Critical Illness Insurance for Organ Transplant Surgery

Health insurance covers medical emergencies such as accidents, diseases, or any other ailment that requires hospitalisation. However, there are specific ailments, which are not covered by your primary health insurance plans. The critical illnesses like cancer, paralysis, coma, major organ transplant, multiple sclerosis, stroke, heart disease, kidney failure, etc. may leave you disabled or paralyzed. For such illnesses, one should have a separate financial buffer called critical illness insurance.

The basic health insurance policy has a sub-limit on treatment expenses. Critical illness insurance comes as a rescue when there is a dire need of lump sum cash for a medical emergency. Major organ failure and the requirement for an organ transplant is one such situation.

With the technological advancement, the organ transplant has turned into a reality. Organ transplantation process requires two parties, the donor and the recipient. An organ is harvested from the living or dead donor’s body and transplanted inside the recipient’s body. This is done after conducting several tests to check the compatibility of the donor and the recipient of an organ transplant. Transplantation is majorly done for vital organs such as heart, liver, kidney, lung, pancreas, intestine, bone marrow, etc.

Organ transplant is a complicated procedure that requires substantial medical expenses. To meet these unprecedented expenses, it’s always advisable to opt for critical illness insurance policy. With no kind of cover, it would be tough to meet these unexpected medical costs. You have to either drain your hard-earned savings, borrow funds, or mortgage assets.

There’s a huge demand for organ transplants, but only a few can be successfully met. The reason is not only the rarity of willing donors but also high treatment cost. Most insurance providers are not keen on providing coverage for organ donor expenses. Under some policy, the donor’s expenses are covered, but with restrictions. For most health plans, organ transplantation is considered as an exclusion. Then, some products offer coverage for organ donor expenses as an add-on.

Whenever you look for critical illness insurance for an organ transplant, here are a few key factors you should consider

1. Diseases covered

It is necessary to check whether organ transplant is covered under critical illness cover or not. Usually, it varies from one insurance provider to another. According to IRDA guidelines, it is compulsory for every insurer to cover at least 12 critical illnesses. Thus, organ transplant generally gets covered under these plans. But, to be doubly sure you should thoroughly read the policy wording or check with your insurer whether organ transplant surgery is covered or not.

2. Timeframe

The timeframe for covering the illness varies from provider-to-provider, ranging from 60 to 120 days from the date of buying a policy. There is a liberty of choosing either a cashless reimbursement or a benefit policy. If you are diagnosed with a critical illness, you are eligible to get a lump sum amount from the insurer. You can use this lump sum amount to pay for treatment expenses, care, and recovery. Nevertheless, you can even choose to use the money for substituting lost income, adapting to lifestyle changes or paying off debts in some cases. Please note that there is a condition for 30-day survival period post the diagnosis of a critical illness to receive lump sum compensation.

3. Expenses covered

The coverage is for the expenses incurred for organ transplant surgery. If post-surgery, the donor falls ill or has some side effect as a result of organ transplant, there will no coverage provided. It is implied that the policy does not cover pre-and post-hospitalisation expenses or any other medical treatment needed due to harvesting the organ. This is because organ transplantation is considered a voluntary act and is known to put the donor’s health at risk. Thus, post-surgery expenses are not covered. However, some insurance providers offer extended post-hospitalisation cover for up to 180 days.

4. Sub-limits

Organ transplant cover is generally subject to sub-limits. ICICI Lombard Complete Health Insurance has sub-limit of up to Rs 50,000; HDFC Ergo Health Suraksha and Optima Restore covers up to sum assured; Religare Care 4 covers up to Rs. 1 Lakh and Care 5 covers up to Rs. 2 Lakh; and Star Health Family Health Optima covers 10% of the sum assured or Rs. 1 Lakh, whichever is lower, etc. Thus, different insurers have different sub-limit set for organ transplantation.

Critical illness may restrict you from working and earning, drain your savings, and affect your everyday lifestyle. A critical illness policy will help you withstand the high cost of organ transplant. It is advisable to go for a combination plan, consisting of both the comprehensive health insurance and critical illness insurance. The standalone health insurance will cover your medical expenses related to hospitalisation. However, in case of expensive treatment, like organ transplants, the critical illness cover will offer you a lump sum benefit that will help protect your financial balance in tough times.

In case you still have doubts, you can contact us at Insurancedekho.com, and we will be happy to solve all your queries related to your health insurance needs.

Also Read

Understand Star Health Red Carpet Health Policy For Senior Citizens

Now Cover Entire Family Under Critical Illness Plan by IFFCO Tokio General Insurance