Are physiotherapy expenses covered under health insurance?
Physiotherapy is a non-invasive medical approach that helps individuals regain mobility, control, and strength via hands-on techniques, heat and cold therapy, therapeutic exercises, electrical modalities, etc. Physiotherapists, or individuals practising physiotherapy are trained and licensed medical practitioners who offer their services in hospitals, clinics, and private sessions.
“Is physiotherapy covered in health insurance?” is a common question that may cross your mind. Well, many health insurance plans do cover physiotherapy. Whether you are managing a chronic condition, or recovering from an injury, it is crucial to have a clear understanding of your insurance coverage.
The need for physiotherapy typically arises in two scenarios - either post-hospitalisation for recovery or in cases where hospitalisation is not required, such as for disabilities or chronic conditions.
Post-hospitalisation physiotherapy
Health insurance policies cover a range of related expenses including hospitalisation, pre-hospitalisation, and post-hospitalisation costs. Physiotherapy sessions prescribed by your doctor as part of your recovery plan falls under post-hospitalisation expenses.
Post-hospitalisation expenses generally cover costs incurred after you have been discharged from the hospital. This coverage typically extends from 60 to 180 days post-discharge depending on the insurer. Therefore, if your doctor recommends physiotherapy to aid in the recovery and rehabilitation process following hospitalisation, the cost of these physiotherapy sessions should likely be covered by your health insurance.
Physiotherapy due to disability, chronic conditions, etc.
If you need physiotherapy due to a disability, chronic conditions, or similar situations, standard policies may not cover it, but few comprehensive health insurance plans may cover it under OPD benefit. Certain policies come with built-in OPD cover or provide it as an additional feature. If your policy includes OPD coverage and encompasses physiotherapy, you can claim expenses for physiotherapy sessions on an outpatient basis. This means you can receive physiotherapy without being admitted to a hospital.
In both the cases, physiotherapy sessions covered by the policy must be provided by qualified physiotherapists and recommended by qualified medical practitioners within the policy period.
How to choose the best health Insurance plans for physiotherapy?
(a) Physiotherapy can’t be your only determiner - You cannot opt for a health insurance policy solely based on whether it offers coverage for physiotherapy. This medical factor can be banked upon a few times, but you need a policy and an insurer that you can fall back upon in case of any medical happenings that would cushion your finances.
(b) Be aware of the waiting period - Waiting periods in health insurance denote a specific duration that you must serve before coverage becomes effective for certain benefits or treatments. Perks like physiotherapy are specific conditions and perks, and often come with a waiting period. So, ask your insurer or advisor about the specific waiting period so that you don’t end up getting your claim rejected.
(c) Check for any sub-limits - Health insurance policies may mention a separate limit for OPD-related expenses. Some insurers may impose a sub-limit determining the extent of coverage for post-hospitalisation expenses. Take note of any such amount/session limits on your health insurance plan for physiotherapy.
(d) Verify any network restrictions/specifications - Some policies stipulate that physiotherapy treatments should be availed through the insurance company’s approved health service providers. If you approach non-partner hospitals or facilities, you either end up losing the cashless mode of claim settlement or you end up losing the coverage completely.
Here are few health insurance plans in India offering physiotherapy under OPD benefit:
- Bajaj Allianz Health Care Supreme Vital/ Smart/ Ultimo: Offers different physiotherapy coverage limit based on the plan variants from INR 5K to INR 50K based on the sum insured opted.
- The treatment should be prescribed by a specialist consultant for muskulo- skeletal /neurological diseases / injuries or other systemic diseases and carried out in a hospital as defined under the policy. Total 10 sittings of Physiotherapy sessions would be considered per illness/injury per policy period, maximum up to the specified limit as per the plan opted
- During the first year of Health Care Supreme policy, 90 days waiting period would be applicable for all the claims, however the waiting period would not be applied during subsequent renewals
- ICICI Lombard health advantage: ICICI Lombard, provides an add-on called BeFit Cover under their health advantage health insurance policy, extending coverage to various OPD-related expenses, including physiotherapy sessions. The plans offers 6-12 physiotherapy sessions based on the BeFit cover plan chosen. The sessions can only be taken in-network physiotherapy clinics on submission of the consultation papers.
- Star Out Patient Care Insurance Policy: Star Health offers an outpatient care insurance policy. This policy can be availed either on an individual or floater basis and offers sum insured options of Rs.25,000; Rs.50,000; Rs.75,000; Rs.1,00,000. This plan also covers physiotherapy expenses incurred at any network facility in India for treatment as an outpatient with the receipt from the treating doctor/ hospital/ physiotherapist.
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