Exploring Specific Surgeries: What You Need to Know About the 24-Month Waiting Period in Health Insurance
Introduction
In health insurance, there are waiting periods of 24 months for some special diseases, which is very important to understand, if you do not have the information then it becomes difficult at the time of insurance claim. Whenever we take any retail health insurance, some diseases are treated only after at least 24 months, and if the disease is already present then it may be for 36 or even 48 months as per the health insurance plans. There may be waiting, once you check this also in the waiting periods of the plan.
Here we take some examples of what percentage of people are suffering from all these diseases in India so that the importance of health insurance can be understood.
According to Narayana Health, approximately 2.6 crore people in India are afflicted with arthritis. Among the population above 60 years of age, the prevalence of this disease stands at 9.6%, while 18% of women worldwide above the age of 50 experience it. It is worth noting that women are more susceptible to arthritis compared to men of the same age group.
According to an article available at http://www.andpi.com/, there are 134 million individuals in India suffering from sinus and nasal allergies. Gynaecology patients face a multitude of diseases, including Polycystic Ovarian Syndrome (prevalence ranging from 3.7% to 22.5% according to the NCBI), Uterine Prolapse, Breast Lumps, Dysfunctional Uterine Bleeding, Endometriosis, Menorrhagia, Pelvic Inflammatory Disease, as per a report from the NIH. Furthermore, 12% to 15% of the Indian population is affected by diseases such as kidney stones and cirrhosis. It is important to note that policy coverage generally does not extend to these and many other diseases within the first 24 months of the waiting period
Here’s the list, and a brief explanation of each one
- EYE- related to eyes
- ENT – related to ear, nose and throat
- Gynaecology – related to women’s diseases
- Orthopedic & rheumatology – related to bone and muscle
- Gastroenterology – related to the digestive system
- Urinary and Reproductive – related to urinary bladder and gall bladder.
- Skin – related to skin diseases
- General Surgery – General
EYE- related to eyes
There are generally two types of eye treatments that are covered by health insurance. cataract surgery (cataract) and second glaucoma surgery (black cataract) – the average cost of their treatment in metropolitan cities can range from Rs 35,000 to Rs 150,000.
List of Eye-Related Specific Surgeries –Cataract, Glaucoma and Refractive Error Correction
ENT – related to ear, nose and throat
Related to ear, nose and throat – This part of the human body is among our five senses. We should know when the treatment for all these diseases becomes effective. These include sinusitis, rhinitis, tonsillitis & adenitis, tamponitis and non-traumatic perforation, deviated nasal septum, otitis media, adenoiditis, mastoiditis, and cholesteatoma. and the cost of all these medical surgeries depends on the complexity of the surgery, which can range from Rs 50k to several lakhs.
List of ENT-related Specific Surgeries– Sinusitis, Rhinitis, Tonsillitis & Adenitis, Tympanitis & Non Traumatic Perforation, Deviated Nasal Septum, Otitis Media, Adenoiditis, Mastoiditis and Cholesteatoma
Gynaecology – related to women’s diseases
Related to gynaecological diseases – There is a waiting period of 24 months for some gynaecological diseases such as – all lumps, warts, swellings, masses, granulomas, polyps (problems in the intestine), fibroids (lumps in the uterus), benign (a type of Tumor in the muscles of the uterus, PCOS/PCOD, prolapse of the uterus, lump in the breast, dysfunctional uterine bleeding (DUB), endometrial dysplasia, menorrhagia, pelvic inflammatory disease (PID).
List of Gynaecology-Related Specific Surgeries– All Cysts, Mass, Swelling, Lump, Granulomas, Polyps, Fibroids & Benign Tumour of the female genito urinary system, Polycystic Ovarian Disease, Uterine Prolapse, Fibroids (Fibromyoma), Breast lumps (excluding Malignant), Dysfunctional Uterine Bleeding (DUB), Endometriosis, Menorrhagia and Pelvic Inflammatory Disease
Orthopedic & rheumatology – related to bone and muscle
Musculoskeletal – Arthritis, All types of Arthritis, All types of Slip Disc, All types of Spondylitis, Joint Replacement Surgery
List of Orthopedic & Rheumatology-related Specific Surgeries– Gout, Rheumatism, Rheumatoid Arthritis, Non-infective arthritis, Osteoarthritis, Osteoporosis, Prolapse of the intervertebral disc, Spondylosis, Spondyloarthritis, Spondylopathies, Ankylosing Spondylitis / Spondylopathies, Psoriatic Arthritis / Arthropathy, Internal Derangement of Knee / Ligament or Tendon or Meniscus Tear, Joint Replacement Surge Non Specific Arthritis
Gastroenterology – related to the digestive system
Related to the system – Related to the digestive system – Gall bladder stones, diseases related to bile, related to pancreatitis, related to piles and ulcers, related to pilonidal, related to the rectum, related to gastric, related to duodenal erosion, ulcers. Related, GERD related, Cirrhosis related, Stone related, Appendix related.
List of Gastroenterology-related Specific Surgeries– Stone in Gall Bladder, Bile duct & other parts of Bilia System, Cholecystitis, Pancreatitis, Fissure, Fistula in ano, haemorrhoids (piles), Pilonidal Sinus, Ano-rectal & Perianal Abscess, Rectal Prolapse, Gastric or Duodenal Erosions or Ulcers + Gastritis & Duodenitis & Colitis, Gastro Esophageal Reflux Disease (GERD), Cirrhosis, Chronic Appendicitis, Appendicular lump, Appendicular abscess
Urinary and Reproductive – related to urinary bladder and gall bladder
Related to the bladder and gall bladder – Any kind of stone in the kidney, any kind of stone in the bladder, related to prostate, Hernia – related to hydrocele, related to varicose, Lump in the testicle.
List of Specific Surgeries Related to Urinary & Reproductive System– Stones in the Urina system (Stone in the Kidney, Ureter, Urinary Bladder), Benign Hypertrophy / Enlargement of Prostate (BHP / BEP), Hernia, Hydrocele, Varicocoele / Spermatocoele
Skin – related to skin diseases
Related to skin diseases – related to all types of skin diseases, including lumps,
List of Specific Surgeries Related to Skin Diseases – Skin tumour (unless malignant), All skin diseases
General Surgery – General
List of Specific Surgeries related to General Surgery – All types of swellings, lumps, ulcers, granulomas, and some internal congenital diseases, Lump, Granulomas, Benign Tumour anywhere in the body (unless malignant)
Now that we know in which disease waiting periods of 24 months are applicable, then how do we have to take claims for all these diseases? All these do not happen suddenly to anyone, some of them take years and happen to almost everyone at one time or another. That is why health insurance should be taken soon.
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Disclaimer This is for informational purposes only. This information does not constitute medical advice or diagnosis
