Surgical Care Benefit Rider in Term Insurance- A Detailed Guide

Riders in term insurance are designed to enhance the coverage of the policy and of course provide additional benefit to the insured. The Surgical Care Benefit Rider is one such benefit, offering expense coverage in case of an emergency surgery requirement. Read more about this rider benefit and how it helps the policyholder during medical emergencies. 

With advancements in medical science, more solutions to critical health conditions were brought to light. Procedures like surgeries are not considered scary anymore, thanks to the technological leaps in science. To keep pace with the changing times, the insurance sector too is undergoing noticeable progress. One example of this is the benefit riders in term insurance that help enhance the coverage of the base plan by offering added protection to the life assured.

And if the life assured needs to undergo a surgical procedure during a medical emergency, there is the Surgical Care Benefit Rider in term life insurance plans. This post aims to guide you all about this rider and how you can use it to your advantage in case of a health emergency.

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What is Rider Benefit in Term Insurance?

Before proceeding with the Surgical Care rider in specific, let us quickly understand what is a rider in insurance terms and how it can help a policyholder.

Term insurance riders refer to optional add-on features that are offered in conjunction with a base term insurance policy. These add-ons are intended to provide additional protection over and above the insurance policy purchased by the policyholder. They come at easily affordable rates and can be bought along with the base plan.

What is a Surgical Care Benefit Rider in Term Insurance?

As stated above, rider benefits are meant to offer extra protection against risks not generally covered under the base insurance plan. Keeping in tune with this, the surgical care plan intends to provide financial support to the insured in case they need to undergo an emergency surgical procedure for a critical health condition.

If the policyholder buys the life care surgical benefit rider along with the term insurance policy, the insurance company would pay a lump sum amount to the insured to cover hospitalization expenses during surgery.

Any surgical procedure would require hospital stay for the patient for a minimum of 24 hours. With this rider benefit, you would not need to bear the hospitalization and the surgical procedure cost from your own pocket. When the situation arises, your insurer would pay you this cost in a lump sum to help you cover up these costs.

How Does a Surgical Care Benefit Rider Help?

A surgical procedure in India is generally expensive and can put a lot of financial strain on the patient and their family. With the help of this rider benefit, the insured can expect to receive considerable financial assistance from the insurance company during the following:

1. During major surgeries: In some critical conditions that involve major surgery of the heart, brain, lungs, liver, or kidneys, the Critical Care Rider can be of great help. Under this benefit, the insured stands to receive at least 5 times the benefit amount initially chosen as part of the rider.
2. During other surgical procedures: Not just with major surgical operations but the rider benefit can be used in case of other normal procedures as well that require hospitalization. In this case, the insurer would offer the benefit equal to the amount chosen by the insured as part of the rider.
3. Cashless hospitalization during emergency: With this benefit, you can be rest assured of availing instant hospitalization facility during emergency without paying a single penny.
4. High-quality treatment: Since the cost for surgery is covered by the rider, you need not worry about anything and can easily go for the best available treatment at the hospital for your condition.
5. Extended coverage for healthcare: The base insurance plan does not cover additional healthcare costs such as room service during hospital stay, fee for the doctor, nurses, and other medical staff, and cost for other treatments like physiotherapy, dialysis, etc. However, with the Surgical Care add-on benefit, all these costs also get covered under the plan.

Note: The life insurance long term health care rider benefit can be availed only up to 10 times the benefit amount chosen by the insured during 1 policy year. In addition, claims can be made only up to 50 times the chosen benefit amount during the entire term of the plan.

What Documents are Needed for Claiming the Surgical Care Rider?

In order to file a claim for availing this benefit, the insured must submit the following documents to the insurer:

• Original documents of the insurance policy
• Medical report that mentions the health condition for which surgery is required
• A certificate by the attending medical practitioner
• Photo ID proof of the policyholder and proof of residence
• A copy of the bank statement of the policyholder.

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What is Excluded Under the Surgical Care Rider Add-On?

We discussed earlier what benefits the rider covers. However, there are certain conditions not covered under the plan. The exclusions under the Surgical Care Benefit Rider are as follows:

• Plastic surgery or cosmetic surgery procedures
• Treatment for pre-existing health conditions
• Treatment for any complications occurred during pregnancy
• Treatment for Sexually Transmitted Diseases (STDs)
• Care for patients admitted for attempt to suicide
• Patients with self-inflicted injuries
• Procedure required for organ donation

To Conclude

The Surgical Care Rider is indeed helpful to the policyholder who can secure financial support in case of a surgery requirement, which is usually very costly and sometimes unaffordable for a lot of people. It’s a good idea to compare term insurance plans with riders offered by different insurance companies before narrowing down on any one.

PayBima offers a host of options in this regard. Visit the company website and take your pick on the best term insurance plan with riders that offer additional coverage on the base insurance plan.

Also read: Types of Life Insurance Policies in India

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