Health Insurance Policies in India that Cover Down Syndrome
Even though not a fatal condition in developed nations, down syndrome has alarming facts and figures in India. Every year, from the 23,000 to 29,000 children who are born with this condition, only 44% survive. The shocking rate is primarily due to inadequate and outdated medical and technological facilities, negligence, and lack of awareness. Worse still, the condition, which occurs due to a defect in chromosomes, has comorbidities such as physical abnormalities, intellectual impairment, dementia, congenital heart diseases, high risk of childhood leukaemia, and immune and endocrine system dysfunction, among others. Medical interventions—early surgical procedures and superior health care—can extend life expectancy to about 60 years and greatly improve quality of life but people fail to avail of these as the condition largely remains untouched by health insurance providers. Some companies, however, do provide cover for down syndrome and many that at least have plans covering issues related to it.
Why the Condition is Left Out from Health Insurance Plans
External congenital diseases were a permanent exclusion from health insurance policies until the Delhi High Court passed an order on 19 March 2018, and the Insurance Regulatory and Development Authority of India (IRDAI) directed all general and health insurers to not include ‘Genetic Disorders’ as one of the exclusions in new health insurance policies. However, health insurance policies for special children, including down syndrome remain elusive in India. Even then, there are some plans by companies that cover the condition or at least its comorbidities.
Why Health Insurance is Crucial
Down syndrome is an incurable and untreatable condition, but with physical, speech and occupational therapies, a person can cope up. India is home to the most number of people with this condition in the world. With no health insurance, not only is one deprived of quality life but the costs of support also add financial burden to the family. One can look at these options:
Bajaj Allianz Women Specific Critical Illness Plan
Bajaj Allianz Women Specific Critical Illness Plan has different types of health insurance plans designed for women. Under this plan, the congenital disability benefit provides an amount equivalent to 50% of the sum assured if a child is born with one of the listed congenital disabilities. Down syndrome is one of these conditions covered. However, the insurer approves the health insurance claim only if the child survives 30 days from the date of diagnosis. The benefit is available if the chromosomal analysis confirms any type of the syndrome that causes physical, genetic and mental defects, including trisomy 21 pattern (an extra chromosome), translocation (when one chromosome breaks and attaches to another), or mosaicism (some cells have 46 chromosomes while the others have 47).
The company provides cover under this plan only for the first two children. The benefit is unavailable if the insured mother is 40 years of age or above, since it significantly increases the risk of down syndrome in the newborn child in case of mothers being older.
Bajaj Allianz Care Joy Maternity Insurance
Bajaj Allianz provides Care Joy Maternity Insurance, which is among the most affordable policies in the country. It gives maternity health insurance cover, pre and post hospitalisation expenses, delivery charges, vaccination charges, childbirth complications, and it covers the treatment for a child with down syndrome if it survives for a month after diagnosis.
Mom’s Belief-Advik Health Insurance Plan
Children’s health and mental wellness company, Mom’s Belief, has launched a plan that bridges the affordability gap for parents who have special children. It aims to provide a holistic solution for the child’s therapy and treatment options without any financial restrictions. These comprehensive group 360 health insurance plans by Care Insurance offer a wide range of sum insured — from INR 1.5 lakhs to INR 4 lakhs. While the enrolled children get cashless access to OPD (Outpatient Department), IPD (Inpatient Department), therapy, nutrition and pathology, parents and families can rely on the family floater health insurance plans. Under the IRDAI mandate, the company cannot sell the policy directly to parents, so, the latter need to first enrol with Mom’s Belief.
Treatments, Therapies and Comorbidities Covers
Some types of health insurance plans cover the cost of certain treatments and therapies such as speech therapy that can treat related issues of down syndrome. That apart, some policies may cover comorbidities including leukaemia and alzheimer’s. However, before you buy child health insurance, be sure to check with the company if they do cover down syndrome or related treatment and therapies. Another factor you must consider is the waiting period in health insurance before raising a claim. Since the condition is congenital, health insurance companies may consider it as a pre-existing disease.
Conclusion
Down syndrome is a congenital disorder that’s neither preventable nor curable. Not every child will have the same severity or comorbidities as someone else. As the condition has been taken off the exclusion list, policies for children with the condition are available. Or, there are plans that cover its comorbidities and certain therapies required for the treatment. Parents can compare health insurance plans and choose the ideal one.
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Health insurance companies have different policies and it depends on the plan whether or not it covers testing. Many insurance plans do but it would be best to confirm the same with the provider. Moreover, the insurer will cover the expense for testing if a doctor recommends it.
Since the severity and related health issues differ for every child, the amount would depend on the kind of care and treatment they need. While there’s no set amount one can consider, some estimates peg it between INR 2 to INR 4 lakhs.
The treatment consists of speech therapy, occupational therapy, physical and mental therapies, special education and self-care, among others.
It depends on the policy’s eligibility. For instance, Bajaj Allianz Women Specific Critical Illness policy provides benefits for first two children only and is not available if the child is born after the mother turns 40 years. Do check with the insurance provider about the same.
Subject to terms and conditions, the insurer pays a lump sum amount if the newborn is diagnosed with down syndrome. Maternity health insurance policies cover pre and post-hospitalisation expenses, delivery charges, childbirth-related medical expenses, and emergencies related to childbirth complications.