Surgery Cost in India vs What Your Policy Actually Pays
What common operations cost in India, set against the sub-limits real policies apply. On some plans a knee replacement is capped below its cheapest price.
Does health insurance cover the full cost of surgery?
Often, but not always - and the gap is not where most people look for it. A policy can carry a ₹20 lakh sum insured and still cap a named operation below what that operation costs, because sub-limits sit separately from your cover and do not rise with it.
Two numbers decide what you pay: the procedure's price, and the ceiling your policy puts on it. Set side by side, they explain most of the bills people are surprised by.
What common operations cost
Ranges as published by Yashoda Hospitals, read July 2026. These are one hospital group's published India ranges rather than a national survey, and price moves with city, surgeon and implant - but they are a fair order of magnitude to plan against.
| Procedure | Published range |
|---|---|
| Hernia surgery | ₹18,000 – ₹45,000 |
| Cataract surgery | ₹15,000 – ₹1,00,000 |
| Cataract, laser | ₹40,000 – ₹2,00,000 |
| Appendix surgery | ₹25,000 – ₹1,60,000 |
| Piles surgery | ₹25,000 – ₹1,40,000 |
| Gallbladder stone removal | ₹45,000 – ₹1,80,000 |
| Kidney stone operation | ₹45,000 – ₹1,80,000 |
| Balloon angioplasty | ₹70,000 – ₹1,10,000 |
| Hysterectomy | ₹80,000 – ₹1,20,000 |
| Knee replacement | ₹1,50,000 – ₹2,30,000 |
| Bariatric surgery | ₹2,45,000 – ₹3,40,000 |
| Coronary artery bypass (CABG) | ₹1,20,000 – ₹4,40,000 |
Where the cap sits below the price
Caps below are quoted from the policy wordings held in our own policy database, read July 2026.
The clearest case is knee replacement. The procedure runs ₹1.5–2.3 lakh. Care Freedom caps it at ₹70,000 to ₹1.2 lakh a knee; Care Heart at ₹80,000 to ₹1.2 lakh a knee. Both ceilings sit below the cheapest quoted price, so on either plan the shortfall is not a matter of choosing an expensive hospital - it is structural.
Care Heart caps a good deal more than the knee, and the pattern is worth seeing whole:
| Procedure | Published cost | Care Heart cap | Who pays the gap |
|---|---|---|---|
| Knee replacement | ₹1,50,000 – ₹2,30,000 | ₹80,000 – ₹1,20,000 a knee | You, always |
| Kidney stone operation | ₹45,000 – ₹1,80,000 | ₹50,000 – ₹80,000 | You, above the cap |
| Hysterectomy | ₹80,000 – ₹1,20,000 | ₹50,000 – ₹80,000 | You, above the cap |
| Cataract surgery | ₹15,000 – ₹1,00,000 | ₹20,000 – ₹30,000 an eye | You, on most cases |
| Hernia surgery | ₹18,000 – ₹45,000 | ₹50,000 – ₹80,000 | Usually covered |
Care Heart also caps cerebrovascular treatment, cancer, renal complications and fractures between ₹2 lakh and ₹3 lakh each. Care Freedom applies the same shape of caps alongside a 20% co-payment on every claim, for life.
Neither plan is badly designed - both are built to accept people a mainstream insurer would decline or load heavily, and the caps are how that is priced. The failure is buying one without knowing the caps are there.
