Moneycontrol
Jun 29, 2015 01:51 PM IST | Source: Moneycontrol.com

Do you know this about organ donor cover in mediclaim plan?

Most insurance companies, in health insurance, do not cover cost of surgery for organ transplant, in addition to other costs incurred on pre and post hospitalization care of organ donors.

Do you know this about organ donor cover in mediclaim plan?

Mahavir Chopra


Medical science and healthcare has seen some great advancement in the past two decades. Of these advancements, organ donation is one of the greatest and most fascinating in my opinion. We are living in the times of endless possibilities, ones that were not very long ago, subjects of popular science fiction. No longer does one have to lose all hope, even after something as debilitating as vital organ failure.


India itself has seen a sharp rise in the number of cases of organ donation, be it heart, liver, cornea or kidneys.


Organ donation, though as miraculous and fascinating a reality as it has become, is still a complicated, risky and an extremely costly procedure. While a cornea transplant can set one back by about a lakh, heart transplants are in the range of 10 lakhs and liver transplants upwards of 25 lakh rupees.


So how does health insurance in India treat organ donation and transplant? Considering that organ donation and transplant involves 2 parties: the donor and the receiver, what comes under the purview of one’s policy?


Health insurance policy is valid for all diagnosed conditions, procedures, surgeries, treatments that require hospitalization, of course subject to terms and conditions. So in case of the receiver in need of an organ, health insurance policies are fairly clear that they would cover the cost of surgery as well as tests and procedures involved with getting the organ transplanted up to the sum insured.


The tricky part which many miss is how will the medical expenses incurred on the donor who is donating his healthy organ get covered?


In spite of organ donation being marketed as a part of the health insurance coverage by many insurers, you shouldn’t take this coverage at face value. We recommend you delve deeper to figure out how comprehensive the coverage over these expenses is..


It is important to note that insurance companies do not cover all the costs related to the hospitalization or surgery of the organ donor
So what kind of costs does one have to face in case one is willing to undergo organ donation?


There are mainly 6 types of medical expenses incurred as far as the organ donor is concerned:
1. Organ screening for compatibility.
2. Pre-hospitalization costs – Once the donor is finalized, the donor may be required to go through certain medication, treatment, before he can be ready to be hospitalized.
3. Hospitalization Costs: Cost of the room, nursing with respect to the donor.
4. Organ transplantation surgery: The actual surgery – Cost of surgery, Surgeon fees.
5. Post-surgery complications, recovery – Post surgical complications are not uncommon with respect to organ transplantation. So there is a high probability of increased cost of recovery, medications, stay in hospital etc
6. Post Hospitalization Costs for the Donor- Medication, Doctor follow-ups etc.


Of the above costs, pre and post hospitalization costs of the donor and costs on account of post-surgery complication are not covered by any insurance policy in India as on date.


However, the cost most expected to be included by all policies, i.e. of the actual surgery is unfortunately only covered by a few companies. From the list of companies we researched Religare, Max Bupa and Star Health cover the surgical expenses. However, ICICI Lombard, HDFC Ergo, Apollo Munich have categorically excluded this expense.


So when many insurance company promise ‘organ donor coverage’ what they are actually going to cover is only the cost of hospitalization and nothing beyond that, which could be a maximum 10% of the total cost incurred. What is even more surprising, yet true is that even if the organ donor has his own health insurance policy, there is still no coverage from his/her own policy either.


What makes matters difficult is the fact that most hospitals charge a lump sum “package” cost for organ transplant procedures. Thus it is extremely important that you clearly ask and understand the complete breakdown of the above mentioned costs when considering this procedure. This way you will be clear about the expense you’ll have to bear from your own pocket.


To conclude, our attempt in this article is not to criticize products or the industry for its shortcomings and show a dark picture. We stand by the fact that though not perfect, health insurance products in India, at the given price, are extremely useful and relevant in today’s times.


While we are hopeful insurers take note of these gaps and improve their products, our attempt is to educate readers about the fine prints that could look harmless in the short-run, but could have a massive impact on your financial plans in the long-term.

The author heads health, accident & life insurance at www.coverfox.com

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