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Is Fracture covered in Health insurance?

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16 Jul, 2021 by  Jaspreet Singh

Hi All,


I'm unsure if fracture is covered in health insurance?/ To the extent I read the policy, I think it is getting covered under day care treatment head, can someone clarify?

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Health Insurance

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16 Jul, 2021
Rohit Dhingra

Dear Jaspreet,


A fracture most times is administered as part of OPD, in general it not covered in a health insurance policy as it does not require over 24 hrs hospitalisation. However, there are someplans that do cover small amount of OPD expenses. If you hold such a plan you will be given coverage.


Day care treatments are procedure that due to advancement of technology can be done with a few hours without requiring hospitalisation. So getting a only hand or leg plastered which requires few hours in an emergeny... will not be covered.




Regards

Rohit Dhingra

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17 Jul, 2021

You can explore Personal Accident Insurance. It covers permanent total, permanent partial & temporary total disability. There are value add-ons available like coverage of medical expenses due to accident. If you do not have a PA cover, take one. They come at a very low premium & serve to enhance your insurance portfolio.


As pointed by Rohit in this thread, Health Insurance usually doesn't cover a OPD event unless it is specifically included in your policy.


Asad

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04 Aug, 2021

Hello Jaspreet,


OPD Day Care


Daycare covers hospitalization costs that require less than 24 hours of "in-patient" treatment due to technological advancement in medical science. OPD is treatment carried out in the OPD section of a hospital or around the doctor's consultation room. OPD is covered only in certain special policies.


The question to ask here is:

  • Whether the person who has suffered a fracture require admission as an inpatient in the Day Care or under OPD?
  • Does the treating of the fracture - plaster etc. necessitate hospitalization - require surgery in an operation theatre, or will it be done in the OPD section of the hospital?


If the person is treated under OPD - then health insurance usually won't cover it.

If admission to a hospital is necessary to treat the injury then it usually would get paid for.


Regards,

Team Beshak.

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