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  • Organ Donation and Health Insurance in India

    As humanity has advanced through the ages, medical science has kept pace – extending our lifespan and keeping us protected from deadly viruses. The number of deaths that were attributed to organ failure have reduced thanks to the incredible advancements in medical science that enable us to replace organs that no longer function.

    Advancements in medical sciences today have resulted in humans being able to replace malfunctioning internal organs with fully-functional ones, but at a price.

    The price is a result of the complications involved, the risks and liabilities that everyone involved in the process (especially on the part of the medical professionals) exposes themselves to. Though it’s a seemingly miraculous procedure, it’s still highly complicated, risky, and expensive.

    Cornea transplants can cost around Rs.1,00,000, heart transplants are in the range of Rs.10,00,000 and the more expensive liver transplants can burn a Rs.25,00,000 hole in your pocket.

    In order to protect your pocket and savings from taking such a huge hit, should it become necessary, many insurance providers in India are stepping up and offering insurance products which have in-built organ donation clauses. But are these clauses all they’re cracked up to be?

    As we all know, insurance companies like to protect their own interests with extremely detailed and intricate policy documents that you need a calculator to decipher. Here are some of the areas of fine print in your policy document you’ll need to analyse with a fine toothed comb, in order to ensure that you’re making the most of the organ donation part your insurance policy.

    Expenses in Organ Transplantation:

    Most insurers with organ donation cover will only cover the cost of hospitalization, which would work out to about 10% (if you’re lucky) of the total expenditure involved in an organ transplant.

    Here are some of the broad headings under which you’ll be spending:

    1. Organ screening. Before a person can be hospitalized for the purpose of an organ transplant, the right organ must be found. There are many factors involved in finding the right organ to replace the malfunctioning one, and finding the right donor is expensive.

    2. Pre-hospitalization expenses. After finding the right organ to transplant from the right donor, the person undergoing the surgery will need to be brought to the right medical condition with drugs and pre-surgery preparation.

    3. Hospitalization charges. These include the room charges, nurse and doctor’s fees, etc.

    4. Organ transplant surgery. The complicated and risky process of actually transplanting an organ between the donor and recipient.

    5. Post-surgery hospitalization, monitoring. After the surgery, it’s not like the recipient can just pick up his bag and leave the hospital. He or she will be monitored under various situations and the stability of the organ will be judged, in order for the patient to live a normal life.

    6. Rectification of complications arising out of surgery. There have been, sadly, many cases reported wherein the surgery had been performed successfully, but the patient had developed many new symptoms, or the organ was being rejected by the body. Rectifying these problems is an arduous and complicated process, and may double or even triple the entire bill.

    Apart from these expenses, there will be many more expenses on the ground level that won’t necessarily make it into your insurance provider’s coverage. Expenses like pharmaceuticals, ambulance charges, expensive medicines and drugs, extra care facilities in hospitals, etc. all add up to a tidy sum.

    Many hospitals today offer organ transplant surgeries as package deals for a predetermined set amount (which is usually sky high), instead of breaking down and categorizing the expenses under clear headings. This makes it more difficult for the insurer to find out how much it is liable to pay you.

    There are a few companies that cover more than one of the above expenses. Star Health and Max Bupa cover the actual cost of the surgery in addition to hospitalization, but ICICI Lombard, HDFC Ergo and Apllo Munich have avoided the coverage of this huge expense.

    While purchasing your health insurance policy, look for the different types of expenses and find out whether there is comprehensive coverage for all the expenses you’ll incur. An insurance provider can simply cover your hospitalization expenses and get away with marketing their policies as “Organ donor coverage” policies.

    In any case, coverage for organ transplantation and donation is relatively new, and until the kinks are worked out in the policy wordings, we can only expect minimal / surface level coverage for expenses arising out of this manner of hospitalization.

    More and more insurance providers – Religare, Apollo Munich, Max Bupa, Bharti AXA, HDFC Ergo and Star Health – are slowly waking to the reality that donor and transplantation insurance is a product whose demand is rising fast. We could see a large number of highly comprehensive insurance policies flooding the market in the near future, as long as the insurance companies read the signs and fill this incredibly important niche requirement in insurance.

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