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Will I get insurance claim for surgery?

Dr Deepak Mendiratta
Health Insurance, Max Healthcare Institute Ltd, New Delhi

Q: I am covered under mediclaim personal insurance of Rs 5 lakhs for the last 6 years and also under company group insurance with New India Assurance. Recently I was admitted to hospital as advised by neurophysician. After conducting two to three tests of the brain, the report was normal and then was advised sleep study for two days. Sleep study was done. I wanted to know whether I will get insurance claim for this as the outcome of the result is CPAP instrument costing around Rs 50,000/- or Rs 85,000/- + hospitalisation cost. Kindly advise.

A:A mediclaim policy covers any illness leading to hospitalisation (i.e. inpatient treatment) and all medical expenses incidental to the treatment of that illness. If I understand correctly, you are being advised a surgical treatment by a qualified and registered medical practitioner on the basis of certain diagnostic results and the same is not cosmetic in nature. In such a case your claim is payable under a mediclaim policy.