Cover medical expenses of donors, too

With costs of medication for organ donors increasing, it makes sense to get them covered

Kishore Gupta (name changed), a Pune-based resident, got his kidney replaced in a private hospital six months ago. It was his mother who donated one. While the entire operation's expense was Rs 8 lakh, he had to spend Rs 2.8 lakh towards his mother's hospitalisation.

This is a financial burden on the donee (person who receives the organ) because he has to incur the donor's expenses in addition to his own. It would be helpful if the donee has an insurance policy and his insurer is ready to cover the organ transplant treatment. However, the donor's medical cost will still have to be borne by the donee. A donor's medical expenses can be up to 20 to 40 per cent of the treatment, depending on complexity and type of hospital.

Organ transplants are gaining popularity and it makes sense to buy a policy that will cover the medical expenses of both donor and donee.

The number of transplants in India was around 15,000 last year. According to media reports, about 200,000 people need a new kidney and about 100,000 need a new liver every year. However, a very small per cent of the demand is met. The number of donors are few and the high cost of treatment is a barrier.

Currently, general insurers such as Religare, Reliance, ICICI Lombard and Apollo Munich offer cover for donors' hospitalisation costs while undergoing the treatment. These policies are for donees through which the donor's expenses get covered. Hence, it's important that the donee has such a policy.

These insurers offer this cover as an in-built facility within one of their health insurance plans. Which means one doesn't have to pay separately to get this. Only ICICI Lombard sells this as an add-on cover, where one will have to spend three per cent extra on the base premium plan.

Shreeraj Deshpande, head (health insurance) at Future Generali India, says: "We are looking at covering the medical expenses of donors in our new product, which is still under development. However, in our group health policies, we can offer if specifically requested."

It needs to be noted that insurers will cover organ transplants only if this is not related to any pre-existing diseases.

This facility will cover a donor's hospitalisation cost the minute he is admitted in hospital till discharge. Some insurers pay claims with sub-limits, whereas some will pay depending on the overall limit of the sum assured.

If you buy a health insurance plan from Religare Health, which offers Rs 2-4 lakh as sum assured, the insurer will pay you for donor's expenses only up to Rs 50,000. If the sum assured is between Rs 5 lakh and Rs 10 lakh, the limit to cover those expenses will be increased to Rs 1 lakh. ICICI Lombard, too, has a sub-limit to pay towards these expenses, capped at Rs 50,000.

Rakesh Jain, chief executive of Reliance General Insurance, says: "This benefit covers expenses towards the donor in the case of major organ transplant, subject to the overall limit of the sum insured and the plan opted as specified in the schedule of this policy."

What happens if the donor falls ill after the treatment? Most policies will not cover them later, as the cover is only up to the surgery. Antony Jacob, CEO of Apollo Munich Health Insurance, says: "For the donor, donating an organ will not be a hurdle for any claims. However, he or she should already be covered."

What about the donee, who receives the organ? According to experts, the donee is at a greater health risk than the donor.

Most health insurance policies do cover post-hospitalisation cover, if the donee suffers health problems. Religare covers post-hospitalisation for donees for about 60 days, whereas Apollo Munich covers it up to 180 days after discharge from the hospital. "Also, in case of the donee, we would cover the complications arising from the transplant as well," says Gulati of Religare Health.

Apollo Munich offers cover for any further hospitalisations in the case of complications from the organ transplant, says Jacob.

However, a chance of the donee's renewal premium going up are higher, as he is exposed to greater health risk.