Best Health Insurance for
Knee Replacement in India
Knee replacement surgery offers a solution for individuals suffering from severe knee pain due to arthritis or injury. But with this invasive surgery comes a hefty price tag to watch out for.
With knee problems affecting millions, the demand for knee replacements is rising rapidly.
Further, the financial burden of surgery goes beyond just the operating room. Expenses include surgeon fees, hospital room rent, OT charges, medicines, and post-operative physiotherapy. Fortunately, health insurance can ease this financial strain. However, insurance coverage remains relatively low.
In this blog, we will explore everything you need to know about health insurance for knee replacement and how it can help you cover these growing healthcare costs.
Top Health Insurance Plans for Knee
Replacement in India
| Features | Reliance Health Infinity | HDFC ERGO my:health Suraksha | Aditya Birla Activ One NXT | Bajaj Allianz Health‑Care Supreme | Chola Flexi Health | Manipal Cigna ProHealth Prime | SBI Divyanga Suraksha | Star MediClassic |
|---|---|---|---|---|---|---|---|---|
| Other pre‑existing diseases covered | Diabetes, HTN, asthma etc. after 36 m | All declared PED after 24‑48 m | Chronic PED after 24‑48 m | PED after 36 m | PED after 36 m | PED after 24‑36 m | 24 m for disability‑linked PED | PED after 48 m |
| Mental‑health in‑patient cover (IPD) | Yes, up to Sum‑Insured; no disease sub‑limit | Yes, up to SI in “Suraksha Silver‑Smart” and above | Yes, up to SI; no room‑rent cap ≥₹10 L | Yes, up to SI; sub‑limit ₹3 L on psych in base, unlimited in “Elite” | Yes, 25 % of SI (max ₹5 L) | Yes, full SI in Prime variants | Yes, full SI (policy designed for PwD + HIV) | Yes, capped at 25 % of SI |
| Other mental illnesses (examples) | Depression, bipolar, anxiety, OCD, psychosis | Depression, bipolar, anxiety, OCD, psychosis + substance‑use disorders if hospitalised | Depression, bipolar, anxiety, OCD, psychosis; ADHD & eating disorders also covered | Depression, bipolar, anxiety, OCD, psychosis; substance‑use excluded | Depression, bipolar, anxiety, OCD, psychosis; dementia excluded | Depression, bipolar, anxiety, OCD, psychosis; alcohol dependence excluded | All ICD‑10 mental disorders | Only ICD‑10 F20‑F48 |
| Pre‑ / post‑hospital expenses | 60 / 90 days | 30 / 60 days | 30 / 60 days | 60 / 90 days | 30 / 60 days | 60 / 90 days | 30 / 60 days | 30 / 60 days |
| Preventive check‑ups | Annual | Annual or biennial (variant) | Annual | Biennial | Annual | Annual | Annual | Biennial |
| In‑patient room‑rent rule | No cap with “More‑Cover” | No cap in “Platinum”; single‑private in Silver | No cap ≥₹10 L SI | Single‑private; no cap in Elite | Single‑private | No cap (Prime) | No cap | 1 % of SI |
| Extended stay / daily cash | Convalescence ₹10 k | Rider ₹1 k‑₹4 k/day | Rider | Convalescence ₹5 k‑₹15 k | Daily cash rider | Daily cash rider | Hospital cash ₹500/day | Rider |
| PED waiting for mental disorders | 36 months | 24‑48 months | 24‑48 months | 36 months | 36 months | 24‑36 months | 24 months | 48 months |
| Instant cover (new illnesses) | 30‑day wait | 30‑day wait | 30‑day wait | 30‑day wait | 30‑day wait | 30‑day wait | 30‑day wait | 30‑day wait |
| Complications cover (e.g., ECT reactions) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Cashless hospitals (approx.) | 8 000+ | 10 000+ | 10 000+ | 7 000+ | 5 000+ | 6 500+ | 6 000+ | 4 500+ |
| Annual premium* (₹) | 8 k‑14 k | 9 k‑15 k | 9 k‑16 k | 9 k‑15 k | 7 k‑12 k | 9 k‑14 k | 8 k‑12 k | 7 k‑11 k |
