Critical Illness Insurance for Major Organ Transplant
Critical Illness Insurance for Major Organ Transplant
Critical Illness can be quite tough. It not only takes a toll on the physical and mental health but also on finances. Though medical advancements make it easier to treat a lot of critical illnesses, the cost of treatment can be astronomical. Not planning financially for such unforeseen circumstances can leave your finances dented for a long time. And can even rob you from getting adequate medical treatment.
To give yourself and your loved ones the best chance to face such medical emergencies, critical illness insurance is important. While a normal health insurance plan can be enough for normal medical needs, it can falter if the insured is diagnosed with any critical illness. Since critical illness requires a lot of intense care and specialised cases, the costs of such treatments can be quite high.
Sometimes, critical illnesses can lead to organ failure which would warrant an organ transplant. Critical illness insurance for organ transplants is one of the most effective ways around such medical contingencies.
What is critical illness insurance for organ transplants?
There are different types of health insurance plans out there. However, only critical illness insurance can cover organ transplants. If the organ of the insured is damaged and not functioning as per the body’s requirements, an organ transplant is usually the last resort. There are a few reasons for the same. For starters, it is not a simple procedure. There are quite a few steps involved, right from finding a donor for the organ to matching the blood type.
Doctors even need to check the combability of the new organ before transplanting one. All these together push the cost of organ transplants quite high. And relying only on savings or employer-based health insurance plans can leave you quite vulnerable.
Critical illness insurance for organ transplants will not only provide you coverage for a long list of critical illnesses but also cover the medical expenses related to organ transplants. A critical illness plan usually pays out a lump sum amount on the diagnosis of a critical illness. The amount can then be used for treatment of the disease.
What is an organ transplant?
Critical illnesses can have severe impacts on different body organs and their functionalities. And there is a likelihood of organ failure in such cases. In some cases, even the failure of an organ can lead to a critical illness. If the doctors deem that there are no other possible solutions, then an organ transplant can be the only option available.
Most of the major organs such as kidneys, liver, heart, lungs, bone marrow, pancreas, etc. can be transplanted. Transplanting is the process where an organ is harvested from the body of the donor and after adequate tests, the organ is transplanted to the body of the receiver. The entire process can be quite complicated and involves a lot of intense care. And the receiver needs a lot of care even after the procedure. Thus, making organ transplants an expensive affair.
Inclusions and exclusions of Critical Illness Insurance for Organ Transplant
Critical Illness Insurance for organ transplants is much like any other insurance plan. The plan has a few inclusions and exclusions. Inclusions are all the scenarios that the plan would offer coverage and exclusions are all the conditions, where you cannot file a claim for the policy.
The actual list of inclusions and exclusions would depend on the insurance provider with whom you proceed to purchase the policy. However, here are the standard inclusions and exclusions.
Inclusions
- Heart attack
- Paralysis of limbs
- Cancer
- Major burns
- Coma
- Repair of heart valves
- Kidney failure
- Organ transplant
- Multiple sclerosis
- Speech loss
- Lung diseases
Exclusions
- Complications related to childbirth or pregnancy
- Diagnosis of critical illness within the waiting period of the policy
- Cosmetic surgeries
- Medical conditions developed due to intake of alcohol, tobacco or other intoxicating substances
- Treatment of HIV or AIDS
- Death of the insured within 30 days of critical illness treatment or surgery
- Treatment of hormone replacement
Eligibility for Critical Illness Insurance for Organ Transplant
Insurance companies keep certain eligibility criteria for you to be able to buy critical illness insurance for organ transplants. The following are some of these criteria.
1. Age
Most policies have an age limit of 18 to 60 or 65 years. You must be within this age group to be able to buy a policy for yourself.
2. Term
You can buy critical illness insurance for a duration of 1, 2, or 3 years. Opting for a higher duration can lead to some discounts on policy premiums.
3. Type of cover
You can opt for either individual plans or a family floater plan that offers coverage to everyone.
4. Relations covered
The policy is available for individuals, their spouses, children, brothers, sisters, dependent parents, dependent parents-in-law, and grandchildren.
5. Premium payment
To make the policies even more accessible, insurance companies offer them with different frequencies such as annual, half-yearly, quarterly, or monthly. You can even choose a single premium for the policy.
Features of Critical Illness Insurance for Organ Transplant
On buying critical illness insurance for an organ transplant, you get access to the following features of the policy.
1. Organ transplant cover
The policy will offer coverage for organ transplants and ensure that the insured has the necessary coverage to undergo such types of surgeries and treatments.
