Second Opinion Cover in Health Insurance – Meaning and Importance


6 min read

Second Opinion Cover

A second opinion is always welcome in all areas of our lives. As humans evolve, they feel the need to seek guidance from different sources and then make an informed decision. To support this human nature, health insurance policies too now provide for a second opinion cover in case of critical illnesses. Read on to know more about how it can help save costs.

When it comes to receiving treatment for a critical or terminal illness, such as cancer, heart stroke, brain stroke, or kidney failure, anybody is likely to think twice before going ahead with the suggested treatment. This is because the treatment options for such health conditions come at a huge cost, which needs to be borne by the patient and their family. Of course, with health insurance, a large chunk of these costs can be saved; however, that is often not the only problem.

With huge advancements being made in the field of medicine every single day, the treatment for several critical illnesses in India is also undergoing tremendous change. For instance, chemotherapy may not be the only prescribed treatment for cancer. Yes, your doctor may be prescribing it but your awareness of other treatment options may be pulling you in another direction.

A voice inside you may be urging you to take a ‘second opinion’. And you rightly deserve so. After all, it is the question of treating a terminal illness, which also comes at a huge price. However, the problem now arises that seeking an alternate opinion or line of treatment for the condition may also involve huge costs that may burn a hole in your pocket. So do health insurance plans provide any facility to cover costs for second opinion for such diseases?

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Why Do You Need a Second Opinion?

As discussed above, sometimes you may feel the need to take consultation from another doctor in the hope that they may suggest a better treatment option. This is particularly true in the case of diagnosis of some critical or terminal health problems. Cancer, liver and kidney damage, heart attack, and the like are some examples.

The treatment for these health conditions is both prolonged and highly expensive, owing to their critical nature. This is why most patients prefer to consult another doctor for a “go-ahead” as a form of reassurance before proceeding with any treatment. However, this also means that the diagnosis procedure, coupled with the consultation fee for the second doctor as well as the treatment expense (in case you wish to continue with them) would be a huge amount.

4 reasons why you should always consider taking a second opinion for critical and terminal illnesses:

  1. Different perspectives provide more clarity: The treatment for critical diseases often involves some harsh side effects on the body. For instance, the effect of chemotherapy on a cancer patient. This is why it helps to seek another medical opinion in the hope that another professional may be able to suggest an alternative line of treatment that is less harsh on the body.
  2. Different treatments for the same condition can provide better results: Sometimes one doctor may suggest the traditional line of treatment that has been going on for years. However, with advancements in medical science, there are newer treatment options being introduced for certain chronic diseases, which are proving to be equally effective. By seeking a second opinion, you can choose to follow a combination of treatment options for better, and sometimes even faster, results.
  3. Gaining more knowledge on the condition helps: When you speak to different doctors, they are bound to have a different point of view on the same chronic condition. This can help you gain more knowledge on the disease and more information always helps. You will be able to better learn not just about the treatment options but also some lifestyle changes that can help control progression of the illness.
  4. Getting a specialist opinion helps: In case of chronic health conditions, you would require a specialist’s view on the illness. A physician would be able to diagnose the disease and offer treatment for immediate relief of symptoms. However, a specialist would be able to better guide you on how to proceed with the treatment so that the symptoms and also the illness in general can be controlled from progressing to advanced stages.

Does Insurance Cover Second Opinions?

Now we already know that it is highly recommended for everyone to buy a health insurance policy because it safeguards us against such unexpected and highly expensive medical care costs. But does it also provide cost protection for second opinions which can be equally expensive in some cases?

Yes, there is a provision under health insurance plans to cover second opinion health care costs in case of some critical or chronic diseases. This cover is usually provided as an add-on benefit to the base insurance policy. However, you may need to check with your insurer about this cover benefit before purchasing a health insurance plan. This is because not all insurance companies offer the second opinion cover as part of or as an add-on cover to base plans.

Also, some insurers may provide cost coverage for second opinions only in case of specific health ailments. Hence, it is always a good idea to check with your specific insurance provider and ask, “does medicare cover a second opinion?”

What is Covered Under the Second Opinion Cover in Health Insurance?

The treatment costs for chronic diseases are generally high and sometimes unaffordable for a common man. Hence, most insurance companies, in view of this concern of their customers, provide them the additional benefit of a second opinion cost cover.

This means that the patient (in whose name the policy is taken) can take a second opinion for their critical ailment anywhere in India without worrying about the costs. The insurance company would pay for the second opinion costs involved, without costing a single penny to the patient. In addition, the current sum insured under the plan would not get affected for the policyholder.

Note that this benefit is usually provided to every insured policyholder once a year in case of any chronic or critical illness. However, please check with your insurance company about their provision terms before purchasing the plan.

Read More: Types of health insurance policies in India

What Diseases Does the Second Opinion Benefit Cover?

Some insurance companies would provide free-of-cost second opinion benefits to their policyholders only in case of some chronic, terminal or critical health conditions. The following diseases are usually covered under this benefit (but again do check with your insurer before signing up for the cover:

  1. Multiple Sclerosis
  2. Last-stage Renal failure
  3. Last-stage Lung failure
  4. Cancer
  5. Coma
  6. Major organ transplantation
  7. Motor Neuron Disease
  8. Complete blindness
  9. Coronary Artery Bypass Graft
  10. Tumors

There may be more health conditions covered under some insurance plans, which you can check with your insurer once.

Note: In some cases, an international second opinion cover benefit is also provided by some insurers. This helps the patient to seek consultation with a doctor outside of India in case they’re uncertain about the diagnosis or treatment option to proceed with. However, your insurer may ask for a higher premium than usual for this benefit.

Wrapping it Up

When it comes to your health, there are no second chances that you can take. This is why it always helps to take a second opinion instead from a medical professional to remove all doubts. And when health insurance can cover the additional costs incurred on the diagnosis and treatment of the condition, following the second opinion, you can proceed with it without a worry. Look for the best health insurance in India that can offer you this benefit and get the best treatment for your condition.

Found this post informational? Browse PayBima Blogs to read interesting posts related to Health Insurance, Car Insurance, Bike Insurance, Term Life Insurance and Investment section. You can visit PayBima to Buy Insurance Online.


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Sep 15, 2022
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PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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