Health Insurance Coverage for Knee Replacement Surgery

Knees are important for a person to run, walk, or even sit. Without our knees, we probably won't be able to do any of the basic mobility functions, let alone any adventure activities. However, knees can be troublesome for a lot of us, especially during old age. And knee replacement surgery happens to be an excellent cure for knee-related issues. Concerns regarding knees have been on a rise. According to the Times of India, over 2.5 lakh individuals undergo knee replacement surgery in India ^[1]. And the cost of knee replacement surgery can be anywhere between Rs. 50,000 to Rs. 2 Lakh. So, shouldn’t we all be protected against an issue so prevalent? This article expounds on how a health insurance plan with a knee replacement surgery cover will prove to be beneficial:

What is knee replacement surgery?

Our knee joints can cause serious problems during old age if we ignore minor, yet important aspects of life during our young age. These factors include obesity, a sedentary lifestyle, stress, etc. Osteoarthritis, knee injury, long-lasting knee pain, etc. are a few reasons why an orthopaedic surgeon recommends knee replacement surgery (also known as Arthroplasty). It involves the replacement of the damaged bone and cartilage with an artificial joint and prosthesis. While partial knee replacement focuses only on the affected area, total knee replacement surgery replaces the entire knee with a prosthesis.

What is a knee replacement surgery cover?

A knee replacement surgery cover offers compensation against expenses involved in undergoing Arthroplasty. Since Athroplasty’s definition was unclear, insurers rejected claims raised against knee replacement surgery. However, that is not the case anymore. Most leading insurance companies cover the cost of knee replacement surgeries as per their terms and conditions. Insurance companies generally reimburse 50% of the cost on old health insurance policies. Hence, it is recommended that you peruse your policy document to get maximum coverage against such medical treatments.

Why do you need health insurance for Knee Replacement Surgeries?

Knee pain can get intolerable at times. During such cases, doctors advise knee replacement surgery. However, these medical procedures can cost a fortune, compelling us to live with the pain as long as we can. However, with a health insurance plan, you can undergo the surgery without worrying about finances. Hence, when buying a health insurance plan, ascertain that it compensates for knee replacement surgeries. Here are the two most important benefits of a comprehensive health insurance plan:

1. Cashless treatment

   With a comprehensive health insurance plan, you do not have to worry about arranging cash for high-ticket treatments. Your insurer will settle your medical bills directly with the hospital. However, you will have to schedule your surgery in advance for a seamless experience. *

2. Coverage for medical treatment

   The right health insurance plan will provide coverage for your pre-hospitalisation and post-discharge expenses as well. These include consultation charges, follow-ups, medical tests, etc. It will also cover in-patient hospitalisation expenses. Health insurance plans also offer coverage against a day care surgery. *

Things to consider before choosing health insurance for knee replacement surgery

While health insurance is essential for everyone, you must consider certain factors before choosing a health insurance plan. And they are:

1. Waiting period

   If you are buying health insurance to undergo knee replacement surgery, check the waiting period. Since insurers have just started to look at this surgery with a positive perspective, they could have a waiting period of 2 to 4 years. Opt for a plan with the shortest waiting period. *

2. Coverage limit

   A lot of insurers offer only 50% coverage against Arthroplasty. Do thorough research and for a plan that offers maximum benefits.

Note: You might have to opt for health insurance with OPD cover to avail coverage during further follow-ups and health check-ups. *

To conclude

Until a decade back, health insurance companies considered this surgery to be a cosmetic procedure. However, they have now understood the need for knee replacement surgery. Not undergoing this procedure means living with excruciating pain whether you are walking or resting. So, now that insurance providers have included knee replacement surgery under comprehensive health insurance, ensure that you are covered against medical emergencies. Along with Arthroplasty, it covers you against multiple other medical treatments such as cataracts, dengue, diabetes, COVID-19, etc.  However, make the most of health insurance premium calculators to make sure that you get the right insurance plan for the best deal.   * Standard T&C Apply Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.