| OPD / psychotherapy cover | Rider ₹10 k‑₹25 k | Rider ₹10 k‑₹20 k | OPD wallet up to ₹25 k | Rider ₹15 k | Rider ₹10 k | Cashless OPD wallet (Prime) | Psych‑consults reimbursed up to ₹5 k | No |
| Claim‑settlement ratio (FY 23‑24) | 89 % | 94 % | 92 % | 94 % | 88 % | 91 % | 88 % | 90 % |
| Unique benefits | Unlimited SI refill; “More‑Time” 180‑day post‑hospital | “Secure+Protect+Restore” quadruples SI | HealthReturns™, chronic OPD | 60 / 90 d pre/post; worldwide cover add‑on | Flexi deductible to lower premium | Cashless OPD; 24‑m PED wait | Designed for PwD & HIV; 50 % AYUSH | Cheapest; lifelong renewals |
| Portability | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Sum‑Insured range (₹) | 3 L‑1 Cr | 5 L‑2 Cr | 3 L‑2 Cr | 5 L‑1 Cr | 3 L‑25 L | 3 L‑1 Cr | 4 L‑5 L | 2 L‑25 L |
| Entry‑age band | 18‑65 y | 18‑65 y | 18‑65 y | 18‑65 y | 18‑65 y | 18‑65 y | 18‑65 y | 18‑65 y |
| Policy type | Individual / Floater | Individual / Floater | Individual / Floater | Individual / Floater | Individual / Floater | Individual / Floater | Individual | Individual / Floater |
| Tenure options | 1‑3 years | 1‑3 years | 1‑3 years | 1‑3 years | 1‑3 years | 1‑3 years | 1 year | 1‑3 years |
| SI refill / restore | Unlimited | Quadruple SI combo | Reload once/yr | 100 % restore | 100 % restore | Unlimited restore | 100 % restore | 100 % restore |
| No‑claim bonus | 10‑50 % / yr | 50‑100 % | 10‑50 % / yr | 50‑100 % | 50‑100 % | 25‑200 % | 5‑10 % / yr | 50‑100 % |
*Please read the disclaimer at the end of this page before purchasing this policy.
Our Top Recommended Insurance Policies for Knee Replacement Surgeries
Below are three standout plans out of the nine compared. Each recommendation is based on overall coverage, benefits, user reviews, and common user scenarios (immediate coverage needs, robust sum insured, or comprehensive wellness features).
Aditya Birla Activ One - NXT
Aditya Birla Activ One - NXT offers comprehensive health coverage tailored for advanced medical needs, including knee replacement.
Why It Stands Out
Chronic‑Care Orientation: The higher variants bundle an OPD wallet that can pay for orthopaedic consultations, pre‑op imaging, post‑op physiotherapy sessions and braces.
Room‑Rent Freedom: At sum-insured levels of ₹10 lakh and above, there is no cap on room category, so you avoid the co‑pay that many hospitals levy for a private or deluxe room in their knee‑replacement package.
HealthReturns™ Rewards: The insurer credits up to 30% of the premium back into a wellness wallet if you meet activity goals, which can later be used to buy medicines or pay renewal premiums.
Annual “Reload” of Sum‑Insured: Once the base cover is exhausted, it is restored 100% for any unrelated claim. This is useful if a second knee (or another major surgery) is needed in the same policy year.
Potential Limitations
Waiting Period for Reimbursement: Reimbursement for knee replacement starts only after a 24 to 48‑month waiting period.
No OPD Benefits for Entry-Level Tier: The OPD/physiotherapy benefit is available only in the “Plus” and “Premier” tiers. The entry‑level “Essential” tier has none.
Higher Premiums: Premiums rise noticeably once you pick a high sum insured and add the OPD module.
Manipal Cigna ProHealth Prime - Protect & Active
ManipalCigna ProHealth Prime - Protect and Active plans provide health insurance coverage for knee replacement surgery, supporting policyholders through medically necessary procedures.
