Best Health Insurance Policy for Liver Transplant in India

The expenses of a liver transplant do not only involve the procedure cost. There are several other expenses that a patient has to incur during a liver transplant procedure. While some of these expenses are covered under health insurance policies, others are not. However, the types of costs covered vary from one insurance company to another. The fees of a liver transplant include:

1. Liver Screening: Before hospitalization and undergoing a liver transplant, the recipient (patient with liver disease) and the donor must undergo a full body check and liver screening. This help in matching the blood groups and other vital measures of the patient and the donor. This process is carried out to find a suitable donor for the recipient. 
2. Pre-Hospitalization Expenses: Following the identification of the liver donor, medications are used to stabilize the recipient’s condition. On the other hand, if the donor is a living donor, they will also be provided with medications before the surgery.
3. Hospitalization Expenses include doctor fees, nursing charges, and room rent (private or general ward). 
4. Liver Transplant Surgery Expenses: The actual surgery cost for retrieving and transplanting the liver comes under this expense. Moreover, it also includes the surgeon fees. 
5. Post-Surgery Complications and Recovery Expenses include the cost of medicines, recovery, and hospital stay for the recipient and donor after the surgery is complete. Moreover, it also provides for the cost of post-surgery complications that are common after a liver transplant. 
6. Post-Hospitalization Expenses: These expenses include medication and follow-up appointments for the donor and recipient after the surgery. 

Government-owned health insurance schemes for liver transplantation include:

1. The Central Government Health Scheme (CGHS)
2. The Ex-Servicemen Contributory Health Scheme (ECHS). 

Reimbursement Criteria for CGHS and ECHS

The reimbursement for liver transplants under these schemes is permitted for cadaveric and live donors (related and unrelated). Liver transplant surgery is allowed only in CGHS and ECHS empanelled Government or private hospitals, like Medanta, Narayana, Sir Gangaram, Apollo, Artemis, ILBS, etc. 

1. For a living donor, the package rate for the surgery under CGHS and ECHS is Rs 14 lakhs (Rs 2.5 lakhs for pre-surgery evaluation of the donor and recipient and Rs 11.5 lakhs for the transplant surgery). 
2. For a deceased donor, the package rate for the surgery under CGHS and ECHS is Rs 11 lakhs. 

The package includes the costs for the following:

1. Thirty days and 15 days of hospitalisation cost for the recipient and donor, respectively, starting one day before the surgery.
2. Medical and surgical consumables charges, operation theatre charges, pharmacy charges, anaesthesia charges, procedure charges, etc.
3. In-house doctor consultation and investigations for donor and recipient during the stay.
4. All post-operative procedures and investigations during the hospital stay.

The package excludes the cost of the following:

1. Drugs like HBIG, peginterferon, and Basiliximab/Daclizumab.
2. Cross-matching for blood and blood products.

Several private health insurance companies offer coverage for liver transplants. Different policies cover different types of expenses. All personal health insurance policies provide a range for the liver transplant recipient according to the sum insured. Some of the best insurance policies for liver transplant patients in India include:

1. Star Health Insurance: In addition to the hospitalisation cost, the insurance policy covers the cost of the surgery. Several star health insurance plans provide coverage for a sum insured, ranging from Rs 5 lakhs to Rs 1 crore. Some projects under Star Health for liver transplantation include:
   1. Star Criticare Plus Insurance Policy
   2. Star Medi Classic Insurance Policy (Individual)
   3. Star Comprehensive Insurance Policy. Depending on the plan, the waiting period for the transplantation is 90 days to 24 months. 
2. Niva Bupa Health Insurance: Formerly known as Max Bupa, Niva Bupa is another health insurance company that covers liver transplants. Niva Bupa’s Critical Illness Insurance Plan provides a lump sum amount which can be used for expenses like doctor visits, diagnosis, medical expenses, and hospitalisation. The plan includes coverage for a sum insured of Rs 3 lakhs to Rs 2 crore. 
3. Care Health Insurance: Care’s Critical Illness Insurance plan covers liver transplantation expenses. Apart from hospitalisation expenses, it also covers pre and post-hospitalisation expenses and organ donor cover. Moreover, it has a network of 19000+ cashless healthcare providers. The initial waiting period for the plan is 90 days. 
4. HDFC ERGO Health Insurance: HDFC ERGO’s Critical Illness Plan offers a lump sum amount that can be used for the treatment, care, and recovery of liver transplantation surgery. You can choose from a sum insured, ranging from Rs 5 lakhs, Rs 7.5 lakhs, and Rs 10 lakhs. The waiting period for the claim is 90 days from the policy inception. 
5. Bharti AXA Health Insurance: Under the Bharti AXA Life Triple Health Insurance Plan, you can get 100% of the sum assured for a liver transplant anytime during the policy term of 15 years. The plan provides coverage for a sum insured of Rs 2 lakhs to Rs 30 lakhs. The waiting period for the claim is 90 days from the policy inception. 
6. TATA AIG Health Insurance: TATA AIG’s Critical Illness Insurance covers the liver transplantation cost in the case of irreversible end-stage liver failure. The plan also covers the liver donor’s medical and surgical expenses if the recipient is insured under the policy. Furthermore, the plan provides in-hospitalisation expense cover for the insured. However, the insured must pay the fees directly related to the hospital. Lastly, the insurance plan also covers the cost of a second opinion in case of liver failure requiring a transplant. 
7. Aditya Birla Health Insurance: Aditya Birla’s Activ Health Plan covers the cost of undergoing a liver transplant resulting from irreversible end-stage liver failure. A specialist medical practitioner must confirm the need for a transplant. However, any transplant resulting from alcoholic liver disease will not be covered. Furthermore, the plan includes medical expenses up to a specified limit for harvesting the donated liver. 
8. Manipal Cigna Health Insurance: Manipal Cigna’s ProHealth Select plan offers a lump sum payment for a liver transplant. The primary basic coverage under the plan includes in-hospitalisation, pre-hospitalisation, post-hospitalisation, ambulance cover, and donor expenses. The donor expenses cover only the in-hospitalisation cost of harvesting the liver. The sum insured under the plan ranges from Rs 2 lakhs to Rs 25 lakhs. 

When buying health insurance for a liver transplant, consider the following tips:

1. Check for donor’s expenses (liver harvesting and surgery).
2. Read the policy documents to know what is included and excluded under the insurance coverage. 
3. Check empanelled hospitals near your location to easily access quality health care. 
4. Choose the sum insured, keeping in mind the treatment cost of liver transplantation. 
5. Choose the one that offers a hassle-free claim settlement procedure. 
6. Check for consumable expenses like pre and post-hospitalisation costs. 
7. Look for costs of post-surgery treatment, continuous monitoring, investigations, etc.

With the rise in demand for liver transplants, several private and government health insurance policies have surfaced to protect patients from high costs. If you are undergoing liver transplant surgery, you must ask hospitals for a detailed break-up of the expenses for both the donor and recipient. This will help you analyse whether buying a health insurance plan is worth it. Moreover, it will help you plan your liver transplant financially. 

If you have any more doubts or queries about choosing the best health insurance for liver transplants in India, you can contact HexaHealth. Our team of over 1,000 specialists can help you choose the right insurance for a liver transplant. Seek advice for your next move from a HexaHealth expert TODAY!