July 26, 2022

Does Health Insurance Cover Orthopaedic Surgery?



Orthopaedic related concerns have increased in recent times owing to the sedentary lifestyle adopted by most working professionals. We have to be vigilant of any aches and pains that we experience and take action on it immediately.

What is Orthopaedic Surgery?

Despite the word “orthopaedic”, this type of surgery is not only done on the human body’s skeleton or bones but also focuses on connected ligaments, tissues, tendons, and other structures. Orthopaedic surgeries are mostly done on the hips, shoulder, wrist & knee region. This surgery is carried out to treat medical problems that may be related to hereditary conditions or acquired illnesses, as well as acute damage or accident related injuries.

What all operations and surgeries are classified under the category of Orthopaedic Surgeries?

Based on the affected regions such as hips, ankles, shoulders, wrist, and/or knee, orthopaedic surgeries broadly comprise of:


  • Shoulder Replacement Surgery
  • Anterior Cruciate Ligament (ACL) Reconstruction Surgery
  • Shoulder Arthroscopy
  • Knee Replacement Surgery
  • Spinal Surgeries
  • Osteotomy
  • Bone fracture repair
  • Soft tissue repair
  • Knee Arthroscopy
  • Joint arthroscopy
  • Ankle Repair
  • Debridement
  • Hip Replacement Surgery
  • Trigger Finger Release

Does Health Insurance cover orthopaedic surgery?

The straightforward answer is YES!


Most Health Insurance policies cover orthopaedic surgeries. The surgery can be done traditionally in the form of an open surgery or through arthroscopy.


In case of an open surgery, you might need to stay in the hospital for a few days.


Arthroscopy is performed as a day operation, requiring less than 24 hours of hospitalisation and allowing you to return home the same day. These claims can be covered under Daycare.


If hospitalisation is required, apart from the surgery costs, even associated expenses like nursing fees, ambulance fees, medication fees, and surgical supplies fees are covered.


This depends on the scope of the policy and the sum that has been insured under it.

Waiting Period for Orthopaedic Surgery Claim

Even though orthopaedic surgery is covered by most Indian health insurance plans, some treatments might only be covered after a waiting period.


The waiting period refers to the time period after buying the health insurance plan during which you cannot raise a claim. In the case of an orthopaedic surgery, the waiting period usually lasts for one to two years.


And for individuals who are suffering from pre-existing conditions, this duration could be a lot longer. However, these terms and conditions are subject to differ from insurer to insurer.


Fortunately, Chola MS Health Insurance has only a 30-day waiting period once you buy the policy. To know more: Read here


Orthopaedic conditions must be addressed immediately in order to prevent serious conditions in the future.


Depending on the severity, the procedure can be an open surgery or a minimally invasive procedure. You can safeguard money kept aside for treatment of orthopaedic conditions with a health insurance coverage that covers both open and daycare procedures.


The best way to know exactly what your policy covers or doesn’t cover is to double-check it with the insurance company before anything else. Ensure to pick a health insurance plan with orthopaedic coverage that suits your situation and avoid any unforeseen financial strain.

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