Organ donations can make a significant difference to someone’s life. But most people shy away from this noble cause owing to safety concerns and the exorbitant cost of organ transplant surgeries.
Though organ transplant surgeries are costly, health insurance policies and critical illness policies do cover them. Nowadays, many health insurers have included organ transplant surgeries in their standard plans.
Aatur Thakkar, co-founder and director, Alliance Insurance Brokers, said, “The health policies provide a cashless or reimbursement facility up to a specified amount incurred by the insured recipient towards the organ donor and gives tax benefit under Section 80D of the Income Tax Act. Besides, with this organ transplant coverage, both donor and insured recipient can get the benefit.”
How the policy works
Let us assume that you are an insured recipient in the hospital awaiting a kidney transplant, and your friend is the kidney donor. The policy will not only cover all your costs, including medical, surgical, and pre-and post-hospitalization expenses, it will also cover the expenses for your friend’s surgery and organ storage. While the health policy will completely cover your treatment expenses up to the sum insured, the coverage for your friend’s expenses can vary from insurer to insurer.
Indraneel Chatterjee, co-founder, RenewBuy, an insurtech firm, said, “Most health insurers cover organ transplants as part of their regular health insurance policies. Some also cover the organ donor’s expenses. The most commonly transplanted organs are kidney, lung, heart and liver. The cost of these can range from RS. 5 lakh to Rs. 35 lakh.”
Adding to it, Amit Chhabra, head – health insurance, Policybazaar.com, said the approximate package for a heart transplant costs Rs. 6 lakh to Rs. 10 lakh, and the figure for a liver transplant can range from Rs. 24 lakh to Rs. 28 lakh.
“Taking these alarming costs into account, some Indian insurers have taken the initiative to provide policyholders with an in-built cover for organ donor expenses,” said Chhabra.
However, the donor must usually be in good health when an organ is donated. Chatterjee said, “In medicine, the organ donor is a high-risk individual. Thus, if one wishes to acquire a new health policy and is already an organ donor, it is up to the insurance provider to decide whether or not to cover the individual.”
Exclusion for donors
The donors usually cannot get their hospitalization costs covered under their regular health insurance policy. Mayank Kale, chief executive officer and founder, Loop Health, said, “Since there are post-surgery complications, the hospitalization costs of the donor are not covered by most insurance policies in India as of date. Further, any other medical treatment for the donor consequent on the harvesting is not covered. Also, costs directly or indirectly associated with the acquisition of the donor’s organ is not covered.”
As a result, the insured recipient may have to bear such costs, making it critical to understand admissible and excluded expenses, as well as sub-limits.
Chhabra said, “The organ donor’s treatment cost is only covered for surgery and organ storage. Other expenses related to the donor’s hospitalization are typically not covered. Typical exclusions include the cost of screening the donor, pre-and post-hospitalization expenses for the donor, and post-surgical complications.”
Further, Gurdeep Singh Batra, head – retail underwriting, Bajaj Allianz General Insurance said, “You can claim for an organ donor expenses if the organ donor has been made available in accordance and in compliance with ‘The Transplantation of Human Organs (Amendment) Act, 2011’.” Also, the organ donated has to be used by the insured recipient. “Moreover, the claim for organ donor is payable only if the claim for an organ transplant of the insured is accepted under in-patient hospitalization,” added Batra.
Exclusion for recipient
In the case of the recipient, most expenses of the sum insured are covered under standard health policies (considering the recipient has taken a health insurance cover).
Thakkar said, “Insured recipient should know about the sub-limits or expenses which are allowed to meet these additional costs. One should read the policy documents in detail to understand what all is covered under organ receiving.”
“Organ transfer is a highly expensive medical affair, and thus it is important for the recipient to understand all the hidden medical expenses so that there is no financial burden after the surgery. It is equally important to understand all the components that are included in the insurance policy,” he added.
The insured recipient should have a comprehensive health insurance policy or a critical health insurance policy, which can cover the exorbitant costs of organ transplant if there is such a crucial requirement in life.
The comprehensive health policy simply covers all the expenses from medical, surgical, pre- and post-hospitalization, donor’s surgery and organ storage.
The treatment expenses of the insured recipient are fully paid for up to the sum insured, but the cover of the donor expenses varies from insurer to insurer.
Hence, one must ask hospitals for a full breakdown of donor and recipient expenses if they undergo any surgery. It is also critical for the organ recipient to get a detailed analysis of donor’s fees to understand the financial implications of the exclusions completely.
