Does Health Insurance Policy Cover Robotic Surgery in India

There has been a tremendous amount of advancement in the field of medicine. The advancement is in terms of medications as well as equipment and technology. All these innovative progressions have made even the complicated things quite simple. Such innovations have helped doctors to carry surgeries and other procedures with ease. One such latest innovation is the ‘Robotic surgery’, which is augmenting medical technologies in terms of improved surgeries. Be it oncology or any other general/critical surgery, the use of robotics makes the process simple for surgeons.

If you are unsure and have not heard about this technology yet, read on to know more.

What do you mean by Robotic Surgery?

It is a kind of surgery that uses minute equipment fixed with automatic/robotic technology. These tools help surgeons to perform complicated surgeries more accurately and reach places where traditional means of surgeries had difficulty.

How is Robotic Surgery  performed? Which surgeries are performed through robotic surgery?

To perform robotic surgeries, the surgeon takes the help of a robotic arm and a computer station. He directs the various robotic movements required during the course of the surgery by sitting at the computer station.

Some of the surgeries done through robotic means are:

• Brain surgery
• Heart replacement surgery
• Cancer of vital organs etc.

It is important to note here that robotic surgery is a costly procedure, especially in India. The charges of various  surgeries in the country at present ranges between 1.4 to 11 lakh  rupees as per the surgery type and the hospital/city that you choose to conduct the surgery. Like for instance, if you go for robotic surgery to heal any of your cardio-vascular ailments, the charges would be higher as compared to robotic surgery of the abdomen. Likewise, a robotic surgery in Mumbai or New Delhi will be more expensive as compared to cities like Varanasi or Allahabad.  Thus, robotic surgeries are treatments that are currently beyond the affordability levels of most common people in India.

But, since these surgeries are precise and present better results, people would like to go through these robotic surgeries to avail better treatment. Thus, the next question that people want to know is, if robotic surgeries are offered under health insurance coverage in India.

Are Robotic Surgeries included under Health Insurance Policies in India?

You would be glad to know that Robotic Surgeries are covered by many health insurance plans in India. IRDAI has mandated health insurance companies in 2019 to offer coverage against robotic surgeries.  Hence, almost every insurer includes coverage against robotic surgery expenses under their best health insurance plans.

Robotic surgery expenses cover the following costs;

• Hospitalization charges
• Surgeon/doctor’s fee
• Expenses incurred on nursing staff
• Expenses incurred on ICU
• Pre and Post hospitalization expenses due to surgery etc.

In certain cases, the insurer might as well offer health insurance coverage for ambulance services.

Under what conditions does coverage on Robotic Surgery allowed in Health Insurance Plans 

Here are the conditions under which robotic surgery coverage offered under health plans:

• On surgeon’s recommendation –  Only when a qualified surgeon recommends a Robotic surgery, it is covered by the insurer. Surgeries without proper recommendation of the surgeon are denied by the insurer. Further, it is also important that the surgeon who recommends the robotic surgery treatment is a trained person proficient in the technique. This is also a condition that insurer’s ask for and without it the claim might get rejected.
• Coverage subject to sub-limits – You might also like to note that the coverage allowed for robotic surgeries depends on sub-limits mentioned in your health insurance policy. So, the coverage that the insurer allows would depend on a limit that is pre-specified. Rest of the costs have to be incurred by the insured person.  So, if the sum insured of your policy is say 10 lakh and the sublimit for robotic surgery is 1% of sum insured. In that case the policyholder will receive Rs 1 lakh only as coverage for robotic surgery.

What is the Waiting Period under Health Insurance for Robotic Surgery?

There is a waiting period levied by insurers to avail coverage on Robotic surgeries for policyholders who are willing to make a claim.  So, you cannot expect insurance companies to allow you to make claims for robotic surgeries from the first day of buying health plans. Thus, you have to wait for a particular period of time that is pre-defined in the policy as waiting period before you could start availing coverage on robotic surgeries. This period of waiting depends on the illness or the health condition of the insured. So, depending on the health condition, 2-3 years waiting period might apply.

However, if the insured is already suffering from a condition that requires robotic surgery at the time of policy purchase, then the waiting period of  pre-existing diseases will be levied by the insurer. And in most cases, insurers allow a period of 2-4 years as a waiting period for pre-existing diseases.