Cataract: the cap ranges twenty-fold across plans
| Plan | Cataract cap |
|---|---|
| HDFC ERGO Optima Secure and Optima Secure+ | None |
| Care Supreme | None |
| Niva Bupa ReAssure 3.0 Black | None, and not restricted to a mono-focal lens |
| Aditya Birla Activ One MAX and NXT | None |
| Magma OneHealth Premium | ₹1 lakh per eye a year |
| Bajaj Allianz Health Guard Platinum | 20% of sum insured per eye, max ₹1 lakh |
| Bajaj Allianz My Health Care Plan | 20% of sum insured per eye, max ₹1 lakh, up to ₹10 lakh cover; at actuals above it |
| ICICI Lombard iHealth Plus | 10% of sum insured, up to ₹1 lakh per eye |
| New India Mediclaim | 20% of sum insured or ₹50,000 an eye, whichever is lower |
| New India Floater Mediclaim | 10% of sum insured or ₹50,000 an eye, whichever is lower |
| United India Family Medicare | 10% of sum insured or ₹50,000 an eye, whichever is lower |
| United India Individual Gold | 25% of sum insured or ₹40,000 an eye, whichever is lower |
| National New National Parivar Mediclaim | 10% of sum insured or ₹40,000 an eye, whichever is lower |
| Care Freedom and Care Heart | ₹20,000 – ₹30,000 an eye |
Against a ₹15,000–₹1 lakh procedure, and a laser cataract running to ₹2 lakh, the bottom of that table leaves most of the bill with the patient. Full detail on this one procedure, including the lens question, is in our guide to cataract surgery and the sub-limit that decides.
Bariatric, hernia and hysterectomy
Bariatric surgery starts at ₹2.45 lakh. Magma OneHealth Premium caps it at ₹1 lakh. Bajaj Allianz Health Guard Platinum allows 50% of sum insured to a ₹5 lakh ceiling, which on a ₹10 lakh policy covers the procedure outright. Same operation, opposite outcomes.
Hernia and hysterectomy are capped on United India's Individual Gold plan and on Care Heart. Against an ₹18,000–₹45,000 hernia the caps generally hold. Against an ₹80,000–₹1.2 lakh hysterectomy they bind. United India's own Individual Platinum plan carries none of these caps - they apply to Gold only, which makes the tier you were sold more consequential than the insurer you chose.
The mechanic that catches people
Most caps are written as a percentage of sum insured OR a rupee figure, whichever is lower. Work it through on a ₹40,000 cataract cap:
- At ₹4 lakh cover, 10% is ₹40,000. The two agree.
- At ₹10 lakh cover, 10% is ₹1 lakh - but ₹40,000 binds.
- At ₹50 lakh cover, ₹40,000 still binds.
Above a low threshold, buying more cover does nothing for a sub-limited procedure. That is the opposite of how a sum insured is assumed to work, and it is why "I have ₹25 lakh cover" is not an answer to "what will my knee replacement cost me".
One genuine carve-out is worth knowing, on two of National Insurance's plans. On National Mediclaim, none of the sub-limits apply to a listed procedure taken as a package rate in a Preferred Provider Network hospital. On New National Parivar Mediclaim the same package route lifts the room limit and the cataract limit. If you hold one of those policies, where you have the surgery can matter more than the cap itself. Ask the insurer for the PPN list before you fix a hospital.
What to do about it
Before you buy:
- Ask for the sub-limit table, not the brochure. It is usually a section headed "sub-limits" or "specified conditions" in the wording, and it is the fastest way to tell two similar-looking plans apart.
- Check the procedures your family is statistically likely to need. Cataract and knee replacement for parents; hernia, gallbladder, kidney stone and hysterectomy across adult life.
- Treat "no disease sub-limits" as a headline feature. The plans we work with - HDFC ERGO Optima Secure and Optima Secure+, Care Supreme, Niva Bupa ReAssure 3.0 Black, Aditya Birla Activ One MAX and NXT, and ICICI Lombard Elevate in its base cover - all carry none. Our comparison of plans with no sub-limits sets them against each other.
Before you admit:
- Get a written estimate that names the implant or lens. The difference between a standard and a premium implant is often the difference between sitting inside the cap and outside it.
- Ask the hospital insurance desk to confirm the sub-limit against the estimate, not just that the policy is valid. "Your policy is active" and "your policy pays for this procedure in full" are different statements.
- Remember room rent is a separate trap. Breaching a room-rent cap triggers a proportionate deduction across the whole bill, on top of any procedure sub-limit. A co-pay then applies to whatever survives both.
FAQs
Does health insurance cover the full cost of a knee replacement?