2. Critical illnesses
Depending on the insurance company that you choose for your policy, it can cover a healthy list of critical illnesses and protect you against them. On the diagnosis of any of these illnesses, the insurance company will pay a lump sum amount, which can then be used for treatment and other expenses.
3. Tax benefits
Buying critical illness insurance for organ transplants gives you access to tax deductions under Section 80D. You can avail of tax benefits ranging between Rs. 25,000 and Rs. 1 lakh, based on the age of the policyholders. For an individual aged below 60 years, the maximum deduction is Rs. 25,000. For an individual who is above 60 years and wants to buy the policy for dependent parents who are also above 60 years, the maximum deduction is Rs. 1 lakh per fiscal year.
4. Premiums that are affordable
Unlike the common notion that critical illness insurance is expensive, they are not. You can opt for a critical illness plan that offers sufficient coverage at affordable prices. Insurance companies even offer different payment schedules, to make it much easier to own these crucial plans.
5. Smooth claim process
Most insurance companies offer lump sum benefits on the diagnosis of a critical illness. Some insurance companies also offer a percentage of the sum insured as a lump sum amount and the remaining as staggered payments over a few years. An insured can easily benefit from the policy by presenting the diagnosis documents and any other documents required by the insurance company.
6. Look-in period
insurance companies usually offer a free look-in period of up to 15 days from the date of purchase of the policy. You can assess the policy and if you do not like any component of the plan, you can choose to cancel it as well.
Benefits of Critical Illness Insurance for Organ Transplant
The presence of critical illness insurance for organ transplants on your portfolio can offer a host of benefits. The following are some of them.
Insurance companies have started covering a host of critical illnesses under the plan. Some companies cover as many as 33 or 35 critical illnesses. Thus, ensuring that you are adequately covered.
It is quite possible that the insured might not be able to work during such times and treatments can even lead to a loss of income. The lump sum received on the diagnosis can be used for the loss of income.
The premiums of critical illnesses for organ transplants are quite affordable, making them an ideal complementary policy for standard health insurance.
Relying only on a health insurance plan for critical illnesses can be quite difficult. A health insurance plan combined with critical illnesses insurance for organ transplants will give you a rounded coverage.
Critical medical conditions such as organ failure can have an adverse effect on the health of an individual. And the cost of treatment for such conditions can be quite high. Critical illness insurance for organ transplants can be a saviour in such times.
Tax benefits
Critical illness insurance for organ transplants is a type of health insurance plan at the end. Thus, there are a few tax benefits of buying the policy. Any premiums that you pay towards securing a critical illness policy, are tax deductible under Section 80D of the Income Tax Act of 1961. And the benefits are not limited to individuals. You can buy the policy for your children, spouses, and dependent parents and avail of the tax benefits.
Beneficiary | Age Limit | Maximum tax deduction |
Self, children, and spouse | Up to 60 years | Rs. 25,000 |
Dependent parents | Up to 60 years | Rs. 25,000 |
Self, children, and spouse | Above 60 years | Rs. 50,000 |
Dependent parents | Above 60 years | Rs. 50,000 |
Thus, the lowest tax deduction that you can receive under the Section is Rs. 25,000 for an individual and the maximum tax deduction is Rs. 1 lakh if both the applicant and their parents are above 60 years of age. By investing in critical illness insurance for organ transplants, you can bring down your tax implications by a considerable amount.
Key factors to consider while purchasing Critical Illness Insurance for an organ transplant
Buying critical illness insurance for organ transplants can offer you adequate coverage for any unforeseen critical illness. Considering their higher cost of treatment, the presence of a critical illness plan can be a differentiating factor between essential treatment and worrying about costs.
If you are planning to buy critical illness insurance for an organ transplant, here are a few factors that you must consider before buying.
1. List of disease
Insurance companies usually list down all the diseases that they cover for critical illness plans. Make sure to get through the list of diseases as some companies cover 8 critical illnesses while others cover 30 critical illnesses. Look for an insurance company that covers adequate illnesses.
2. Sum insured
It is crucial that you choose the right sum insured for your insurance. You must look ahead and decide on a sum insured that you will be comfortable with. Since medical inflation is constantly on the rise, the cost of treatments will only go up. One must also look at the current sources of income before committing to the plan.
3. Health condition
Your current health condition will play a crucial role in your future health as well. People who are under a lot of stress, smoke, consume alcohol, etc. are at a higher risk of health hazards in the future. If you belong to any of these groups, you will need to plan well.
4. Complementary policy
A critical illness plan combined with a standard health insurance plan offers you robust coverage for all your health care needs. It is important that you balance out both plans, thereby getting you maximum coverage without having to strain your finances. They will ensure that your healthcare-related worries are negligible.
