Health Insurance for Organ Transplantation in India

Introduction

“Multiple organ failure” - one phrase that is enough to bring the idea of fatality into the minds of an individual. For that matter, even the idea of a single organ failing is a serious concern. A major organ failing to fulfil its assigned tasks indicates that the body is about to crash and cause a significant problem that might result in fatality.

Medically speaking, organ transplantation is the best way forward, as a long-term solution. But, here is where the series of troubles walk in -

• Meeting the medical requirements as placed by the organ transplantation organisation
• Finding the perfect match for the organ
• The high-end costs involved in organ transplantation.

While the first 2 pointers might remind you of famed book adaptations (like The Fault In Our Stars), the last pointer is a reality-check that is not often highlighted.

So, how do you tackle such expenses? Crowdfunding? Social media platforms? NGOs? Well, all of these might be of help, but they all mean staying dependent on others - not exactly a situation that you would want to burden yourself with.

The next best alternative is - availing of health insurance plans for organ transplantation. A readymade financial safety blanket that is directed at funding organ transplantation expenses and is widely offered by the best health insurance companies across India. However, that is not the sole purpose of these policies. Read through to know more about such policies, and why and how India is gaining ground as a popular organ transplant location.

India: A Popular Location for Organ Transplantation?

India, as a nation, has an appreciable wave of globetrotters visiting it. In fact, a significant amount of India’s revenue is generated over foreign visits. Such visits come with diverse purposes - vacation, job opportunities, business trips, and/or medical requirements. For this piece, our focus is on the latter. Medical tourism across the nation has gained prominent ground. The Indian medical tourism market is valued at US$ 7417 million in 2022 and is predicted to surpass US$ 42,237.47 million in 2032. This significant growth prediction of 19% CAGR from 2022 to 2032 can be attributed to -

1. Availability of cutting-edge medical tools/equipment
2. A highly skilled team of specialists
3. Thinner waiting queue for treatments
4. Affordable treatment/surgery charges
5. Convenient and speedy Visa procedures

All of the aforementioned pointers have made the country a popular destination for organ transplantation (multiple and singular).

Now, while it is true that the treatment and surgery charges are comparatively lower, it still is capable of burning a hole through one’s savings. And avoiding such a significant financial burden requires convenient access to major funding that can be availed over health insurance for NRIs and standard citizens for organ transplantations. But, more on such financial aid later. First, let’s take a look at what organ transplantation means.

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Organ Transplantation: The Complete Story - Days Required, Charges & More

Whenever a major organ in the body fails to function to its fullest capability, it's a major concern for the overall well-being of an individual. While in the initial stage, medical practitioners and specialists try their level best to improve their original organs, in case they fail to do so, organ transplantation becomes the sole option.

Here’s a look at some of the most popular types of organ transplantation that occur in India, the approximate days of hospitalisation required for the surgeries, and the estimate of the charges -

(Please note that the extent of hospitalisation and the charges are completely subjective and change depending on the health complications of the recipient and the approached network hospital.)

Now, while the advancements across the world of medical science as offered by skilled specialists in India are admirable, the incurred expenses, as you can see, can pose a significant financial burden. Add to this the charges over pre and post-hospitalisation expenses and the absence of a source of income during these days of treatment. All of this adds up to an amount that is enough to eat away all the savings of any individual.

On the other hand, the fear of such expenses shouldn’t lead to a compromised medical treatment that can cause a significant deterioration in one’s health in the future. Hence, the reliance on the best health insurance plans for organ transplantation.

Tips to Choose the Best Health Insurance Plan for Organ Transplantation

#Tip 1: High sum insured for the health insurance plan

As has been portrayed and proved before, organ transplantation is not an inexpensive treatment procedure. Irrespective of which organ needs to be transplanted, the involved expenses are significant. This means you are in dire requirement of a higher coverage amount that would offer convenient coverage for the surgery and its auxiliary expenses.

