What insurance policies state on organ donation?

Both of Vani’s kidneys had stopped working. Her only shot at survival was an urgent kidney transplant. Aanya, her daughter, matched as a donor, but all expenses related to organ donation were excluded both from Vaani’s, and Aanya’s individual health insurance policies. In the end, left with no option, Vaani had to bear this hefty expenditure all by herself.

At just 0.86 per 10 lakh individuals, India’s organ donation rate is amongst the lowest in the world. Data suggests that, as of 2023, India’s organ recipient waiting list stretched beyond 5 lakh. In fact, 20 Indians die everyday, unable to find a suitable, life saving organ.

This problem is only amplified by how financially draining this entire process is. On an average, in a private hospital, a kidney transplant could set you back by around Rs 15 lakh, while a heart transplant could cost you up to Rs 40 lakh. Liver transplants could also go as high as Rs 25 lakh.

It can be a financial nightmare to bear the cost of this entire process without adequate insurance coverage. However, insurance policies present in the market offer just a fraction of financial protection needed for both to the recipient and the donor. Let’s take Vani’s example to understand this better.

Vaani’s health insurance policy will cover the cost of her surgery, diagnostic tests and other procedures needed during organ transplantation up to the policy’s sum insured. But her policy will exclude all expenses associated with the individual donating her organ i.e. Aanya. So, expenses related to Aanya’s hospitalization and recovery will have to be borne by Vaani, who’s the organ receiver.

Aanya’s insurance policy will also not offer any coverage while she is donating her organ. So, if Aanya falls ill, or is hospitalized as a result of donating her kidney, her policy is not liable to honour any claims.

All in all, the monetary burden of all the donor’s procedures will have to be taken care of by the recipient.

If the organ receiver and donor have not had any prior insurance coverage, they might find it impossible to get one after the transplant procedure. This is because insurers anticipate very frequent claims from both parties after the surgery, and hence, refrain from extending coverage.

In the few cases where the coverage is offered, it is ridden with conditions. These can range from excluding all claims related to the donated or received organ, or charging significantly longer than usual premiums or waiting time.

Anshul Bohara, Product Head, Go Digit General Insurance, advises double- checking with your insurer on this front before opting for a health insurance plan.

“Even though an organ transplant might happen once in a life, it is a monetarily high impact claim. Since organ donor coverage might not always be part of the policy, one may need to opt for it as an additional coverage. This may also come with specific waiting periods and may have sub-limits, co-payment or some type of capping on different types of expenses related to organ transplant. Check with your insurer about the organ transplant conditions and understand them carefully before opting for a plan”, he notes.

IRDA guidelines note that your insurer cannot deny your current policy’s renewal request on grounds of you having donated an organ. However, it is essential that you disclose critical information like this while signing up for a new policy. In case you don’t do so and your insurer finds out, they can terminate your policy owing to the fact that you’ve hidden crucial medical information.

Experts also recommend getting a critical illness rider along with your standard insurance policy to strengthen your financial coverage for such times. Critical illness riders offer comprehensive coverage against a number of ailments, which generally includes organ donation.

For instance, the Max Life Critical Illness and Disability rider covers 64 critical illnesses, which includes a major organ /bone marrow transplant, offers a minimum sum assured of Rs 1 lakh, and a maximum of Rs 1 crore

The HDFC Life critical illness rider, which offers protection against 19 critical illnesses, offers a minimum coverage of Rs 25,000. At the same time, the maximum coverage can be equal to the sum insured of the base policy.

Since this comes as a rider, the premium payable is dependent on various factors like  sum insured chosen, policy tenure, age, health status, gender and the insurer opted for.

For instance, under the Manipal Cigna lifestyle protection critical care’s enhanced cover, which safeguards against 30 critical illnesses, the premium payable by a 40-year old female who opts for a sum insured of Rs 1 crore will stand at Rs 69,000. On the other hand, the premium charged under the same parameters for a 40-year man would be Rs 62,700.

Per Abhishek Gupta, Chief Marketing Officer, Edelweiss Tokio Life Insurance, ” While benefits of each health insurance policy may vary, there are some products available in the market that provide cover for medical, surgical, pre-hospitalization, and post-hospitalization costs, fully paid up to the sum insured for a recipient. For a donor, expenses related to harvesting, surgery, and organ storage are covered, but the extent can vary from insurer to insurer”

“Only a few insurers cover the complete cost of organ transplantation surgery. Understanding exclusions and sub-limits in insurance policies is crucial. For instance, it is likely that the surgery cost for harvesting organ is covered, but expenses related to the donor’s hospitalization are not covered”, he continues.

In all, it is a good idea to get a critical illness rider added to your base policy, lest you end up bearing the unanticipated, yet significant cost of organ transplantation from your own pocket.