Modern Treatments in Health Insurance

In today's world, medical technology has advanced tremendously. Recently, we saw how a drug could potentially be the cure for cancer. With billions of dollars being invested worldwide by medical research companies, such incredible medical breakthroughs and remarkable achievements happen in the medical field.

Of course, everyone wants access to the best, most advanced treatment when they need it. The thing is when launched these modern treatments, understandably, can cost you a fortune!

So are such treatment costs covered by your health insurance plan? What are the terms and conditions if they are covered? Let’s find out.
 

So, What Are Modern Treatments?

Modern treatments are treatments that use ultra advanced technologies like robotic surgeries, stem cell therapy, oral chemotherapy, etc. They have made curing diseases that were once regarded as incurable possible.

For example, severe asthma was once considered incurable. Nowadays, people are treated effectively with a modern treatment called bronchial thermoplasty.
 

Are Modern Treatments Covered By Health Insurance Policies?

In India, thanks to IRDAI’s guidelines, health insurance covers modern treatments under the 'Modern Treatment Benefit'. There are a variety of modern treatments available and as per IRDAI 12 types are covered under health insurance.

For example, Leela was diagnosed with 2nd stage leukaemia. The doctor recommended immunotherapy for her condition, as it can treat her condition effectively while causing lesser side effects. The treatment cost shall be covered by her health insurance.

What Are The Conditions Associated With Coverage For Modern Treatments?

Health insurance policies shall protect you from the whopping costs of modern treatments only under certain conditions.

Those conditions include –

• 24 hours Hospitalisation

  A hospitalisation of more than 24 hours is necessary to be eligible for modern treatment coverage. However, if the treatment is part of a day care procedure, this condition need not be met.

  Day care procedures are treatments or surgeries that can be carried out in a few hours and don’t require a 24-hour hospitalisation. For instance, sinus infections are treated by balloon sinuplasty, a procedure spanning only a few hours.

• Treatment Must Be Prescribed By A Doctor In Writing

  In order for the modern treatment to be covered under your health insurance policy, it should be deemed medically necessary and prescribed in writing by a medical practitioner.

• Coverage May Be Subject To Separate Conditions

  In addition to the above conditions, there may be separate conditions that must be met for modern treatments to be covered under your health insurance policy.

  For example, Max Bupa's Health Companion and Health Reassure cover robotic surgeries under special conditions. The maximum coverage for robotic surgeries is Rs 1 lakh, except for robotic radical prostatectomy, robotic cardiac surgery, robotic partial nephrectomy, and robotic cancer surgery.

• Pre And Post-Hospitalization May Be Covered Under Certain Conditions

  Some policies like the Max Bupa Reassure, National Insurance Mediclaim Plus, also cover the expenses incurred for pre and post-hospitalization, provided such expenses incurred by you are for the same illness for which you underwent modern treatment.

• Not All Insurers Cover Your Expenses Up To The Sum Insured

  Some insurance companies will cover the expenses for modern treatments up to the sum insured and a few others have set certain sub-limits for coverage.

  For instance, In Star Health's comprehensive plan, only Vaporisation of the prostate (Green laser treatment or holmium laser treatment), Intra Operative Neuro Monitoring (IONM), and Bronchial Thermoplasty are covered up to the sum insured. Other treatments have certain amount limits. Bajaj Allianz Health Guard Plan has a sub-limit of 50% of Sum insured or 5 lakhs, whichever is lower.

Note: Many insurers like Care, HDFC Ergo, Manipal Cigna etc, have neither mentioned that they will cover this benefit nor have they specified the same in the exclusions. However, these insurers may cover modern treatment since IRDAI guidelines mandate coverage. Hence, if it isn't mentioned in the policy, it is necessary to check the same with your insurer.
 

Few Insurers Who Provide Modern Treatments?

A number of diseases that were once regarded as incurable can now be cured, thanks to advances in medical technology. Your health insurance will cover these modern treatments only if certain conditions are met. Ensure you go through your policy wordings to know the scope of coverage and associated conditions.