Modern Treatments in Health Insurance

What are Modern Treatments?

Modern treatments refer to treatments that use advanced cutting-edge technologies to treat diseases that were once considered untreatable. These advanced methods include robotic surgeries, oral chemotherapy, Intraoperative Neuro Monitoring (IONM), stem cell therapy, and others to manage and treat various health conditions like cancer. Modern treatments speed up the effectiveness of the treatment and reduce the recovery time substantially.

By incorporating the latest scientific advancements in healthcare, modern treatments offer hope and new possibilities for patients facing severe health conditions. However, these treatments are extremely costly due to innovative and experimental technologies.

This makes people wonder if health insurance covers the cost of modern treatments. Let’s find out.

Are Modern Treatments Covered Under Health Insurance?

Yes.

Modern treatments are covered by several health insurance plans in India. It covers the cost of in-patient hospitalisation, domiciliary hospitalisation, day care procedures and pre & post-hospitalisation expenses. As per the guidelines set by the Insurance Regulatory and Development Authority of India (IRDAI), health insurance policies provide coverage for as many as 12 advanced medical treatments under the "Modern Treatment Benefit." This ensures that patients can access advanced medical technologies without any financial burden.

However, some mediclaim insurance policies may impose sub-limits on one or more modern treatments. This means there is a cap on the amount the insurance provider will pay for a specific modern treatment. So, it is essential to check the policy documents for any sub-limits applicable to modern treatments to avoid any unexpected out-of-pocket expenses later.

List of Modern Treatments Covered by Health Insurance

Following are the 12 modern treatments covered by health insurance as per IRDAI guidelines:

1. Immunotherapy - Immunotherapy is a modern treatment that empowers the body's immune system to fight cancer. By helping the immune system to identify and attack cancer cells, it offers a targeted method to treat various types of cancer.
2. Oral Chemotherapy - Oral chemotherapy involves taking cancer-fighting medications by mouth, often in the form of pills or capsules. This method allows patients to undergo chemotherapy treatment at home, making it a convenient alternative to traditional intravenous chemotherapy.
3. Intra Vitreal Injections – Intra vitreal injections deliver medication directly into the eye's vitreous cavity to treat retinal conditions like age-related macular degeneration (AMD) and diabetic retinopathy.
4. Stem Cell Therapy- Stem cell therapy uses special plasma cells from the patient’s body to repair and replace damaged tissues. This modern treatment helps treat Parkinson's, heart conditions, and multiple sclerosis.
5. Robotic Surgeries - Robotic surgery enhances precision and control in surgical procedures by using robotic systems. It requires surgeons to operate from a console, guiding robotic arms to perform complex surgeries with smaller incisions and improved accuracy.
6. Stereotactic Radio Surgeries - Stereotactic radiosurgery uses highly focused radiation beams to treat tumours and other abnormalities in the brain and spine without incisions. It targets abnormal tissues while minimising damage to surrounding areas.
7. Deep Brain Stimulation- Deep brain stimulation involves the implanting of electrodes in specific brain areas to produce electrical impulses that regulate brain activity. It is effective for movement disorders like Parkinson's disease and essential tremor.
8. Bronchial Thermoplasty - Bronchial thermoplasty treats severe asthma by using heat to reduce excess muscle around the airways, thus allowing asthmatic patients to breathe easily. It inserts a catheter into the lungs to provide controlled radiofrequency energy to the airway walls.
9. Uterine Artery Embolization and HIFU - Uterine artery embolization and HIFU are minimally invasive procedures used to treat uterine fibroids. They minimise recovery time and reduce surgical risks.
10. Intra Operative Neuro Monitoring (IONM) – Intra operative neuro monitoring uses electrophysiological methods to monitor neural structures during high-risk surgeries. This modern procedure helps prevent nerve damage and guides surgeons in real-time.
11. Balloon Sinuplasty - Balloon sinuplasty is a minimally invasive procedure to treat chronic sinusitis. During this treatment, a small balloon is inserted through the nose to open up blocked sinuses, providing relief from the sinus infection.
12. Vaporization of the Prostate - Vaporization of the prostate uses a high-power green light laser to remove excess prostate tissue and enlarge the urinary channel. This bloodless procedure is effective for treating mild to moderate prostate enlargement.

Things to Keep in Mind While Claiming Modern Treatment in Health Insurance

Here are a few things to keep in mind while claiming modern treatments under medical insurance:

• Sub-limits on Coverage - Some health insurance plans set a limit on how much they will cover for modern treatments, like robotic surgeries or advanced therapies. This means the insurer will only pay a portion of the total treatment cost, based on the sub-limit, rather than covering the full amount.
• Waiting Periods - Generally, all medical insurance plans cover modern treatments after an initial waiting period of 30 days. But if the treatment is for a pre-existing condition, PED waiting period ranging from 2 to 4 years will apply. The duration of pre-existing disease waiting period can vary from insurer to insurer.
• Medical Prescription Required - The cost of modern treatments is covered under a health insurance plan only if the procedure is medically prescribed. Policyholders need to submit a written recommendation from a qualified medical practitioner indicating the necessity of the modern treatment to validate the claim.

Conclusion

Modern treatments represent a significant advancement in the healthcare sector and offer new avenues for managing & curing severe health conditions. The IRDAI's mandate for including 12 modern treatments in health insurance policies ensures access to these innovative procedures without facing any financial hardships. However, make sure to know the sub-limits, waiting periods and other terms & conditions associated with modern treatments to avoid increased out-of-pocket expenses or rejection of claims.