarthrosis Knee – Lavage
  • Abscess knee joint drainage
  • Repair of knee cap tendon
  • Revision or removal of the knee cap
  • Fixation of knee joint
  • Removal of kneecap bursa
  • Repair of knee joint

New India Janata Mediclaim Policy

The insurer covers the expenses related to total knee replacement up to the sum insured or the actual cost, whichever is less. It covers the cost of treatment taken in the general ward of the hospital or daycare center per day, subject to a maximum of INR 450. The insurer shall cover the following expenses as well –

  • Pre and post-hospitalization expenses up to 30 and 60 days, respectively
  • Ambulance services up to INR 1,000 per hospitalization
  • Surgeon, Anaesthetist, Medical Practitioner, Consultants’ Specialist fees

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