Best Health Insurance Plan for Kidney Transplant Patients

Kidney transplantation is a major surgical procedure performed to remove and replace a diseased kidney with a healthy kidney from a donor. Therefore, the procedure involves the recipient (suffering from kidney failure) and the donor (who donates the kidney). 

Kidney transplantation is performed when the kidney fails, i.e., it stops working, and no medications or surgery can revive its functions. The replaced kidney starts making urine as soon as blood flows through it. It works for two failed kidneys, avoiding the need for dialysis.

Yes, health insurance covers patients for kidney transplants. Health insurance for chronic kidney disease can help you secure yourself from financial burden during kidney failure treatment. If your health insurance plan does not include kidney failure, you can invest in critical illness health insurance.

Critical illness policies cover not only kidney failures but also other life-threatening diseases. Once you get diagnosed with kidney disease, the insurer will provide a lump sum amount that you can use for your medical expenses.

Treatment of kidney failure in India requires huge medical expenses without health insurance. More than 2.5 lakh people in the country suffer from last-stage kidney disease every year.

7 out of 10 patients opt for dialysis due to the unavailability of a donor’s kidney, and nearly 6 of these 10 cannot continue treatment due to its huge costs. 

1. Kidney dialysis treatment costs between ₹ 12,000 and ₹ 20,000 per month. Generally, you need to undergo 12 dialysis sessions in a month. 
2. The cost of kidney transplants in private hospitals in India ranges between ₹ 4 lakhs to ₹ 10 lakhs. After treatment, the monthly cost is about ₹ 15,000, with medicines costing around ₹ 10,000 per month.

The cost of dialysis and kidney transplant varies depending on the city.

Several critical health insurance plans cover the costs of kidney transplantation. However, since the procedure involves two parties, i.e., the donor and recipient, it is important to understand the inclusions and exclusions beforehand.

Usually, organ transplant policies cover all recipient costs (diagnostic tests, procedures, surgeries, etc.), subject to certain conditions. However, only a few insurance companies cover the expenses for donors as well (harvesting, storing, screening, etc.). 

The various health insurance for kidney transplant patients in India include:

1. Aditya Birla’s Activ Secure - Critical Illness: The critical illness plan from Aditya Birla Health Insurance comes in three variants: Plan 1, 2 and 3. Plan 1 covers 20 critical illnesses, plan 2 covers 50, and plan 3 covers 64.
   The coverage for kidney failure requiring regular dialysis and kidney transplantation is covered under all three plans. The sum insured options under the plan range from ₹ 1 lakh to ₹ 1 crore.
   You can avail 100% of the sum insured and get a lump sum payment when diagnosed with kidney failure.
2. Star Critical Illness Multi-Pay Insurance Policy: Star insurance offers one of the best health insurance for kidney transplant patients. This standalone policy offers a lump sum amount on the diagnosis of four groups of critical illnesses covered under the policy.
   While the policy covers the treatment expenses of kidney transplants, the first diagnosis of the disease should be experienced by the policyholder only after 90 days of policy commencement.
   Also, the person should have survived for 15 days from the diagnosis of kidney disease. Any adult aged between 18 and 65 can buy this policy. Furthermore, there is no need for medical screening up to 50 years of age. 
3. HDFC ERGO Critical Illness Plan: HDFC ERGO health insurance’s critical illness plan is available under two variants, Silver and Platinum, to remove policyholders’ financial stress during a kidney transplant.
   The cover ranges from ₹ 5 lakhs to ₹ 20 lakhs. Any person aged 5 to 65 can be covered under the plan. Children between 5 to 18 years are covered only when both parents are also covered.
   Under the plan, the policyholder receives a lump sum amount in one transaction on the first diagnosis after a survival period of 30 days. 
4. Care Critical Illness Plan: Care Health Insurance’s Critical Illness Plan is a beneficial policy for protecting yourself from a major organ transplant. This health insurance for kidney transplant patients provides a sum insured up to ₹ 2 crores.
   Any person within the age group of 5 to 50 years can avail of this policy. The initial waiting period for filing a claim is 90 days from the commencement of the policy. 
5. Bajaj Allianz Critical Illness Plan: The Critical Illness Plan from Bajaj Allianz is good health insurance for chronic kidney diseases such as kidney failure. The policyholder will receive a lump sum on diagnosis of the illnesses listed in the policy terms.
   The kidney transplant expenses covered under the plan include organ screening, coverage for pre-hospitalisation costs, transplantation costs, and post-surgery expenses, such as medication and follow-up charges for both the donor and the recipient.
   The eligibility criteria under the plan are 91 days to 80 years. The sum insured ranges between ₹ 1 lakh to ₹ 50 lakhs for the age group of 6 to 60 years. The sum insured ranges between ₹ 1 lakh to ₹ 5 lakhs for the age group of 61 to 65 years.
6. TATA AIG Critical Illness Insurance: The Critical Illness Plan from TATA AIG covers kidney transplantation costs in case of irreversible end-stage kidney failure.
   Some benefits of this health insurance with organ transplant coverage include inpatient treatment, second opinion, cashless hospitalisation at 7200+ hospitals, etc.
   The sum insured ranges between ₹ 1 lakh to ₹ 15 lakh. The entry age to the policy is 18 years, and the maximum is 35 years. The insured must survive for 30 days after being diagnosed with the illness to avail of the benefit of the sum insured.

