• All you need to know about health insurance for tonsillitis

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    Tonsillitis refers to the inflammation of tonsils. It is a condition characterised by various symptoms including enlarged tonsils, swollen lymph nodes, fever, headache, sore throat, trouble swallowing, etc. While this is not a life-threatening condition, it may cause severe pain and irritation. Though antibiotics can be used in the earlier stage, the most common way of treating severe tonsillitis is through a surgical procedure called tonsillectomy. The good news is that tonsillectomy can be covered by many health insurance plans available in India. Although, a certain level of waiting period may be applicable based on the health cover chosen.

    What is tonsillitis?

    Before we take a look at the health insurance plans that cover tonsillectomy, we must find out what is tonsillitis and how it affects our everyday functioning. Tonsils are glands located in our throat and act as the first line of defense against various pathogens entering our body through food and air. Tonsils have a specific function in our human body, but these are not vital organs necessary for the survival of a person. Sometimes, tonsils get virally infected and lead to inflammation. This inflammation, on the other hand, leads to swollen or enlarged tonsils that may block the airway in the throat. Some of the common symptoms of tonsillitis include:

    • Sore throat
    • Difficulty swallowing
    • Fever
    • Swollen lymph glands
    • Bad breath

    Tonsillitis is most common among young children and adolescents. Since tonsils reach their full growth during puberty, its size could be large relative to the size of young children’s throat. This is the main reason why surgical removal of tonsils might be required. Tonsillitis is contagious and can be contracted from another person through cough. In most cases, tonsillitis may not be severe enough to warrant a surgery. It can be easily treated with drugs and medications. However, people with recurrent tonsillitis or extremely severe case of tonsillitis may have to undergo surgery to remove the tonsils completely. Though it is not a life-threatening condition, it may cause severe pain and irritation.

    Health insurance for tonsillitis

    Since tonsillitis is not a life-threatening condition, many health insurance plans do not provide any coverage for tonsillectomy. It is also a common thing that people often overlook when they subscribe to a new medical insurance policy. If you prefer to have coverage for tonsillitis, you must check your policy document and understand the terms and conditions. Though it wasn’t a common thing, more and more health insurers in the market have started offering coverage for tonsillectomy.

    Tonsillectomy is not a major surgery, and it is most often listed under day care treatment since patients are usually discharged in a time period less than 24 hours. You must check the list of day care procedures covered by your health insurance plan before you subscribe to a cover. There are health insurance plans that provide coverage for all kinds of day care treatment procedures. These covers naturally provide coverage for tonsillectomy. However, it is still better to check the other terms and conditions related to tonsillectomy. Some of the common terms related to tonsillitis treatment can be listed as follows:

    • There is usually a waiting period before coverage can start for tonsillectomy. This is mainly to prevent people from taking a health insurance cover just for the purpose of a specific treatment or surgery. Typically, most health insurers have a waiting period of one to two years.
    • There is generally a sub limit on the sum insured amount that can be spent for tonsillectomy. For instance, a health cover may allocate 10% of the sum insured amount to tonsillectomy. There are also covers that cap the limit at a specific amount. All the expenses incurred for this treatment must be within this limit. If it exceeds the limit, the policyholder may have to pay the balance from his/her own hand.
    • Treatment for tonsillitis may be required mostly for children rather than adults. Hence, it is important to check the coverage availablility for children if you are taking a family floater policy. If you are not sure about the coverage pertaining to children, you may have to check with the customer care of your insurer to know more details about the policy.

    Health insurance plans that offer tonsillitis coverage

    Some of the health insurance plans that offer coverage for tonsillitis can be listed as follows:

    Insurer name Plan name Waiting period Extent of coverage
    ICICI Lombard Complete Health Insurance 2 years No sub-limit
    Care Health Insurance Care 2 years No sub-limit
    Oriental Insurance Happy Family Floater 1 year No sub-limit
      SBI General Health Insurance 1 year No sub-limit
    Apollo Munich Health Insurance Optima Restore Family 2 years No sub-limit

    Though tonsillitis is not a serious health hazard, a health insurance plan that takes care of the extra expenses may come in handy during the time of need. If you have young children in the family, it is always better to choose a health plan that has coverage for tonsillectomy. In addition to the ones listed above, there are many other plans that offer this coverage. Before you subscribe to a health insurance plan, make sure that you read the terms related to exclusions for specific conditions and the sub-limits set for certain treatments.

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