Why It Stands Out
Shortest PED: Musculoskeletal conditions (including degenerative knee disease) are covered after 24 months in the Protect/Active variants.
Cashless OPD Wallet: The “Prime Active” option settles 10‑20 physiotherapy or doctor visits directly with partnered clinics, easing the cost of mandatory rehab after surgery.
No Room‑Rent Capping: Prime tiers let you choose any room category without extra co‑pay, preventing unexpected deductions from hospital packages that bundle implant cost with a private room.
Unlimited Restoration: Every time the entire sum insured is used, it is refilled for a new, unrelated claim. This is handy if both knees eventually require replacement.
Potential Limitations
Smaller Hospital Network: The hospital network (≈ 6,500) is smaller than Care or HDFC ERGO. Hence, confirm beforehand whether your preferred orthopaedic hospital is covered.
Cashless OPD Available for Network Centres: Cashless OPD works only with network physiotherapy centres. So, check availability in your city before relying on it.
Additional Premiums for Riders: Adding optional riders (daily cash, critical illness) pushes the premium toward the higher end of the market.
Care Supreme - Value
Care Supreme - Value by Bajaj Allianz provides comprehensive health insurance coverage even for knee replacement surgery, ensuring financial security during critical medical procedures. Below are some of its features and limitations:
Why It Stands Out
Huge Hospital Network: This plan has the largest cashless network (≈ 16,500 hospitals) in India, increasing your choices.
No Room-Rent Cap: In the Value variant, there’s no room-rent cap, and the cost of the knee implant is paid inside the full sum insured rather than a disease sub‑limit.
Unlimited Automatic Refill: After the first claim, the sum insured is topped up as many times as needed within the policy year; both knees could be replaced in one year without buying extra cover.
Competitive Premium: It offers a competitive premium for a ₹10 lakh cover, making it cost‑efficient for policyholders focused on a single total knee replacement.
Potential Limitations
Short Reimbursement Period: Post‑operative physiotherapy is reimbursed only within the 60‑day post‑hospitalisation window. This means that long‑term rehab must be self‑funded unless you purchase a separate OPD add‑on.
Longer Waiting Period: Orthopaedic pre‑existing conditions have a 36‑month waiting period, longer than Manipal Cigna’s 24 months.
Limited Instant Cover: “Instant Cover” marketing applies only to brand‑new illnesses. It does not waive the PED waiting for an existing knee condition.
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What is Knee Replacement Surgery?
Knee replacement surgery, also known as knee arthroplasty, is a medical procedure designed to relieve pain and restore function in severely diseased knee joints. Typically recommended for patients suffering from osteoarthritis, rheumatoid arthritis, or traumatic injury, this surgery removes the damaged cartilage and bone from the surface of the knee joint and replaces it with an artificial implant, usually made of high-grade plastics, metal alloys, or polymers.
Explore the
best health insurance plans for arthritis.
Types of Knee Replacement Surgery
Depending on the patient’s specific condition and needs, there are different types of knee replacement surgeries available:
Total Knee Replacement Surgery
This is the most common form of knee arthroplasty, where the knee joint is resurfaced. The surgeon removes the damaged portions of the femur (thigh bone), tibia (shin bone), and sometimes the patella (kneecap), and replaces them with prosthetic parts that mimic the movement of a natural knee that can withstand the stresses of everyday activities.
Partial Knee Replacement Surgery
Partial knee replacement, also referred to as unicompartmental knee replacement, is a less invasive option where only the damaged part of the knee is replaced. The knee is divided into three compartments: medial (inner), lateral (outer), and patellofemoral (front). If the damage is confined to just one of these compartments, a partial replacement may be suggested.
Bilateral Knee Replacement Surgery
Bilateral knee replacement refers to the surgical replacement of both knees during the same operation (simultaneous bilateral knee replacement) or in two separate procedures performed weeks or months apart (staged bilateral knee replacement).
