Most standard health insurance plans take care of hospitalisation expenses in case of illness and accidents. But when it comes to life-threatening medical conditions, you will find that standard health insurance policies do not take care of the same. Expenses related to organ transplant is one such expense which is not usually covered by standard health insurance policies.
What Exactly is an Organ Transplant?
The kidney, liver, heart, lungs, pancreas and intestines are the organs that are most commonly transplanted from one human donor to a human recipient. It is an extremely complex procedure which becomes necessary when there occurs irreversible organ failure, otherwise referred to as terminal organ failure. In some cases, the organ may come from a living donor, or a donor who has just died.
How Likely are You to be Needing an Organ Transplant in Your Lifetime?
Organ failure is usually triggered by some illness or injury leading to any one or more of your body’s organs stopping their natural functioning. If the organ’s functioning cannot be revived with surgery or any other medical treatment, an organ transplant is required for survival.
Need for Critical Illness Insurance for Organ Transplant:
Organ transplant, being an extremely complicated procedure, is also an extremely expensive one. The cost may vary from INR 5 Lakhs to INR 35 lakhs or more depending on the organ to be transplanted, the donor or the donor organ location, the facility handling the transplant and a host of other factors. Most health insurance plans come with clauses regarding which procedures/illnesses they will cover. Organ transplant is usually excluded from standard health insurance policies. However, they are covered under add-on/supplementary critical illness insurance cover policies offered by medical insurance service providers
Critical Illness Insurance Service Providers:
There are several medical insurance service providers that provide critical illness insurance. These include Future Generali India Insurance Company Ltd, Bajaj Allianz, Niva Bupa, Bharti AXA, HDFC Ergo, SBI, Max Life, Tata AIG, Chola MS, SBI and several others. These cover 10 to 35 or more critical illnesses depending on the plan chosen. The insured amount will also vary from plan to plan, pre-existing medical conditions and the premium paid.
Tips for Choosing the Critical Illness Insurance Policy to Cover Organ Transplant:
The entire procedure around organ transplant is an extremely traumatic one for not just the person needing a new organ, but for his or her entire family. From knowing that one’s organ is failing, to locating possible donors, finding a right match and finding the surgeons and medical facility – there is a huge pressure on the entire family. Given the high cost of the entire procedure, knowing that one is protected financially, can reduce the stress and trauma significantly. This is all the more traumatic as organ donors are far fewer in number than those who need a transplant.
Here are some questions you should ask while selecting the critical illness policy:
- Does this policy cover organ transplant? Which organs are included?
- Are the donor expenses covered - expenses such as donor surgery and organ harvesting?
- Are organ transportation expenses covered? Transporting an organ so that it reaches the receiver in a live condition is a complicated and difficult procedure.
- Does the policy cover the expense related to consumables, pre and post hopsitalisation expenses?
- Does it offer a cashless facility? Which are the network hospitals that offer this cashless facility?
- Does it offer a reimbursement facility? How smooth is the reimbursement process?
- What is the time-lag between submitting a claim and obtaining a reimbursement?
- What is the claim to settlement ratio?
- Does it cover the cost of treatment and monitoring post the surgery?
- What are the exclusions under the critical illness insurance policy? Almost all policies will have some exclusions. Be sure to understand these at the time of taking the policy.
- Does it cover the cost of a second opinion? As this is a critical procedure, one is likely to want a second opinion before finalising all the necessary details.
- Is there any way I can get better value for money? Weigh the cost of the premium against the coverage, the exclusions and inclusions offered by other service providers.
- Is there a waiting period? How long is this waiting period?
To Conclude
There are several plans that cover organ transplant through the critical illness insurance policies as these are not usually covered by standard health insurance plans. While choosing the critical illness cover plan, study it well and ensure that it complements and balances the existing standard health insurance policy under which you are covered. Also ensure that all aspects of organ transplant are covered. Read the fine print carefully regarding the specified severity of disease and pre-existing diseases. Return the plan within the “free look” period if you are not happy.
