Is Piles Covered Under Health Insurance?

Does Health Insurance Cover Piles Operation?

Piles, also known as haemorrhoids, are a common anorectal condition that develops due to increased pressure in the pelvic and rectal areas. In fact, according to the Association of Colon & Rectal Surgeons of India, around 50% of people may experience haemorrhoids by the age of 50.

However, while sometimes this condition can be managed with dietary and lifestyle changes, severe piles may require surgical treatment. This is why having a piles cover in health insurance is important for individuals planning treatment.

But does health insurance cover piles operation? Well, the answer depends on your policy’s coverage, waiting period, exclusions and medical necessity.

Waiting Period for Piles Treatment

Understanding the applicable waiting period terms in piles treatment is essential before making a claim. At Bajaj General Insurance, you will get piles cover in health insurance with the following waiting period timelines.

1. Initial Waiting Period: Health insurance starts with a 30-day initial waiting period applied to illnesses, including piles, starting from the beginning of policy coverage.
2. Specific Waiting Period: For any surgery related to haemorrhoids or piles, health insurance policies have a specific waiting period of 24 months.
3. Pre-existing Piles: If piles are a pre-existing condition, the policyholder may have to serve a pre-existing disease waiting period of 36 months, based on the policy terms.

What Hospital Expenses Does Health Insurance Cover for Piles?

In a health insurance policy for piles, the policyholder can get the following coverages.

1. In-Patient Hospitalisation: Eligible inpatient expenses for piles treatment requiring over 24 hours of hospitalisation, such as room rent, ICU charges, and doctor consultation fees, can be covered.
2. Medicines and diagnostics: Prescribed medicines, surgical supplies, laboratory tests and X-rays can also be covered under the policy.
3. Day-care Treatments: Procedures such as modern laser surgeries for haemorrhoids that take under 24 hours can also be covered.
4. Pre- and post-hospitalisation: Eligible medical expenses incurred up to 60 days before admission and 90 days after discharge can be covered.

What is the Cost of Piles Surgery in Health Insurance?

The actual cost of piles cover in insurance generally varies by city, hospital, procedure and treatment needs. However, to help you get an estimation about the cost, we have listed the piles surgery costs based on the type of Indian cities.

Documents Required to Claim Piles Treatment

To make your piles treatment claim smoother, keep these documents ready:

1. Duly completed and signed claim form with NEFT details and cancelled cheque.
2. Health card for identification during cashless claims.
3. Valid identity proof such as Aadhaar Card or PAN Card.
4. Original discharge summary and final hospital bill.
5. Original laboratory and investigation reports with corresponding bills.
6. First consultation letter and relevant prescriptions.

How to Claim Piles Surgery Cost Under Health Insurance?

To ensure hassle-free treatment, follow the given steps to make a piles Insurance claim.

Step 1: For planned surgery, inform the insurer at least 48 hours before admission.

Step 2: Retain prescriptions, reports and other required documents for claim processing.

Step 3: For cashless treatment, visit the network hospitals. Alternatively, you can receive treatment at a non-network hospital and file a reimbursement claim.

Step 4: The hospital’s insurance desk will submit the pre-authorisation request for approval during cashless claims.

Step 5: Once approved, eligible expenses will be directly paid to the hospital as per the policy terms.

Step 6: Submit the required documents and hospital bills to seek reimbursement for eligible expenses.

Choose comprehensive health insurance from Bajaj General Insurance for hassle-free cashless treatment. With access to 18,400+ network hospitals, get the healthcare support you need with greater convenience.

Tips to Ensure Your Piles Treatment Claim Isn't Rejected

With these simple precautions, you can reduce claim-related issues for piles cover in health insurance.

1. Read your policy documents carefully to confirm whether piles treatment is covered.
2. Provide accurate information about pre-existing conditions.
3. Preserve medical reports, prescriptions, bills and discharge summaries.
4. Inform the insurer within the specified timeframe to avoid claim delays or rejection.

Final Thoughts

Understanding piles cover in health insurance can help policyholders plan treatment expenses for their piles surgery without unexpected financial stress.

In fact, in most cases, eligible piles treatment can be covered when it is medically necessary and the applicable waiting period, exclusions and policy terms are satisfied. Therefore, before undergoing this treatment, review your policy to understand its coverage and claim requirements.

Explore Bajaj General Insurance’s comprehensive health insurance plans now to manage eligible surgery expenses with our easy claim process and round-the-clock assistance.

FAQs

Are piles covered under health insurance from day one?

No, treatment for piles is generally not covered from the first day of a policy. In most cases, an initial waiting period and a specific waiting period for surgeries may apply. Therefore, check your policy documents carefully to understand when your coverage for piles becomes effective.

Does health insurance cover piles operation cost fully?

Health insurance generally covers eligible piles surgery expenses if it is medically necessary and covered under the policy. However, your insurer may not pay the entire hospital bill as the coverage depends on the sum insured, deductibles, exclusions, and other applicable policy terms and conditions.

What is the waiting period for piles treatment in health insurance?

The waiting period for piles treatment varies between health insurance providers in India. For instance, at Bajaj General Insurance, piles surgeries are covered after the 24-month waiting period as per the applicable policy terms.

Is laser treatment for piles covered under insurance?

Yes, laser treatment for piles can be covered in health insurance when it qualifies as an eligible and medically necessary treatment under the policy. However, coverage is subject to applicable policy terms, treatment eligibility, waiting periods, exclusions and other conditions.

Can I claim piles treatment as a day-care procedure?

Yes, eligible piles treatment can be covered as a day-care procedure if it is included in the policy’s list of covered day-care treatments. But since eligibility differs between plans, check the policy documents or confirm with your insurer before undergoing the procedure to understand the applicable coverage.

Is piles considered a pre-existing disease if diagnosed before buying the policy?

Yes, if piles existed or were diagnosed before purchasing the policy, it may qualify as a pre-existing disease, based on the policy definition. In most cases for pre-existing diseases, a 36-month waiting period applies to policyholders.

Which health insurance plans offer the shortest waiting period for piles treatment?

Waiting periods for piles cover in health insurance can differ across insurers and policies. Thus, there is no single plan that is universally the shortest. In fact, as per the IRDAI guidelines, the waiting period for specific diseases and treatments can be up to 36 months.

*Standard T&C apply

**Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

***Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to change. Please consult an expert before making any related decisions.