Organ Transplantation & Health Insurance Cover- Things You Need to Know

Written on Wednesday, December 23, 2015
By Mukesh Kumar- Executive Director, HDFC ERGO

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Advances in medical sciences have significantly impacted the expectancy and quality of life in the last few decades. One of the most noteworthy achievements of the medical sciences is the transplantation of organs such as Kidneys, Lungs, Liver, Pancreas, Intestine, Heart etc. from one body (donor) to another (receiver), to replace the recipient’s damaged or absent organ. A number of lives are saved every year with successful organ transplantations.


While the transplantation of organs like Kidneys and Liver are common, the topic of organ transplantation has been in news with a series of successful Heart transplantations in Mumbai in the last couple of months. Organ transplantation is a complex procedure that comes with high cost.


The procedure of organ donation involves two separate complex surgeries – one for the harvesting of the organ from the (deceased, living or brain-dead) donor and second for the transplantation of the organ in the receiver. It takes a skilled team of doctors/staff and super-specialty facilities to carry out the entire procedure. All of these individual components add to the overall cost of the transplantation, making it beyond the reach of most people.


According to the findings of the study¹ reported recently in PLOS One, an open access peer reviewed scientific journal published by the Public Library of Science, direct expenses for kidney transplant in India ranged from Rs 1.3 lakhs–Rs 14.2 lakhs and accounted for two-thirds of the total expenses. Indirect expenses ranged from Rs 13,560–Rs 9.1 lakhs. Various reports suggest the cost of heart transplantation in India to be around Rs 23 lakhs – Rs 30 lakhs.


What can help in the event of an Organ Transplantation is a comprehensive Health Insurance Policy. Earlier, (most) organ transplantation were not covered under Health Insurance policies due to the risks involved. However, with Organ Transplants getting common, most Health Insurance policies cover organ transplantations now. According to estimates³, around 3,000-3,500 organ transplants are carried out in India every year. Beyond these, the demand for transplants remains high. According to media reports, about 200,000 people need kidney and about 100,000 need liver every year. However, only a very small per cent of the demand is met due to low awareness/availability of organs.


A standard comprehensive Health Insurance policy covers organ donor’s harvesting surgery without any capping. The benefit is payable under the receiver’s policy, if the organ donated is for the use of the insured person. It must be noted that the policy does not cover the donor’s pre- and post-hospitalization expenses or any other medical treatment, which needs to be provided as a consequence of harvesting the organ. This is because organ donation is considered a voluntary act, which can put the donor’s health at known risk, which is not covered under any Health Insurance policy. Thus, the policy pays to the organ receiver, if the company accepts an inpatient hospitalization claim under the policy.


Most Health Insurance policyholders in India have a sum insured of Rs. 2-3 lakhs and the average coverage under individual policies would be even lower. In such situations, the need for organ transplant can play havoc with any family’s well-calculated budget. However, if your basic sum Insured is low, you can significantly enhance your coverage at low cost with a Top-up plan on your basic Health Insurance policy.  Top-up plans are regular indemnity plans covering hospitalization, but only after exhaustion of a threshold limit, known as deductible. When the severity of the illness is high like an organ transplant, which can push your basic treatment cost to Rs. 5 lakhs or more, a Top-up cover prove extremely beneficial.


Another type of Health Insurance cover that can help you withstand high cost of organ transplant is a Critical Illness Insurance. In fact, the Critical Illness Insurance for organ transplant is highly desirable because of the lump sum amount received post diagnosis. This amount will be in addition to your basic Health Insurance as it helps wipe off your monetary worries.


To protect against the financial hardship that can potentially arise in the event of a Heart Transplant, it is advisable to go for a Combination Plan, consisting both the basic Health Insurance (preferably with a Family Floater with a good Top-up cover), supplemented with a Critical Illness Insurance. Such a combination can protect your financial balance by providing a decent coverage at a reasonable cost.


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