Health Insurance for Hernia Surgery – Coverage, Cost & Claims

Hernia surgery is a common medical procedure, yet the financial implications of treatment can be significant. Health insurance can play a vital role in easing these costs, but navigating coverage specifics can be challenging. In this article, we will explore how health insurance policies address hernia surgery, including coverage details, waiting periods, associated costs, and the claims process. Bajaj Finserv, as a facilitator of health insurance plan comparisons, provides a seamless platform to help you find the right policy tailored to your needs.
 

Is Hernia surgery covered under standard health insurance plans? 

Hernia surgery involves repairing a hernia, which occurs when an organ or tissue pushes through a weak spot in the surrounding muscles. This condition can lead to discomfort, pain, and potentially severe complications, making timely medical intervention crucial.

Most standard health insurance plans cover hernia surgery, recognising its medical importance. Coverage typically includes hospitalisation, surgical procedures, and post-operative care. However, exclusions may apply, such as congenital hernias or conditions caused by lifestyle factors like obesity or smoking. It is essential to review policy terms for clarity.

Bajaj Finserv serves as a trusted platform to compare health insurance policies from leading insurers, ensuring you find plans that suit your specific requirements. Additionally, you can explore riders like critical illness coverage, which may include hernia-related conditions, providing enhanced protection. 

Explore plans today

Health insurance policies typically include a waiting period for pre-existing conditions or specific treatments, such as hernia surgery. The waiting period refers to the time you must wait before claiming coverage for certain medical procedures.

For hernia treatment, the waiting period can vary depending on the insurer and the policy chosen. In most cases, it ranges from 24 to 48 months for pre-existing hernia conditions. However, some policies may offer shorter waiting periods or even immediate coverage for new hernia cases. For example, Bajaj Finserv facilitates access to health insurance plans from trusted insurers, which may provide options with reduced waiting periods.

If you have a family history of hernias or suspect you may need surgery in the future, choosing a plan with a shorter waiting period is advisable. This ensures you are covered when the need arises. 
Check premium for plans that cover pre existing illness. 

Many comprehensive health insurance policies include coverage for hernia surgery as part of their benefits. These policies typically cover hospitalization expenses, pre- and post-hospitalization costs, and daycare procedures like laparoscopic hernia surgery.

Through Bajaj Finserv, you can compare health insurance plans from various reputed insurers to find the one that suits your needs. Some policies even offer cashless treatment at network hospitals, making the process seamless and stress-free.

Individual health insurance plans generally cover hernia surgery for adults aged 18 to 65 years. Family plans extend coverage to spouses, children, and dependent parents. It is important to review the policy terms carefully to understand the inclusions, exclusions, and any co-payment clauses.

A health insurance policy typically covers most major expenses related to hernia surgery, depending on your plan type and sum insured.

 
Expenses usually covered
 

• Pre-hospitalisation costs: Doctor consultations, diagnostic tests, and medications (usually up to 30 days before admission).
• Hospitalisation costs: Room rent, nursing charges, surgeon’s fee, anaesthesia, and operation theatre expenses.
• Surgery and treatment charges: Laparoscopic or open hernia repair, mesh implantation, and post-surgical care.
• Post-hospitalisation expenses: Follow-up visits, medicines, and medical tests (for up to 60–90 days after discharge).
• Daycare procedures: If hernia surgery doesn’t require 24-hour hospitalisation, it’s still covered as a daycare treatment.

Not typically covered
 

• Non-medical consumables (gloves, syringes, bandages, etc.)
• Room rent beyond policy limits
• Surgery for cosmetic or non-medical reasons

Choose a health insurance plan with broad hospital coverage and cashless claim benefits to reduce out-of-pocket expenses for hernia surgery.

What are the costs of hernia surgery covered by insurance?
 

The cost of hernia surgery can vary based on factors such as the type of surgery (open or laparoscopic), hospital charges, and the city where the treatment is conducted. On average, hernia surgery in India can cost between Rs. 50,000 and Rs. 1,50,000.

Health insurance policies typically cover the following expenses related to hernia surgery:

• Hospitalization costs: Including room charges, surgeon fees, and operating theatre expenses.
• Daycare procedures: Policies often cover laparoscopic hernia surgery, which does not require extended hospital stays.
• Pre- and post-hospitalization expenses: Such as diagnostic tests, consultations, and medication.

Bajaj Finserv enables you to access health insurance plans with premiums starting as low as Rs. 9.3/day* for coverage up to Rs. 10 lakh. While specific features may vary by insurer, these plans often include co-payment clauses, where you share a portion of the treatment cost. 
You can claim insurance for hernia surgery in two ways — cashless or reimbursement.

Cashless Claim

• Select a network hospital listed by your insurer.
• Inform your insurer/TPA at least 48–72 hours before admission (or within 24 hours in emergencies).
• Submit a pre-authorisation form and doctor’s recommendation at the hospital desk.
• Once approved, the insurer directly settles eligible bills with the hospital.
• You only pay non-covered charges, if any.

Reimbursement Claim

• Inform your insurer before or soon after hospitalisation.
• Pay the hospital bill yourself.
• Submit documents like discharge summary, bills, payment receipts, and diagnostics.
• The insurer reviews and transfers the approved claim amount to your account.

Quick Tips

• Check waiting period for hernia cover (usually 2–4 years).
• Keep all bills and reports safely.
• Track claim status on your insurer’s portal.

Looking for health insurance with cashless hospitalisation and quick claim approval? Compare premium of health insurance plans today. 
 

Conclusion 

Hernia surgery is a critical medical procedure that can be financially burdensome without adequate health insurance coverage. By choosing a comprehensive health insurance plan, you can ensure that hospitalization, surgery, and related expenses are well taken care of. Bajaj Finserv simplifies the process by offering access to health insurance plans from trusted insurers, allowing you to compare and select the best policy for your needs.

Whether you are looking for coverage for daycare procedures like laparoscopic hernia surgery or plans with minimal waiting periods, Bajaj Finserv provides a reliable platform to explore your options. Take the first step towards securing your health and finances by checking your eligibility and comparing plans today.