What you need to know about insurance for knee replacement surgeries

8 May 2019

As we grow older, our body starts becoming weaker. It becomes more and more difficult for us to continue with our daily activities. Most old people complain of pains in their joints, muscles and even knees. In most cases, as the knee begins to weaken, people find the need to undergo knee replacement surgeries. Thankfully, a few insurance companies allow you to file insurance for knee replacement surgeries. Some even offer a special knee replacement insurance coverage in India. Here are a few things you need to know about this type of insurance.

Knee replacement surgery can be quite expensive

Opting for knee surgery can prove to be a life-changing decision as it puts one under tremendous physical and mental pain. Knee replacement procedure is also one of the most expensive medical procedures ever. With the ever escalating medical costs, you could end up spending anywhere between ₹500,000 to ₹800,000 on this single surgery, in the absence of a good health insurance plan. This is attributed to the fact that knee implants are very expensive, and in most cases, they need to be imported from foreign countries. Moreover, you need to consider additional costs such as hospital and surgeon fees and the taxes levied on importing the implants.

Special plans for knee surgery are relatively new in India

Most people are unaware that you can now purchase a special knee replacement insurance coverage plan. This is because, knee surgery was earlier considered a part of cosmetic procedures, which are not typically covered under insurance plans. Also, the numbers of claims filed for knee replacement have increased in the last decade. As such, a few government-run insurance providers started offering this special insurance. In the light of this, private insurance companies too started offering insurance plans for knee replacement surgeries.

It can be covered under your ongoing insurance plan, but there’s a catch

Just a decade ago, the claim rejection ratio for knee surgeries was extremely low, because the surgery fell into a grey area (read implants). However, reputed health insurance company have started honouring claims for knee replacement surgery. In fact, you can use your regular insurance plan to undergo treatment for the same. That said, if you have been holding the same health insurance plan for many years, it is better to get in touch with your insurance provider before you undergo surgery. Some providers agree to pay only a part (typically 50%) of the total cost of treatment in case of knee replacement coverage by insurance, especially in the case of old insurance plans that did not cover this surgery.

The waiting period to encash this policy can last anywhere between 2- 4 years.

Every health insurance policy comes with a specific waiting period in which policy holders cannot encash the policy or file a claim. While in the case of general health insurance, the waiting period lasts from 1 to 3 months, in case of special policies such as medical policies for pre-existing ailments, the waiting period can last anywhere between 2-4 years. The same applies for knee replacement insurance coverage in India.

Filing a claim for knee surgery on your general insurance can result in increased premiums.

Using your general insurance plan to file a claim for knee surgery can prove to be a little tricky. Even if your general health insurance policy comes with a high sum assured, there is a good chance that the insurance provider can increase the premium amount, once the policy is encashed. You also lose your no-claims bonus. Also, you need to remember that even if you are seeking surgery on a general insurance plan, you can seek coverage for knee replacement surgery only after completing the minimum 2- 4 years waiting period or your claim can be rejected. As such, it is better to purchase knee replacement insurance coverage.

Final thoughts:

While one cannot change the course of nature, it is our best interest to stay active. Activity keeps you bones and muscles healthy, reducing chances of any surgeries. Also, in case of knee replacement surgery, one can take anywhere between 1-3 months to fully recuperate. If you have older parents, it is better to ensure they invest in a knee replacement insurance plan so that they can sit out the waiting period and encash the policy when required in future.