Organ transplants are expensive, but insurance can help

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Although organ transplants are expensive, health insurance policies and critical illness insurance policies cover them. Nowadays, many health insurers have included organ transplant surgeries in their standard plans.

Aatur Thakkar, co-founder and director of Alliance Insurance Brokers, said: “Health insurance policies offer a cashless or reimbursement facility up to a specified amount incurred by the insured beneficiary towards the organ donor. and provide a tax benefit under Section 80D of income tax. Act. In addition, with this organ transplant coverage, the insured donor and recipient can benefit from it. “

How the policy works

Suppose you are an insured recipient in hospital awaiting a kidney transplant and your friend is the kidney donor. The policy will not only cover all of your costs, including medical, surgical and pre- and post-hospital costs, it will also cover the costs of surgery and the preservation of your friend’s organs. While the health insurance policy will fully cover your treatment costs up to the sum insured, your friend’s expense coverage may vary from insurer to insurer.

Indraneel Chatterjee, co-founder of RenewBuy, an insurance company, said: “Most health insurers cover organ transplants as part of their regular health insurance policies. Some also cover the expenses of the organ donor. The most common organs transplanted are the kidneys, lungs, heart and liver. The cost of these can range from ??5 lakh to ??35 lakh. “

Adding to this, Amit Chhabra, head of health insurance, Policybazaar.com, said the approximate flat rate for the costs of a heart transplant. ??6 lakh to ??10 lakh, and the number for a liver transplant can range from ??24 lakh to ??28 lakh.

“In view of these alarming costs, some Indian insurers have taken the initiative to provide policyholders with integrated coverage for organ donor expenses,” Chhabra said.

However, the donor must generally be in good health when an organ is donated. Chatterjee said: “In medicine, the organ donor is a person at high risk. Thus, if you want to take out a new health contract and you are already an organ donor, it is up to the insurer to decide whether or not to cover the individual. “

exclusion for donors

Donors generally cannot have their hospital costs covered by their regular health insurance policy. Mayank Kale, CEO and Founder of Loop Health, said: “Since there are post-operative complications, the donor’s hospital costs are not covered by most insurance policies in India at this time. day. In addition, any other medical treatment of the donor following the removal is not covered. In addition, the costs directly or indirectly associated with the acquisition of the donor organ are not covered. “

As a result, the insured beneficiary may have to bear such costs, making it essential to understand the allowable and excluded expenses, as well as the sub-limits.

Chhabra said, “The cost of treating the organ donor is only covered for surgery and organ storage. Other expenses related to the donor’s hospitalization are generally not covered. Typical exclusions include the cost of donor screening, pre- and post-hospital donor expenses, and post-surgical complications. “

In addition, Gurdeep Singh Batra, Head of Retail Underwriting, Bajaj Allianz General Insurance, said: “You can claim the costs of an organ donor if the organ donor has been made available in accordance with and in accordance with the Human Organs Transplantation (Amendment) Act 2011. In addition, the donated organ must be used by the insured recipient. In addition, the organ donation request is only payable if the insured’s organ transplant request is accepted in the context of hospitalization.

Exclusion for the recipient

In the case of the beneficiary, most of the expenses of the sum insured are covered by standard health policies (assuming that the beneficiary has purchased health insurance coverage).

Thakkar said, “The insured beneficiary should be aware of the sub-limits or allowable expenses to cover these additional costs. One must read the policy documents in detail to understand what everything is covered by receiving organs. “

“Organ transfer is a very expensive medical affair, so it is important that the recipient understands all hidden medical expenses so that there is no financial burden after the surgery. It is also important to understand all the elements included in the insurance policy, ”he added.

Mint to go

The insured recipient must have a comprehensive health insurance policy or a critical illness insurance policy, which can cover the exorbitant costs of organ transplantation if there is such a crucial requirement in life.

The comprehensive health insurance policy simply covers all medical, surgical, pre- and post-hospital costs, donor surgery and organ storage.

The treatment costs of the insured recipient are fully covered up to the sum insured, but the coverage of the donor’s costs varies from one insurer to another.

Therefore, hospitals should be asked for a full breakdown of donor and recipient expenses if they are having surgery. It is also essential for the organ recipient to obtain a detailed analysis of the donor’s fees to fully understand the financial implications of the exclusions.

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