Does Transplantation Expenses Covered Under The Health Insurance?

Every organ plays a crucial role in the functioning of our body. With today’s laid back lifestyle and polluted urban environment, people are now more vulnerable to get diagnosed with serious illness. Sometimes, the disease becomes so severe that it may damage the organ and can result in organ failure.

Does Transplantation Expenses Covered Under The Health Insurance?

With the advancement in medical sciences, transplantation of organs like eyes, lungs, heart, kidney, pancreas, liver, bone marrow, stem cells, etc. is a reality now. But an organ transplantation procedure involves huge medical expense which can range between INR 5 to 30 Lakhs. It involves two major surgeries, one for the harvesting of the organ from the donor and second for the transplantation of the organ to the recipient. And hence, a health policy that covers the expenses of organ transplantation can come to the rescue.

The procedure of the organ transplantation is very complex and hence the companies were not used to cover the expenses earlier because of the risks involved. But with the success rates of organ transplantation nowadays, most Heath Insurance companies cover transplantation expenses.

As Organ transplantation involves two parties – the donor and the receiver. Now, if the recipient is a policyholder, his policy will cover the expenses of the donation surgery. However, the policy does not cover the hospitalization charges or any other medical treatment of the donor. The reason behind this is the fact that the donor’s life is a known risk, which does not get covered under any Health Insurance Plan. So, there are two major concerns regarding the donor’s medical cover:

• Firstly, If the donor falls sick after the surgery, he cannot get any claim from the company even if he has a health insurance policy.
• Secondly, because the receiver is more vulnerable to falling sick and since the organ transplant cover is not subjected to cover the expenses for the after treatments of the surgery, the receiver ends up bearing that costs on his own.

However, some selective insurance plans* (varies from company to company) offer the post-hospitalization charges that are valid for 3 to 6 months, but there should be more policies in the market that would cover both the donor’s and recipient’s expenses that might hit after the surgery.

In India, where most of the health insurance policyholders have a sum insured of INR 4 to 5 lakhs, the untimely need for an organ transplant can lead to a financial burden for a very long time, it is advised to invest in a plan that can help you to withstand the expensive treatment. Critical insurance plans are desirable in such cases. They provide a lump sum amount post diagnosis which can be added to your basic Health Insurance Plan.One can also choose the combination plan, which consists of the basic health insurance policy complemented with the critical illness insurance policy.

According to stats, almost 20,000 people need kidney transplants every year and close to 10,000 need liver replacements. But only 2 to 3 percent of this demand is met because of the unawareness or unavailability of organ donors but the reason behind this is the gap in health insurance for donors. With organ transplantation becoming common the country, we are hopeful that the insurers might take notes of the situations for donors and come with better and improved plans.