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SMC Insurance Brokers Pvt. Ltd.
Parsvnath Metro Mall, Near Pratap Nagar Metro Station, Pratap Nagar, New Delhi-110007
Registration No: 289, Registration Code No: IRDAI/DB-272/04/289, Valid till: 27/01/2026, License category: Direct Broker (Life & General), CIN: U66000DL1995PTC172311
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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 –
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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.
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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.
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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.
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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.
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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?
| Max Bupa | Star Health | Aditya Birla | |
|---|---|---|---|
Coverage |
Covers All the 12 types of Modern Treatment | Covers All the 12 types of Modern Treatment | Covers All the 12 types of Modern Treatment |
Covered Up to |
Upto SI, sub-limit of 1 Lakh on robotic surgeries | Vaporisation of the prostate (Green laser treatment or holmium laser treatment), Intra Operative Neuro Monitoring (IONM), and Bronchial Thermoplasty covered up to sum insured, rest treatment have separate amount limit. | Up to Sum Insured |
Covers Pre & Post Expenses |
Covered | Sublimits of Oral Chemotherapy includes Pre and Post Hospitalisation | Not Covered |
Available for covers like |
In-patient & Day Care | In-patient & Day Care | In-patient & Day Care |
Summing Up!
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.
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Our Customers' Stories
Sharing the experience of happy and satisfied customers with you.
Sameer Yadav
I was searching for investment plan but I couldn't find it, then I got the call from SMC insurance and they aligned a call with Ishita Sharma as point of contact (POC) for all my queries and she explain me very well. Ishita explain me all investment plan with advantage and disadvantage, I really appreciate her. Ishita always enthusiast towords work and ready to answer all my questions .I have taken two policies ( HDFC click to invest) plan with 15k premium per month. I always recommend SMC insurance to all, for better life and happy retirement with huge health and wealth. Thank You SMC insurance for your best service. Special thanks to Ishita for E2E help and endless support, you did fabulous work. Show More
Dheeraj Bhatia
I am associated with SMC insurance since 2011 and found them to be most ethical, trustworthy and highly responsive. Some of my precious policies done thru other agencies are still running on SMC’s advice. That is a strong testimony to their customer-centric approach. I am glad to be associated with SMC and strongly recommend their services to all concerned. Wishing the very best to Team SMC !Show More
Jyoti Sharma
We were fortunate enough to have selected SMC as our Health Insurance Broker for they have been very helpful in resolving our queries related to health insurance. I would like to cite two examples where SMC's role has been very crucial. One was when payment for cashless hospitalization was not coming through as the insurance company was taking undue longer time to approve the Hospital Bill. It was then I talked to Neha and it was she who through her contacts in the Insurance co. facilitated and expedited the approval for payment of hospital bill. Second was very recently when the Insurance co. had proposed a top up "Enhancer" policy for our existing policy. When I talked to Neha she immediately told me not to take this policy being offered without any medical test as it will not be beneficial to us and may create problem later on account of recent hospitalization. If I had I not consulted Neha, I would have into a big trouble with the insurance co. These two instances speak very high of sincere advice and timely help rendered by the SMC Staff, Ms. Neha Khanna which helped us a lot in time of need.Show More
Sumit Khanna
Hi, I am Sumit here, purchasing insurance policies from SMC for almost 8 years. Would like to recommend this company to other customers because they are taking care of my insurance broking services in a fabulous way. I would like to extend my gratitude and thanks to policy servicing and also insurance claim backend services. They have rendered fantabulous services for me and would like you guys to definitely go and rely on them for all your insurance needs.Show More
Kishor Kumar Bijlani
My experience with SMC Brokers is excellent. They provide support from the beginning till end i.e from issuance of insurance policies till settlement of claims. They explain very nicely various provisions relating to Insurance Policy also facilitate settlement of claims with Insurance Companies. Show More
Megha Singhal
I have purchased HDFC policy from SMC Insurance with the help of Harsh Sharma. I have got the satisfactory services from SMC Insurance. Thank you SMC Insurance.Show More
