More information on health insurance terms while planning an organ transplant

More information on health insurance terms while planning an organ transplant  15th October 2022

Organ transplant is a process where we replace a malfunctioning organ with a healthy one from a fit donor. With the advancement of medical science and the introduction of state-of-art technologies, we can go for transplants of vital organs such as the liver, kidney, heart, etc. But these life-saving transplants come with heavy costs ranging between 1-2 lakhs to 30-35 lakhs of rupees!

Health insurance providers have started offering policies covering organ transplants to meet such heavy expenditures. You read it right! Let us look into such policies in detail.

1. Coverage:
Two parties are involved in organ transplants: the organ receiver and its donor. Health insurance companies will cover the cost of various tests, hospitalisation expenditure, cost of surgery, and other related procedures vital for an organ transplant of the receiver. However, there are restrictions on coverage with regard to donor expenses.
The insurance policy will cover the in-patient hospitalisation charges of the donor. But it does not cover expenses regarding medical screening, storage or transportation of the organ, and pre and post-hospitalisation charges that the donor may incur in the process. Coverage for the above costs is subject to the sum insured and cannot exceed that.

2. Types of costs:
You should be aware of the types of costs that you will incur during an organ transplant. The first cost to bear is organ screening. The hospital will check the condition of the donor's organ.
The donor will incur pre-hospitalisation costs for medicines and different tests. Then hospitalisation expenses, including room charges, doctor fees, nursing expenditures, etc., will be considered. Post all these initial formalities and screenings; the actual surgery can be performed.
Post-surgery complications often arise, and there might be a need to bear additional hospital and doctor fees, medical expenditures, etc. The donor's post-surgery expenses, such as doctor follow-up, medication, etc., are also to be considered.

3. Waiting and survival period:
A health insurance policyholder with organ transplant coverage cannot raise a claim for the initial few days after buying the policy. Such policies usually come with a waiting period of 90 days to even 2-3 years from the policy's inception, after which a claim for an organ transplant can be raised. This waiting time may vary from one policy to another as per their respective terms and conditions.

4. Guiding Act:
The "Transplantation of Human Organs Act (THOA) 1994" is the guiding act for all organ transplants in India. It guides the removal, storage, and transplantation process of human organs. Any health insurance service provider will not cover your organ transplant claim if it violates any of the provisions of this law. Also, your claim will be rejected if the organ transplant is done for commercial dealings or smuggling activities of human organs.

Saving a life by donating or receiving an organ is a fortunate incident, and having the right insurance plan can make the experience less daunting. We recommend that online health insurance is the best way to invest in organ transplantation coverage. Buying the policy online will allow you to study and compare various policies that provide such coverage per our convenience and requirements.

Organ transplantation is an expensive process, and making haste decisions can land you in unwanted trouble. Go through each policy's terms and conditions in detail before making your final decision.

You should also ask for a detailed break-up of the recipient and donor expenses from the hospital before going for an organ transplant. This will give you a fair idea of what expenditure will be excluded from your insurance policy coverage and what will be its financial implication.

Click HERE to buy an online health insurance policy.

Disclaimer: The information provided above is for illustrative purposes only. To get more details, please refer to policy wordings and prospectus before purchasing a policy.