Modern Treatment List Covered in Health Insurance

Posted on: Dec 17, 2024 | 3 mins | Written by: HDFC ERGO Team

Modern Treatment List Covered in Health Insurance

You take your mother for a heart check-up as she is having some discomfort, and the doctor says she has a few blockages, which should be addressed at the earliest. As you look stressed and worried at the very thought of surgery, hospitalisation, and recovery, the doctor introduces you to modern treatment, i.e., robotic surgery, which is minimally invasive with smaller incisions, more accurate, and has a quick recovery time. The only flip side is it is quite expensive. But if you have a comprehensive health insurance plan, all the expenses will be covered up to the sum insured. Let's learn more about health insurance coverage when it comes to modern treatment procedures.

Modern Treatments in Health Insurance

Modern treatments in health insurance refer to those procedures which use advanced or high-end technologies to cure diseases that were once considered incurable. These procedures are minimally invasive for which the patient recovers faster as compared to traditional open surgeries. They are also more effective but quite expensive because of the advanced technologies used.

Are Modern Treatments Covered in Health Insurance

Yes. In 2019, the IRDAI directed insurance companies to cover as many as 12 modern treatments under the 'Modern Treatment Benefit'. The expenses incurred on any of the modern procedures, such as hospitalisation, pre- and post-hospitalisation, daycare procedures, and domiciliary care, are covered by health insurance plans. However, some policies may impose sub-limits on the treatments, which means there will be a cap on the amount the insurer will pay for a specific treatment. It's good to be aware of the sub-limits and other exclusions related to modern treatments so you are financially prepared for any out-of-pocket expenses.

List of Modern Treatments Covered by Health Insurance

The 12 modern treatments covered by health insurance plans are –

1. Robotic Surgeries

2. Stem Cell Therapy

3. Immunotherapy

4. Oral Chemotherapy

5. Intra vitreal Injections

6. Deep Brain Stimulation

7. Stereotactic Radio Surgeries

8. Bronchial Thermoplasty

9. Intra Operative Neuro Monitoring (IONM)

10. Uterine Artery Embolization and HIFU

11. Balloon Sinuplasty

12. Vaporisation of the Prostate

Things to Keep in Mind While Claiming Modern Treatment in Health Insurance

While claiming modern treatments, here are some things you must not ignore –

• Coverage:

Understand what are modern treatments or procedures and pick only those which you may need in future. This will also reduce your premium costs.

• Waiting Periods:

All health insurance plans have an initial waiting period of about 30 days, during which you cannot raise any claim. If you have a pre-existing condition, the waiting period is 1 to 3 years, depending on the insurer.

• Sub-limits:

When a health insurance plan has a sub-limit or cap, the insurer will pay only a portion of the total claim amount based on the sub-limit, and the policyholder must bear the remaining amount. In the case of modern treatments, while some insurers cover up to the sum insured, others have a cap of, say, 25% or 50% of the sum insured. So, you must be aware of the sub-limits of modern treatments mentioned in the health insurance plan.

• Medically necessary:

Modern treatments will be covered only if prescribed by a medical practitioner and are medically necessary. The policyholder has to submit a written prescription.

• Terms and conditions:

Always check the policy terms and conditions, such as co-payments, room rent limits, and other exclusions.

Conclusion

Due to advancements in science and technology, many ailments are now being cured, which was not possible years ago. These modern treatments or procedures are expensive but fortunately covered by health insurance. So, ensure you have comprehensive health insurance plans for financial protection against high medical expenses. Along with health cover, you can opt for add-ons like critical illness insurance, hospital daily cash allowance, OPD cover, etc., to enhance the scope of coverage.

FAQs related to Modern Treatments in Health Insurance

1. Are modern treatments covered by health insurance?

Yes, modern treatments are covered by health insurance. As per IRDAI regulations, all insurers must cover 12 modern treatments under 'Modern Treatment Benefit’.

2. Is there a waiting period for claiming modern treatments?

There is no separate waiting period for claiming modern treatments. As with all health insurance plans, you can claim after the initial waiting period of 30 days from the date of policy purchase. However, you must check the policy document carefully to ascertain whether there is any specific waiting period for a particular treatment.

3. Are modern treatments expensive?

Yes, they are quite expensive, and some insurers may have sub-limits on the sum insured. Make sure you buy a policy with low or no sub-limits to avoid out-of-pocket expenses.

4. Are there any conditions for claiming modern treatments in health insurance?

Yes. The treatment has to be prescribed in writing by a medical practitioner stating that it is medically necessary. Without a valid prescription, the insurer can reject your claim.

5. How many times can I claim for modern treatments during a policy period?

This depends on the policy terms and conditions and the insurer. While some plans may have a limit on the maximum number of claims, others may not have any limit.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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