Health Insurance Policies - Fine Prints - Cosmetic / Aesthetic Surgeries

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Cosmetic / Aesthetic Surgeries

Circumcision unless necessary for the treatment of a disease not excluded hereunder or as may be necessitated due to an accident, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as part of any illness.

Under this clause, circumcision done as part or religious ritual in communities such as Muslims and Jews, then this procedure is not payable by Insurance. Circumcision done for treating an ailment or a disease is only reimbursable by Insurance for eg. Phimosis, Paraphimosis, Urinary Tract Infection etc., but it depends on case to case study on an individual basis. Relevant proof is required for establishing that circumcision is not being performed for cosmetic reasons and is purely for treatment of an ailment.

Vaccinations and inoculations which are mandatory for human beings for their survival and well-being are not reimbursable by Insurance.

Cosmetic or Aesthetic treatments and Plastic Surgery (which forms a part of Aesthetic/Cosmetic treatment) are not reimbursable by Insurance. Surgeries involving liposuction, enlargement of breasts in women, Botox treatment, removal of mole/birthmark, surgery for re-shaping the nose, facial features, chin etc are not reimbursable by Insurance.

Under Cosmetic or Aesthetic treatment, Lasik surgery is also included. As per IRDA regulations, it is termed as cosmetic treatment. Lasik treatment can be reimbursable only if the vision in both the eyes exceeds the vision-limit parameters as specified. (The limits are being withheld for confidentiality purposes and the same are subject to change.)

Under Cosmetic or Aesthetic treatment, certain lenses used in Cataract surgery such as Restor, Accor etc. may not be payable, which are subject to guidelines issued by Insurance companies from time to time. Justification for usage of such expensive lenses is essential before sending the claim for reimbursement process.

Plastic Surgery performed subsequent to any surgical procedure and that too, if it is necessary with suitable justification, can be reimbursed based on case-to-case analytical study. For e.g. plastic surgery done on a scar or a wound subsequent to it’s healing. But note that the plastic surgery can be reimbursed only if the occurrence of trauma or scar has occurred within the policy coverage period. Plastic surgery performed for cosmetic reasons is not eligible for claims reimbursement.

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ila_upadhya

what are ENT daycare procedures?

rajmiba2001

Hi, My father [Age-62yr] underwent Cardiac by-pass surgery in 2006 and after that he undergoes annual cardiac check-up every year. He is in good health now. I want to take a Mediclaim policy for him which covers him for any possible future hospitalization (for all generally covered diseases including his pre-existing condition). Please recommend me good options which is also not very expensive.

Hi, I reside in a Metro city and my child is admitted in a Child Care Centre / Nursing Home last night due to illness last night. However the Nursing Home is a small one and has 5-6 beds only. But it is registered one under the regulatory authorities. I seek clarification on below: "HOSPITAL/NURSING HOME: means any institution in India established for indoor care and treatment of sickness and injuries and which either Is duly licensed and registered as a Hospital or Nursing Home with the appropriate authorities and is under the supervision of a registered and qualified Medical Practitioner. OR In areas where licensing and registration facilities with appropriate authorities are not available, the institution must be one recognised in locality as Hospital / Nursing Home andshould comply with minimum criteria as under: [1] It should have at least 15 in-patient medical beds in case of Metro cities, A Class cities......................." Will I be able to claim for reimbursement? Regards, Sameer

My Wife was Pregnant and was in 9th month. All was normal but one night we finish our dinner and went to our bed. But suddenly at midnight my wife found Heavy Bleeding. We immediately run for our Doctor treating her. She refer us to one of the Big n Best Hospital of our city. The problem raised is called Ante partrue Hemarhage [APH] according to Doctor. As due to heavy bleeding my wife was almost in shock. And to save the life of both (Baby n Mother) a Emergency LSCS was done. A baby born via Cesarean. So, I submit a file for claim against my Medical Policy with United India Insurance Co. but that was rejected by saying "Treatment arising from or traceable to Pregnancy (including Caesarean) not covored. But as per me, as My Wife have no Labour Pain nor the whole process was done because of or for Delivery. So, kindly guide me for the same. Should I go to Insurance Ombudsman???

bchandra

I am 26 years old and I would like to undergo Lasik Operation. My sight is -7 in both eyes. Can I get free operation in Hospitals?

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