REMEMBER Baymacx from Big Hero 6 - the bouncy robot meant to be a medical assistant?
OKAY - We are miles away from having our personal Baymax. (Well, not precisely miles, but maybe a decade or two).
However, sci-fi movies reflect the era’s futuristic thoughts. And considering how the 1902’s sci-fi movie “A Trip to the Moon” was 67 years ahead of the actualisation, the fact that sci-fi movies are futuristic reflections is well proved!
While Baymaxes are still a few years off, robotic surgeries and other modern treatments are already playing out in the field. Undoubtedly, these modern treatments have been positive innovations meant to mitigate errors, reduce the timeline for recovery, and alleviate post-procedure complications.
However, no rainbow comes without rain! As shiny and incredible as these treatments sound, they are pretty high-end and become inaccessible for individuals with a financial crunch. On the other hand, it makes no sense to have such accurate result-yielding procedures and yet not be able to provide those who need them the most out of the bare financial hurdle.
Subsequently, health insurance providers and the IRDAI (Insurance Regulatory and Development Authority of India) soon acknowledged the widening chasm between advanced modern treatments and the finances required to avail them and decide to close this widening gap. The solution is - modern treatment coverage in health insurance.
One of the highlights of these health insurance plans is the incredible access to supreme healthcare services. However, the downsides to such coverage are also long. When choosing such niche-specific coverages, there are multiple pointers that one needs to be aware of. Let’s discuss these coverages in detail and help you determine if you should at all avail of these plans or not.
Modern Treatment and India in 2023
Medical science is an ever-evolving industry. Innovation and state-of-the-art technologies play hand-in-hand offering individuals advanced modern treatments. Billions of bucks are being invested in medical labs across the globe with the hope of developing cures for cancer, developing stem cell therapies for genetic conditions, Advancing mRNA technology, Artificial Intelligence, AR/VR technologies, and more.
India has been a leading nation in its initiatives towards modern medical technologies. Considering how more and more individuals keep getting affected by critical ailments that require modern treatment methods, India’s efforts are going towards the right direction. However, unfortunate as it is, India’s current economic condition and the low to medium-income level of the population make availing of such hefty fees yielding modern medical treatments, a cumbersome situation.
As a financial solution, a 2-fold approach serves it the best - a health insurance policy and the policy that offers adequate coverage for modern treatments. With IRDAI’s guidelines and drawn policy wordings from the best health insurers, individuals in dire requirement of quality & innovative healthcare services, availing of modern treatments becomes financially convenient.
What is Modern Treatment Coverage in Health Insurance?
Modern treatments are largely based on ultra-modern medical technologies. The use and functioning of such equipment are an expensive burden to bear that is most likely to take a burden on the savings of an individual. Mitigating such financial pile-on is very feasible by availing of a health insurance plan that offers coverage for modern treatments.
What are the types of modern treatments covered by health insurers?
With the best health insurance plans, policyholders can have coverage for a variety of modern treatments that are inclusive of, but not conclusive to -
- Uterine Artery Embolization and HIFU (High Intensity Focused ultrasound)
- Robotic Surgeries
- Oral Chemotherapy
- Bronchial Thermoplasty
- Balloon Sinuplasty
- Intra Vitreal injections
- Intra Operative Neuro Monitoring (IONM)
- Stereotactic Radio Surgeries
- Immunotherapy
- Deep Brain Stimulation
- Stem Cell Therapy
- The vaporisation of the prostrate, and more
Things to know about coverage for modern treatment in health insurance
When it comes to health insurers offering extensive coverage for modern treatment procedures, they have a specific set of rules and conditions that need to be met and a few criteria that policyholders need to be aware of before availing of such niche-specific policies -
- Disease-wise Sub-limit is a reality: Health insurance providers usually offer an upper cap limit on the coverage amount that can be dedicated towards any modern treatment procedure/treatment.
For example: With health insurance plans like Niva Bupa Reassure 2.0, the upper limit is set at INR 1 Lakh (except for some modern treatments/procedures).
- Modern treatment coverage for in-patient, daycare & domiciliary cases: As per IRDAI regulations and guidelines, when it comes to the list of modern treatments, whether a patient is receiving in-patient care, domiciliary treatment, or daycare process, these modern treatments are covered under a health insurance plan.
- Waiting period on modern treatment coverage: There is no waiting period that policyholders need to hold out for prior to vailing of this coverage option. The only exception to this is in the case of Pre-Existing conditions that require modern treatment. In such cases, policyholders need to expect a waiting period that varies based on the health insurer that he/she has approached.
- Not all health insurers offer modern treatments: While a majority of health insurance plans have in-built clauses for modern treatments, the same doesn’t run true for all of the policies available across the market. So, if you are specifically seeking a health insurance policy offering modern treatment coverage, make sure to check the policy wordings, or enquire about the same from your insurer or health insurance advisor.
- Pre and post-hospitalisation coverage is not frequent: Pre- and post-hospitalisation expenses been covered by a health insurance policy are entirely subjective, depending on the insurance provider that you have approached and the health insurance plan that you have availed.
- The procedure needs to be prescribed medically: If policyholders are looking for coverage from their health insurance provider regarding their modern treatment, then the procedure has to be prescribed by a medical practitioner in a written format. (This prescription will be of value during claim settlement, whether you are going for a cashless or reimbursement format).
How to Choose the Best Health Insurance Plans for Modern Treatment Coverage?
#Tip 1: Choose a health insurance policy that offers coverage for the specific modern treatment that you plan to avail. Not all health insurance plans cover all modern treatment procedures. So, go through the policy wording and look for the clause titled “Modern Treatment” or “Advanced Medical Treatment”.
#Tip 2: Make sure to ask the insurer about the kind of upper limit you are looking at for the coverage of your modern treatment method. With a cost estimation of your entire procedure from your medical team, you will be better prepared about how you can pay for the balance amount.
#Tip 3: Research and compare the health insurance plan with the others available in the market that you are about to avail as much as you would go ahead with a second opinion for your medical plan.
Best health insurance plans for modern treatment coverage
| Best Plans with Modern Treatment Coverage | Coverage Limit | Modern Treatments Covered |
|---|---|---|
| Care Supreme | Up to the Sum Insured |
|
| HDFC ERGO Optima Secure | Up to the Sum Insured | (Same as above) |
| Niva Bupa Reassure 2.0 | Up to INR 1 Lakh |
|
Conclusion
Seeking health insurance plans with the singular factor of coverage for modern treatments makes sense only if you are certain about the modern treatment procedure that you are about to undergo. However, since in most cases, such coverage for modern treatments is an in-built feature, you might want to compare the plan with other policies available based on the metrics of - waiting period, coverage, copayment, room rent restrictions, super top-ups available, restoration benefits, no-claim bonus, loading charges, AYUSH treatment coverage, health insurance add-ons, and more. This is important because, while the plan you are seeking might give out coverage for one specific condition (modern treatment), any top-notch health insurance plan has to be a strong financial security net for any and all medical emergencies to safeguard your savings.