After all, if you have a health insurance plan whose premium you pay diligently, and yet need to pay for such surgery from your pocket, the entire reasoning behind availing of health insurance policies becomes null and void.

#Tip 2: Medical expense coverage for both donor and recipient

Now, here’s a reality check - health insurers are mostly reluctant to pay for the donor’s organ harvest expenses. With some of the best and newly launched health insurance plans, insurers do cover the donor’s cost, but there are significant clauses attached to this.

For example, with Niva Bupa’s ReAssure 2.0 health insurance plan, the donor’s organ harvesting charges are automatically covered. However, their pre and post-hospitalisation charges are only funded if the donor is also a ReAssure 2.0 policyholder.

So, do remember to ask your expert health insurance advisor and/or insurer if their offered coverage extends to both donors and recipients. This would make your plan a value-for-money policy.

#Tip 3: Extensive coverage for pre and post-hospitalisation expenses

Any medical treatment and surgical procedures indeed involve a certain % of risk factors. This makes it crucial for the patient to be followed up after the completion of the procedure and hence, the requirement of post-hospitalisation.

However, in the case of organ harvesting, the risks involved are pretty high. After all, it is the introduction of one’s organs into another human’s body. Irrespective of how well the organs are matched, it is a foreign organ. This -

1. Increases the vulnerabilities of the donor towards infections.
2. Brings forth the chances of health complications in the recipient because of a missing portion or an entire organ in itself.

Subsequently, both the donor and the recipient require added attention during their pre and post hospitalisation preparation days. This will ensure that there are no last-minute medical complications before the organ transplant and neither are there chances of any immediate organ rejection.

Thus, choose a plan that offers the most pre and post-hospitalisation coverage days (the ideal option would be 90 days of pre-hospitalisation and 180 days of post-hospitalisation coverage).

#Tip 4: Availability of specialist network hospitals in your vicinity

When it comes to organ transplantation, not all medical facilities are well-equipped enough to handle the procedure and treatments. Moreover, there is also the case of some hospitals being specialists in dealing with some specific organ transplantations.

Considering such requirements, potential policyholders will have to be particularly careful about the health insurance provider that they approach. That is because the chosen insurer will decide the kind of network hospitals that one has access to. And the better the partner hospitals, the more the chances of policyholders getting to undergo their treatment under specialists with cashless payment modes.

With niche-specific and diverse network hospitals under the belt, donors and recipients don’t need to worry about spending from their pockets and then raising claims so that the expenses can be reimbursed.

#Tip 5: Convenient claim settlement procedure

When we talk about cashless mode vs reimbursement mode in health insurance, we do know which of these is the preferred option: cashless. However, in both these cases, there is a detailed claim settlement process involved. One that requires

1. Documentation,
2. Interaction with the Third Party Administrator/ Health insurer
3. Submission of hospital invoices, etc.

Under such circumstances, you must choose an appropriate health insurance provider that has the reputation of offering a convenient claim settlement process. This would be of great help considering that organ transplantation is a time-taking process that requires an extensive number of hospitalisation days. This means more amount disbursed over hospital cash, a requirement of protector riders that offers coverage over consumables, etc.

All of these diverse expenses mean a ton of documentation. Hence, the least that you can look out for is a health insurance provider that has a market rapport of ensuring a hassle-free claim settlement process.

(P.S. In addition to the Claim Settlement ratio of a health insurance provider, do remember to take into account the Incurred Claim Ratio of the insurance provider as well. This will help you land a health insurance provider that is credible and will cater to your long-term financial and medical goals.)

So, now that you know what to look for when seeking a health insurance plan for organ transplantation, here’s a quick look at some of the best policies available in the market.

(P.S. With a majority of the reputed health insurance stables, there is either a case of outright reject or permanent rejection in the case of organ transplantation for donors or recipients if it’s a pre-existing condition. Under such cases, only a handful of health insurance plans for organ transplantation are available in the market that can be relied upon.)

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What are the Best Health Insurance Policies for Organ Transplantation in India?

(*Organ Screening is not covered in any of the plans)