Best Health Insurance Plan for Kidney Transplant Patients

Has anyone ever advised you to buy health insurance for kidney stones? Wondered why you need health insurance for kidney stones or other chronic kidney diseases?

Did you know about two lakh patients in India are waiting for an organ against the availability of 15,000 donors? According to the Ministry of Health, the annual requirement of kidneys ranges between two to three lakh, with only 6,000 kidney transplants happening. Even when donors are available, the cost of kidney transplantation is huge.

Considering the alarming costs of kidney stones, several companies offer health insurance for kidney transplant patients. The following blog discusses health insurance plans for a kidney transplant. Furthermore, it discusses the inclusions and exclusions under the plans for both donor and recipient. Lastly, you will learn to choose the best kidney transplant cover according to your needs and requirements.

What is Kidney Transplantation?

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.

Does Insurance Cover Kidney Transplants?

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.

Cost of Kidney Transplantation Without Insurance

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.

Insurance Plans for Kidney Transplants

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.

Ayushman Bharat Insurance for Kidney Transplant

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.

Tips to Choose the Best Kidney Transplant Cover

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.

Claim Process

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.

Takeaway

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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Frequently Asked Questions

Can I buy health insurance for kidney stone treatment?

Yes, you can buy health insurance for kidney stones coverage. Kidney stones are usually covered under critical illness plans of health insurance companies. These plans can provide financial aid while undergoing kidney stone removal surgery.

Is there health insurance for kidney transplant patients?

Almost all health insurance plans cover kidney transplant expenses. Health insurance for kidney transplant patients usually includes expenses for the recipient. However, donor expenses are also covered under some insurance plans.

Health insurance plans for kidney transplants help people protect themselves against the huge expenses of the transplant procedure.

Which is the best kidney stones insurance policy?

Several insurance companies offer insurance policies for kidney stone expenses. Some of the best kidney stone insurance policies include:

  1. Aditya Birla Health Insurance
  2. TATA AIG Health Insurance
  3. Bajaj Allianz Health Insurance
  4. ICICI Lombard Health Insurance
  5. Star Health Insurance
  6. HDFC ERGO Health Insurance

Does health insurance cover kidney stone treatment?

Kidney stones are common in India, especially in men. Usually, kidney stones are not problematic. However, kidney stones may sometimes not get treated with medicines alone, and you may need surgical removal.

The cost of removing kidney stones in India can range from ₹ 30,000 to ₹ 90,000. A basic health insurance plan may not cover you against a specific illness. Buying critical illness health insurance can come in handy to protect you against the cost of stone removal surgery.

Which is the best health insurance for chronic kidney disease patients?

Several health insurances offer coverage to patients with chronic kidney diseases. Some of the best health insurance for chronic kidney diseases include:

  1. Aditya Birla Activ Secure - Critical Illness
  2. Star Critical Illness Multi-Pay Insurance Policy
  3. HDFC ERGO Critical Illness Plan
  4. Future Generalli Critical Illness Insurance Health Plan
  5. Care Critical Illness Plan
  6. Bajaj Allianz Critical Illness

Are kidney transplants covered by insurance?

Yes, kidney transplants are covered by health insurance or critical illness plans, usually after a waiting period of 90 days. These policies cover most of your dialysis or transplant expenses.

Health insurance for kidney transplant patients mostly covers the recipient’s costs. However, some policies also cover the cost of donors under the same plan but with some restrictions.

How much does a kidney transplant cost with insurance?

The cost of a kidney transplant in India ranges between ₹ 4 lakhs to ₹ 10 lakhs. Additionally, it may cost around ₹ 15,000 every month for post-treatment care.

Health insurance for a kidney transplant can help you remain financially secure during an emergency of kidney failure. If the policy does not cover chronic kidney disease, you can opt for an add-on critical illness health insurance.

The cost of a kidney transplant with insurance varies depending on the procedure cost and the insurance sum insured.

Are both donor and recipient charges for kidney transplants covered under insurance?

The coverage of donor and recipient charges for kidney transplants varies from one plan to another. While some critical illness plans cover both recipient and donor expenses, others cover only recipient costs. In such situations, the policyholder pays the donor’s expense out of their pockets.

Which is the best health insurance for kidney transplant patients?

Several insurance companies in India offer health insurance for kidney transplant patients. Some of the best kidney transplant insurance plans include:

  1. Star Health Insurance’s Critical Illness Multi-Pay Insurance Policy
  2. HDFC ERGO Health Insurance’s Critical Illness Plan
  3. Aditya Birla Health Insurance’s Activ Secure - Critical Illness Plan
  4. Bajaj Allianz Health Insurance’s Critical Illness Plan
  5. Care Health Insurance’s Critical Illness Plan

Does group insurance covers kidney transplant cost?

