Orthopaedic Surgery Insurance in India

The general process

• Pre-authorisation — case details, imaging and estimated cost are submitted to the insurance TPA
• Approval or query — the TPA typically responds within 24-72 working hours
• Admission with cashless — with pre-authorisation, the patient is admitted with a nominal advance
• Discharge and final settlement — the final bill is submitted to the insurer; the patient pays only non-covered items

What to check in your policy

• Room category sub-limit — some policies cap the room type covered
• Implant sub-limit — some policies cap the implant cost
• Waiting periods — for pre-existing conditions or specific procedures
• Co-payment clauses — a percentage the patient pays regardless of coverage
• Network hospitals — whether the treating hospital is in your insurer's network

Corporate GPA policies