The knees are joints that support our body weight and enable us to perform daily activities easily. When knee pain strikes, it impacts your quality of life, limiting your mobility and causing discomfort. For many, knee replacement surgery becomes a necessary option. However, knee replacement surgery costs can be substantial.
Therefore, in cases where knee replacement surgery is necessary, individuals can consider health insurance plans for a family that can help manage these expenses and alleviate financial burdens.
This article explores whether health insurance cover extends to knee replacement surgeries and what factors to consider when choosing such plans.
What is Knee Replacement/Arthroplasty?
Knee replacement surgery involves replacing the damaged parts of the knee joint with artificial components, or prosthetics, to restore normal function. This procedure is for individuals suffering from severe knee pain and disability due to conditions like osteoarthritis, rheumatoid arthritis, or significant injuries. The surgery can be:
- A total knee replacement, which replaces the entire joint.
- A partial knee replacement, which focuses on the damaged area only.
When Do You Need Knee Replacement Surgery?
You may need a knee replacement surgery when non-surgical treatments, such as medication, physical therapy, or lifestyle changes, fail to alleviate severe pain and improve mobility. Symptoms suggesting the need for surgical intervention are:
- Persistent knee pain during rest or activity
- Having problems with basic physical activities like walking and climbing stairs
- Swelling and stiffness that limit movement
- Inadequate relief from pain medications and other therapies
Orthopaedic surgeons assess these symptoms through various tests, including X-rays and MRIs, to determine the extent of joint damage and the necessity of the surgery.
How Much Does a Knee Replacement Surgery Cost?
The cost of knee replacement surgery in India can vary widely, ranging from ₹50,000 to ₹2 lakhs. Several factors influence this cost, including:
- The type of surgery (total or partial)
- The hospital and city where the surgery takes place
- The surgeon’s expertise and fees
- The cost of prosthetics, which are often imported
- Additional expenses such as hospital stay, physiotherapy, follow-up appointments, and transportation
Is Knee Replacement Covered by Insurance?
Given these knee replacement costs, comprehensive health insurance coverage is crucial to manage the financial burden. But the question is: is knee replacement covered by insurance?
Fortunately, most leading insurance providers now offer knee replacement insurance as part of their health plans. However, the scope of coverage differs.
- Knee replacement covered by insurance may include complete or partial coverage, depending on the specific policy terms.
- Some policies classify knee replacement under critical illness or specific surgical procedures, providing tailored benefits.
Why Consider Health Insurance for Knee Replacement Surgery?
Investing in health insurance plans that include coverage for knee replacement surgery offers several benefits:
- Financial Protection
Health insurance plans can significantly reduce out-of-pocket expenses and cover a substantial portion of the knee replacement cost.
- Cashless Treatment Facility
Many cashless health insurance plans allow you to undergo treatment without upfront payment. The insurer settles the bills directly with the hospital, provided it is part of the network.
- Comprehensive Coverage
Good health insurance cover includes pre- and post-hospitalisation expenses, such as consultations, tests, and physiotherapy, ensuring that all treatment and recovery are financially supported.
Things to Consider
When selecting health insurance plans for a family that cover knee replacement surgery, consider the following factors:
- Waiting Period
Many insurers have a waiting period of 24 to 48 months before you can claim knee replacement surgery costs. Opt for plans with the shortest waiting period to ensure timely coverage.
- Sub-limits
Some policies may have sub-limits on the coverage amount for specific procedures, like knee replacement. Know these limits to avoid any out-of-pocket expenses.
- Co-pay and Deductible
The co-pay is the percentage of medical expenses you must pay out of pocket, while the deductible is a fixed amount before the insurance kicks in. Choose health insurance plans for a family with manageable co-pay and deductible amounts.
- Coverage Limits
Ensure the health insurance plans offer adequate coverage for the entire knee replacement cost, including hospital stay, surgery, prosthetics, and post-operative care.
Is knee replacement covered by insurance? The answer is often yes, but the extent of coverage depends on your specific policy. Adequate knee replacement insurance coverage is essential to managing the financial risks associated with knee replacement surgery. You can make informed decisions about your healthcare needs by carefully reviewing your policy and understanding its provisions.
Remember, prevention is always better than cure. Maintaining a healthy weight, engaging in regular exercise, and protecting your knees from injuries can help reduce the risk of knee problems in the future.
Don’t let the fear of unexpected medical expenses hinder your health. Protect yourself and your loved ones with a comprehensive health insurance plan from Future Generali.
Future Generali has got you covered with options like DIY Health Insurance for customised coverage, Health Absolute for family protection, and Health Elite for premium benefits. Experience peace of mind with Future Generali.
