Coverage of Various Heart Surgeries under Insurance
Heart surgery is usually covered under Indian health insurance, but coverage depends on policy terms, waiting periods, exclusions, and hospital network rules.
Heart Valve Replacement under Insurance
Coronary Artery Bypass Graft Surgery under Insurance
Total Arterial Revascularization under Insurance
Frequently asked questions
Is Heart Surgery Covered under Insurance?
Yes, heart surgery is covered under health insurance in India under most standard policies. Procedures like bypass surgery, angioplasty, valve repair or replacement, and pacemaker implantation are usually included. Coverage typically pays for hospitalisation, ICU, surgeon fees, and medicines. However, claims depend on policy terms, sum insured, and waiting periods, especially for pre-existing heart conditions, which often have a 2–4 year waiting period.
What type of Heart Surgery is not covered under Insurance?
In India, health insurance usually does not cover certain types of heart surgeries based on policy exclusions and conditions. These commonly include experimental or unproven procedures, surgeries done purely for cosmetic or non-medical reasons, and treatments not approved under standard medical guidelines. Pre-existing heart conditions are not covered until the applicable waiting period (usually 2–4 years) is completed. Surgeries performed at non-network hospitals without emergency, or those exceeding sub-limits (such as room rent or implant caps), may also face partial or no reimbursement. Always check policy exclusions carefully before treatment.
Is post-hospitalization cost covered in Insurance for Heart Surgery?
Yes, post-hospitalization expenses are generally covered under health insurance in India for heart surgery, as long as they are medically related to the surgery. Most policies cover follow-up consultations, medicines, diagnostic tests, and rehabilitation costs for 60 to 90 days after discharge, depending on the insurer. Coverage is subject to policy limits, exclusions, and claim approval. Always verify the post-hospitalization period and expense caps mentioned in your policy document before treatment.
Is pre-hospitalization covered in Insurance for Heart Surgery?
Yes, pre-hospitalization expenses are usually covered under health insurance in India for heart surgery, provided they are directly related to the planned cardiac procedure. Most insurers cover diagnostic tests, consultations, and investigations done 30 to 60 days before hospital admission, depending on the policy. These may include ECG, angiography, blood tests, and cardiology consultations. Coverage is subject to policy limits, waiting periods, and claim approval. Always check the exact pre-hospitalization time window mentioned in your policy document.