Not always. A knee replacement runs ₹1.5–2.3 lakh on published ranges, and some policies cap it below that - Care Freedom at ₹70,000 to ₹1.2 lakh a knee, Care Heart at ₹80,000 to ₹1.2 lakh. Both ceilings are under the cheapest quoted price. Plans that carry no disease sub-limits pay up to the sum insured instead, so check your own wording.
What is a sub-limit in health insurance?
A separate ceiling on a named procedure or expense, sitting inside your sum insured rather than alongside it. It is usually written as a percentage of the sum insured or a rupee figure, whichever is lower, which means increasing your cover stops raising the cap once the rupee ceiling binds.
Which surgeries are most often sub-limited?
Cataract most of all, then knee replacement, hernia, hysterectomy, prostate and kidney stone surgery, and bariatric surgery. These are also the procedures people are most likely to actually need, which is why the caps matter more than their obscurity suggests.
How much does appendix surgery cost in India?
₹25,000 to ₹1,60,000 on Yashoda Hospitals' published range, with the spread driven by city, hospital, and whether the surgery is laparoscopic or open. Appendix surgery is not commonly sub-limited, so on most policies it is paid up to the sum insured, subject to room-rent terms and any co-pay.
Can I avoid sub-limits?
Yes, by choosing a plan that has none. HDFC ERGO Optima Secure and Optima Secure+, Care Supreme, Niva Bupa ReAssure 3.0 Black, Aditya Birla Activ One MAX and NXT, and ICICI Lombard Elevate in its base cover all carry no disease sub-limits. You cannot remove a sub-limit from a policy that has one, so this is a decision made at purchase, not at claim.
Does a bigger sum insured raise my sub-limit?
Only where the cap is a pure percentage. Where it is written as "a percentage or a rupee figure, whichever is lower", the rupee ceiling binds above a fairly low sum insured - so at ₹10 lakh and ₹50 lakh of cover you may get exactly the same amount.
Is cataract surgery cost fully covered?
It depends entirely on the plan. Cataract runs ₹15,000 to ₹1 lakh, and ₹40,000 to ₹2 lakh for a laser procedure. Caps across the plans we have read range from nothing at all to ₹20,000 an eye on Care Freedom and Care Heart. The cap, not your sum insured, decides what you pay.
Cost against cover, at a glance
| Where the costs come from | Yashoda Hospitals' published procedure-cost list, India ranges, read July 2026. One hospital group's published rates, not a national survey. |
|---|---|
| Where the caps come from | The policy wordings held in NYVO's own policy database. |
| The mechanic | Sub-limits are usually written as a percentage of sum insured OR a rupee figure, whichever is LOWER - so a larger sum insured stops helping once the rupee ceiling binds. |
| Worst mismatch found | Knee replacement, ₹1.5-2.3 lakh, capped at ₹70,000-₹1.2 lakh a knee on Care Freedom and ₹80,000-₹1.2 lakh on Care Heart. |
| Plans with no disease sub-limits | HDFC ERGO Optima Secure and Optima Secure+, Care Supreme, Niva Bupa ReAssure 3.0 Black, Aditya Birla Activ One MAX and NXT, ICICI Lombard Elevate in its base cover. |
| A carve-out worth knowing | On National Insurance's National Mediclaim, none of the sub-limits apply to a listed procedure taken as a package rate in a Preferred Provider Network hospital; on New National Parivar Mediclaim the package route lifts the room and cataract limits. |
Costs vary by city, hospital, surgeon and implant, and the figures here are one hospital group's published ranges. Get a written estimate for your own case, and read the sub-limit table in your own policy schedule.
Book a call for advice on the best policy for you and your family
A salaried, IRDAI-certified NYVO advisor will look at your cover, flag the gaps that matter, and tell you plainly what to fix. No commission, no pressure.
16+ years in financial services. Former investment banker at Bank of America, Kotak Investment Banking, and SBICaps, and ex-CFO of slice. Founder of NYVO and Principal Officer - IRDAI Certified.