A group insurance policy covering all group members' healthcare expenses also covers kidney transplant costs under certain conditions. The donor costs are covered only if the recipient is insured under the group insurance plan.

The insurer can refuse to cover certain kidney transplant expenses, such as pre and post-hospitalisation, harvesting the donor’s kidney, costs associated with identifying the donor, etc.

What are the benefits of health insurance for kidney transplant patients?

Different health insurance plans offer different benefits for kidney transplant patients.

The most important benefit of health insurance for kidney transplant patients is the coverage of kidney transplant cost in case of irreversible, end-stage kidney failure. This helps the insured to protect themselves against the financial burden during an emergency.

What are the features of health insurance with kidney stone treatment coverage?

The key features and benefits of health insurance with kidney stone treatment coverage include:

  1. A wide range of sum insured for treatment costs coverage of kidney stones
  2. Full-fledged hospitalisation coverage
  3. Low-cost premiums, starting at just ₹ 499 per annum
  4. Pre and post-hospitalisation coverage

Can kidney failure patients get term life insurance?

Yes, patients with kidney diseases can get term life insurance. While term life insurance is more affordable than whole life insurance, approval of the former can be difficult, depending on the details of the kidney disease.

Can I get health insurance if I have kidney failure?

You can get health insurance if you have kidney failure. However, you must notify your healthcare provider about this pre-existing disease. Almost all companies provide health insurance for kidney failure after a specified waiting time.

Can transplant patients get life insurance?

Getting life insurance for transplant patients can be challenging. Most insurance companies do not issue life insurance policies to individuals with pre-existing kidney diseases. However, some providers will offer life insurance if you meet specific requirements. 

What questions should I ask while buying the best health insurance organ transplant coverage?

Questions that you must ask your provider while buying health insurance for organ transplant include:

  1. What type of health plan is this?
  2. What does the plan cover?
  3. What is not included in the plan?
  4. Does the plan cover routine tests?
  5. What is the cost of the plan?
  6. Will I be able to avail of treatment from my preferred doctor?
  7. What services could be billed to my insurance?
  8. What is the claim filing process?

What are the documents required to purchase kidney transplant health insurance?

The documents required to purchase kidney transplant health insurance include the following:

  1. Age proof
  2. Address proof
  3. Identity proof
  4. Passport size photograph
  5. Medical reports

Who is eligible for health insurance with kidney transplant coverage?

Adults between 18 and 65 are usually eligible for health insurance with kidney transplant coverage. However, the eligibility criteria for health insurance may differ from one policy to another. Patients may or may not require pre-medical screening up to 50 years of age.

What are the exclusions under health insurance with kidney transplant coverage?

The exclusions under health insurance with kidney transplant coverage include donor expenses. Therefore, the insured recipient will have to bear such expenses. Plans that cover donor expenses cover costs only for surgery and storage of the organ.

Other costs associated with donors are usually not covered. These exclusions include screening the donor, the donor’s pre and post-hospitalisation costs, and any post-surgical complications.

Under insurance after a kidney transplant, are postoperative medicines and follow-up charges covered?

The inclusions under health insurance plans for kidney transplants differ from one plan to another. While some plans cover follow-up and postoperative medicine costs, others do not. Therefore, discussing the inclusions and exclusions with your provider before buying a health insurance plan is important.

What is the claim process for health insurance with kidney transplant coverage?

To file a health insurance claim for kidney transplant coverage, you generally need to follow these steps:

  1. You must fill out a claim form provided by the insurance company.
  2. Submit the original and copy of the required documents. 
  3. The hospital will verify the documents. 
  4. If the documents are approved, the hospital will inform the insurance provider.
  5. The insurer will settle the approved bill amount directly with the network hospital.

Can you get life insurance after a transplant?

Getting life insurance after a kidney transplant is possible but not easy. Several factors determine whether a kidney transplant patient will get life insurance. While some patients may get the coverage, it may be declined for others.

One major factor considered while providing life insurance coverage is the condition that leads to kidney failure. For example, if the patient’s excessive drinking habits cause a kidney ailment, they may not get life insurance.

Are organ transplant expenses covered under Ayushman Bharat?

Patients from economically weaker sections of the country can now avail of kidney transplant facilities under the Ayushman Bharat scheme.

Is there government health insurance for kidney transplant patients?

There is government health insurance for kidney transplant patients like Ayushman Bharat. The scheme offers financial cover to economically weaker sections of society.

Other government schemes specific to states include the Tamil Nadu CM scheme, the Telangana Aarogyasri scheme, and Assam National Rural Health Mission.

About the Author

HexaHealth Care Team

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