5. Renewal benefits
Considering the shorter term of critical illness plans, you will need to renew them yearly or once every couple of years. Make sure to look for any renewal benefits from your insurance provider for years without any claims.
6. Claim process
Though the process would remain similar across insurance companies, there can be a little bit of difference. Make sure that you go through the claims process, the documents needed for filing a claim and any other requirements that your insurance provider has.
7. Exclusions
As important as it is to know the inclusions and coverage of a policy, it is equally important to be aware of the exclusions. Being aware of these will help you better understand the policy and its limitations.
8. Premiums
One of the most critical factors before deciding on a policy is its premium. It is recommended that you do not solely rely on the premiums and look for a good balance between premium and coverage. Relying entirely on the premiums might leave you asking for more.
9. Waiting period
Insurance companies have different waiting periods as far as critical illness policies are concerned. The usual period is between 60-120 days from the date of commencement of the policy. Make sure you are aware of the waiting period.
Expenses associated with Organ transplantation
Organ transplantation can be an expensive affair. And what makes it expensive is the numerous processes involved and the complexities as well. Here are the different expenses associated with organ transplants.
1. Screening
This is the first step and one of the most important ones as well. Searching for a compatible donor can be time and resource-consuming, as not all people are willing to donate. The lump sum received from a critical illness diagnosis can be used for organ screening.
2. Pre-hospitalisation expenses
After identifying the donor for an organ, the next step is to carry out several tests on the insured to check compatibility and whether the body will accept the new organ or not. And these tests can be a bit expensive. Plans that offer pre-hospitalisation expense cover are ideal for such scenarios.
3. Surgery
Organ transplantation surgeries are quite complex and intense. A considerable team with adequate experience is needed for the procedure. Not having enough coverage can make this process quite stressful.
4. Post-surgery expenses
Post surgery both donor and receiver must undergo follow-ups, be under medications, and a few other expenses as well. Policies that cover such expenses, give you an additional cushion.
Documents needed for claims
Before filing a claim for critical illness for organ transplant, you will need to be ready with a few documents. The following is a list of all the documents that you must be prepared with.
1. Claims form :
The first and foremost document is the claims form that must be filled out. There are different ways to do so. You can fill out the claims form online and submit it. Or you can do so offline. Filing a claim online will make it easier to track and view all the updates.
2. Medical reports :
You will need to submit all the necessary medical reports such as the history of the case, discharge summary, diagnostic tests, investigation reports, etc.
3. Insurance providers also expect a detailed diagnosis of the treatment while you submit a claim.
It is important that you submit these documents at the earliest to your insurance provider. They will assess the documents and request you to provide any additional supporting documents. On reviewing the documents, they will approve or reject the claim. On approval, the payment is usually made within 30 days of approval of all the documents.
While these are standard documents that you will need to submit, the actual list might differ based on your medical condition and the insurance provider. On filing for a claim, the insurance provider will aid you in the process and let you know of any other supporting documents that you might have to submit.
To Sum Up!
Organ transplants can be quite expensive and not getting access to quality healthcare at the earliest can prove to be fatal as well. Critical illness insurance for organ transplants is one of the smartest ways to prepare yourself for any unforeseen medical emergencies. When combined with a standard health insurance policy, it can offer satisfactory coverage for all health needs. Right from minor hospitalisation expenses to major surgeries. The plans will cover them all. And most importantly, you can avail of tax benefits when you opt for the plan and the premiums are affordable as well.
Frequently Asked Questions
No, it is not mandatory. However, it is essential that you secure your future by opting for critical illness insurance for organ transplants. The plan will make sure that you and your loved ones always have the necessary coverage for any unforeseen medical contingencies.
It is the period during which you cannot file a claim for your insurance policy. You must wait this period out before you can start filing for a claim. And the waiting period can differ, based on the insurance company that you opt for.
While there is no hard and fast rule for individuals to opt for such plans, a certain demographic is a bit more prone to such diseases. People who have a family history of critical illnesses, people who are the sole earning members of the family, people who work at high-pressure jobs, etc. are more susceptible to such illnesses and therefore must buy the plan.
It is highly recommended that you inform them immediately of the diagnosis of any critical illness. Though each insurer has a specific timeline within which you must inform them. Failing to do so can have some impacts on your claims.
Before you choose the policy, it is important to assess any medical history, financial obligations that you have, your current financial status and the average cost of the treatment of any critical illness. Choosing the right sum insured will aid you in the process.
No. Insurance providers do not have any provisions for increasing the sum insured during the year. However, you can review the sum insured and change it during the policy renewal.
Leading Health Insurance Companies