The Ayushman Bharat scheme, the largest healthcare insurance scheme in the world, has revolutionised Indian healthcare. The scheme provides quality healthcare to the financially weaker sections of society.

The benefits under the scheme offer huge relief to end-stage kidney disease patients, given the dialysis costs can go as high as ₹ 12,000 to ₹ 20,000 every month. Furthermore, the cost of a life-saving kidney transplant can be as high as ₹ 4 lakhs to ₹ 10 lakhs. 

Earlier, the Ayushman Bharat scheme did not cover the cost of kidney transplants. On 6th April 2022, the government added three hundred sixty-five new procedures to the revised health benefits package 2.2.

As per the new package, the dialysis treatment relief has increased from ₹ 1500 to ₹ 1800. Furthermore, beneficiaries can now get coverage for kidney transplant expenses under the scheme. SKIMS in Jammu and Kashmir was the first hospital to perform a kidney transplant under the Ayushman Bharat scheme.

Since a kidney transplant is a complicated, critical surgery, it is important to understand the exclusions and inclusions under the policy. While considering health insurance for kidney transplant patients, make sure that it includes the following:

1. Donor expenses (organ harvesting and surgery cost)
2. Pre and post-hospitalisation expenses
3. Cost of monitoring, investigations, post-surgery care, etc. 
4. Cost of consumables
5. Annual medical check-ups that help identify potential health complications

Some other tips that can help you select the best kidney transplant cover include:

1. Choose the sum insured while considering the expected treatment cost. 
2. Check the nearest network hospital list to receive immediate and quality healthcare. 
3. Select the plan that provides hassle-free claim settlement through a cashless or reimbursement facility.
4. Make sure the insurance provider offers 24/7 customer support.

The claim process for kidney transplant health insurance varies from one insurer to another. Policyholders are allowed only a single claim throughout the tenure of the critical illness insurance policy. The general steps followed to make a claim under the policy include the following:

1. Inform the insurance provider about the diagnosis as soon as possible. 
2. A representative from the insurance company will provide you with a list of documents to be submitted. 
3. Submit the required documents within 90 days of the first diagnosis. 
4. After verification of your documents, the insurance company will release a lump sum amount that you can use at your convenience.

Undergoing a kidney transplant can allow kidney failure patients to live longer, but the costs can be concerning. This is where health insurance for kidney transplant patients can come in handy. Good coverage can help patients cover major procedure costs, such as donor expenses, pre and post-hospitalisation, transplant expenses, post-surgery care, etc. 

Since several companies that offer health insurance for chronic kidney diseases are available in the market, it is difficult to choose the best plan. If you are considering a kidney transplant and want to buy insurance coverage, talk to an expert at HexaHealth TODAY! Our team will help you select the best insurance plan per your needs and requirements and connect you with the best surgeons at the right hospital to help you get quality treatment.

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