Simultaneous replacement may be recommended for individuals with severe arthritis in both knees, as it allows them to undergo a single hospital stay and rehabilitation period. However, it is generally reserved for patients who are in good overall health, as it can be more physically demanding on the body. Staged replacement, on the other hand, is often suggested for older adults or those with underlying health conditions, allowing the body time to recover between surgeries.
When Do You Need Knee Replacement Surgery?
Typically, if you struggle with simple activities such as walking, climbing stairs, or even getting out of a chair, and medications, physiotherapy, or assistive devices no longer help, your doctor may suggest knee replacement surgery as an option. The main cause of undergoing this surgery is when the patient is suffering from advanced osteoarthritis, rheumatoid arthritis, or injury-related joint damage, where the cartilage has worn away, causing bones to rub painfully against each other.
How Much Does a Knee Replacement Surgery Cost in India?
The cost of knee replacement surgery in India varies based on several factors, including the type of surgery, the choice of hospital, the city, the surgeon's expertise, and the type of implant used. Here's a general overview:
| Types of Knee Replacement Surgeries | Average Cost in India |
|---|---|
| Unilateral Total Knee Replacement | ₹1.5 lakh to ₹2.5 lakh |
| Bilateral Total Knee Replacement | ₹2.5 lakh to ₹4.5 lakh |
| Partial Knee Replacement | ₹1.5 lakh to ₹2.2 lakh |
| Costs Post Surgery | Average Cost |
|---|---|
| Pre-Surgery Tests | ₹500 to ₹25,000, depending on the tests required |
| Physiotherapy Sessions | ₹250 to ₹2,500 per session |
| Medications and Follow-Up Consultations | ₹5,000 to ₹10,000 |
Besides the type of surgery and aftercare costs, the price of knee replacement surgery in India also depends on which city you live in. Here’s a rough idea of what you might expect to pay:
| City | Average Cost |
|---|---|
| Mumbai | ₹1.5 lakh to ₹3.5 lakh |
| Delhi | ₹1.4 lakh to ₹3.2 lakh |
| Bangalore | ₹1.6 lakh to ₹3.7 lakh |
| Hyderabad | ₹1.5 lakh to ₹3.5 lakh |
| Chennai | ₹1.4 lakh to ₹3.3 lakh |
| Kolkata | ₹1.3 lakh to ₹3 lakh |
Is Knee Replacement Covered Under Health Insurance?
Yes, knee replacement surgery is typically covered under health insurance plans in India. Most comprehensive health insurance policies, whether individual or family floater plans, include coverage for major surgeries like total or partial knee replacement.
What is Included in Health Insurance for Knee Replacement?
Given the significant costs you need to bear while and after surgery, it is vital to choose a health insurance plan that comprehensively covers all aspects of your treatment. Below, you will find the key inclusions you should look for in a knee replacement policy:
Benefits of Health Insurance Coverage for Knee Replacement
Taking a health policy to cover your knee replacement surgery is essential to avoid financial strain on your pocket. Below are some major advantages:
Financial Protection
Cashless Treatment Facility
Comprehensive Coverage
Advanced Treatment Coverage
Factors to Consider Before Buying Health Insurance for Knee Replacement
When buying a health policy for knee replacements, it is important to consider factors that directly affect coverage and out-of-pocket expenses. Below are the key elements to keep in mind:
1
Waiting Period
This is the time you must wait before the policy covers knee replacement surgery, especially if you have pre-existing conditions. The waiting period in India can vary from 12 months to several years.
2
Sub-Limits
These are the caps on how much your policy will pay for specific treatments, such as knee replacement surgery. Ensure the sub-limits are adequate for your needs.
3
Co-Pay and Deductible
Co-pay is the percentage of the claim you pay, while the deductible is the amount you pay before coverage kicks in. Lower co-pay and deductible mean less out-of-pocket expense.
4
Coverage Limits
These are the maximum amounts the insurer will pay for your surgery and related expenses. Ensure the limits align with the expected costs of the procedure.
Disclaimer
