News details

• 22 Feb 2025

Modern Treatments in Health Insurance

Modern treatments in health insurance now include state-of-the-art medical procedures that treat conditions once thought incurable. These breakthrough treatments give new hope to patients through amazing technologies like:

Artificial Intelligence (AI)

Virtual Reality (VR)

3D printing

Robotic

Nanotechnology

These treatments stand out because they barely intrude on the body. Patients bounce back faster than they would from traditional open surgeries. The advanced procedures also work better to manage health conditions like cancer. The Insurance Regulatory and Development Authority of India (IRDAI) took a big step in 2019. They made insurers cover specific modern treatments. Many health insurers used to deny coverage for these procedures and called them 'experimental'. These modern treatments use customized approaches to patient care that work better for severe health conditions. The sophisticated technologies and expertise needed make these advanced procedures cost more. Doctors can give these treatments in two ways. They either admit patients for 24-hour care or treat them in daycare without overnight stays. Health insurance covers these treatments to make them affordable and available to patients who need them.

Does Modern Treatment cover under Health Insurance?
Your health insurance covers modern treatments! The Insurance Regulatory and Development Authority of India (IRDAI) made this mandatory back in 2019 for all health insurance policies to cover specific modern treatments. These treatments can be covered as in-patient procedures that require 24-hour hospitalization or as daycare treatments. All the same, you should know that insurance companies may set certain sub-limits on these treatments even though coverage is mandatory.
To cite an instance, see how some insurers might cover up to 50% of the sum insured for modern procedures. Some policies may restrict oral chemotherapy coverage to 20% of the sum insured, with a maximum cap of Rs. 2 lakh. A qualified medical practitioner must prescribe the treatment in writing to claim coverage for modern treatments. The treatment should meet your policy's medical necessity requirements under the terms and conditions.

Benefits of Modern Treatment
Modern treatments reshape the healthcare scene with evidence-based practices and advanced technologies. Patients who receive continuous modern treatment see lower direct medical costs - USD 6,192 compared to USD 8,361 with standard treatment.
These are the benefits you'll get from modern treatments:

Shorter recovery time and hospital stays

Individual-specific treatment approaches

Better diagnostic accuracy

Remote health monitoring capabilities

Better quality of life

The effect on healthcare costs looks promising. Modern treatment approaches save about USD 3 billion in yearly healthcare costs. These treatments have shown amazing results in treating conditions that doctors once thought untreatable. Modern treatments make your healthcare journey smoother. Advanced approaches help detect diseases early and monitor various conditions remotely. This works especially well when you have chronic conditions like hypertension, diabetes, and asthma. Evidence-based practices in modern treatments have proven their worth through positive returns on investment for healthcare systems. You get treatments that work better and save both time and resources. Your care plan becomes unique with modern treatments. They look at your specific traits, including genetics, environment, and lifestyle factors. This creates targeted interventions that work better and stay safer. This individual-specific approach ended up giving better treatment results and happier patients.

List of Modern Treatments Covered by Health Insurance
Your health insurance policy now covers 12 cutting-edge medical treatments that IRDAI requires insurers to include.
The coverage typically includes:

Immunotherapy: Strengthens your immune system to fight cancer cells

Oral Chemotherapy: Lets you take cancer treatment pills or capsules at home

Intra Vitreal Injections: Delivers medication directly to treat retinal conditions

Stem Cell Therapy: Uses special plasma cells to repair damaged tissues

Robotic Surgeries: Improves surgical precision with robotic systems

Stereotactic Radio Surgeries: Targets tumors with focused radiation beams

Deep Brain Stimulation: Regulates brain activity through implanted electrodes

Bronchial Thermoplasty: Treats severe asthma using controlled heat

Uterine Artery Embolization: Treats fibroids with minimal invasion

Intra Operative Neuro Monitoring: Protects nerves during complex surgeries

Balloon Sinuplasty: Relieves chronic sinusitis

Vaporization of the Prostate: Uses green light laser for prostate treatment

These treatments come under either in-patient procedures or day care treatments. Your policy's specific terms determine the coverage amount, and insurers often set sub-limits for certain procedures. A qualified medical practitioner must recommend these treatments in writing for insurance coverage. The policy includes these modern treatments, but some insurance plans need you to wait 2 to 3 years before covering specific procedures.

Choosing the Right Health Insurance for Modern Treatments
You need to assess several factors when picking the right health insurance for modern treatments. A policy should give you detailed coverage without restrictive limits.
Here's how to pick the best coverage:

Verify Treatment Coverage: Make sure your policy covers the specific modern treatment you might need. To name just one example, if you want robotic surgery, check the policy terms to see if it's included.

Examine Sub-limits: Find policies with minimal or no sub-limits on modern treatments. Some insurers might cap benefits at 50% of the sum insured, which could leave you with high out-of-pocket costs.

Research and Compare: We assessed multiple health insurance plans in the market. Look at factors like network hospitals, claim settlement ratio, and waiting periods.

Additional Considerations:

Add-on Coverage: Add-on covers are a great way to get extra protection. These optional coverages can boost your policy's scope, though they need extra premium.

Sum Insured: Medical inflation keeps rising, so pick adequate coverage. Many insurers now offer Rs 1 crore health insurance plans at reasonable premiums. Young buyers can get these starting at Rs 10,000 per year.

Network Hospitals: Pick a policy with tie-ups at hospitals that offer modern treatments. This will give a smooth cashless treatment experience at leading healthcare facilities.

Note that you should review the policy documents and clarify any unclear terms. Contact your insurer if something isn't clearly stated in the policy.

Conclusion
Medical treatments have revolutionized healthcare delivery. Previously incurable conditions are now treatable with reduced costs and faster recovery times. Your health insurance now covers 12 advanced procedures, though policy terms and limits will apply. New treatments give patients clear benefits through customized care and cost savings. Research shows modern methods can save USD 3 billion each year in healthcare costs and lead to better outcomes for patients. The right insurance policy is vital since coverage terms differ among insurers. Look at sub-limits, waiting periods, and network hospitals before you select a health plan. A detailed policy will give you access to advanced treatments without straining your finances.

Smart planning starts with knowing your coverage options. Visit https://basketoption.insure/health-insurance, the best insurance broker in Bangalore, can help you explore modern treatment coverage in health insurance. Expert advice and competitive quotes are a great way to get state-of-the-art healthcare—reach out to us today! Good insurance coverage for modern treatments protects your health and finances. Understanding your policy details and checking procedure coverage before you need them will keep you prepared.