Organ donation is one of the kindest and most selfless acts: giving someone a second chance at life. 😇
But while the gift of life is priceless, the medical expenses associated with organ transplants can be overwhelming. From donor screening to surgery and post-transplant care, the costs can add up quickly.
This raises an important question: Are organ donor expenses covered under health insurance?
Well, yes! Understanding how insurance policies handle these costs can help both donors and recipients navigate this life-changing journey without financial stress. We will break down for you what’s covered and what’s not!
Organ donor expenses covered in health insurance mean that if you need an organ transplant (like a kidney or liver), your insurance will help pay for the medical expenses of the donor (the person donating the organ) and the receiver (the person receiving the organ).
This can include costs like hospitalisation and surgery for the donor, medical tests and checkups before the transplant, or any other necessary medical expenses related to the donation.
It is also known as Critical Illness Insurance or Organ Transplant Coverage.
Organ donation and transplant involve two parties: the donor and the receiver!
But what comes under the scope of one’s policy?
A health insurance policy is valid for all diagnosed conditions, procedures, surgeries, and treatments that require hospitalisation, of course, subject to terms and conditions. So, in case the receiver needs an organ, health insurance policies are fairly clear that they would cover the cost of surgery as well as tests and procedures involved with getting the organ transplanted up to the sum insured.
However, the person getting the organ will have to bear the donor expenses (harvesting, storage, screening, etc.). Thus, some insurance companies also cover the donor expenses.
Coverages
Double Wallet Plan
Infinity Wallet Plan
Worldwide Treatment Plan
Important Features
This covers for all hospitalisation expenses including due to an Illness, Accident, Critical Illness or even pandemics like Covid 19. It can be used to cover for multiple hospitalisations, as long as the total expenses are up to your sum insured.
You need to wait for a defined period from the first day of your policy to get covered for treatment related to any non-accidental illness. This is the Initial Waiting period.
Exclusive Wellness Benefits like Home Healthcare, Tele consultations, Yoga and Mindfullness and many more available on our App.
We provide a back-up Sum Insured which is 100% of your Sum Insured amount. How does Sum Insured Back Up work? Suppose your policy Sum Insured is Rs. 5 lac. You make a claim of Rs.50,000. Digit automatically triggers the wallet benefit. So you now have 4.5lac + 5 lac Sum Insured available for the year. However, one single claim, cannot be more than the base Sum Insured as in the above case, 5 lac. .
No claims in the Policy year? You get a bonus -an additional amount in your total sum-insured for staying healthy & claim free!
Different categories of rooms have different rents. Just like how hotel rooms have tarrifs. Digit plans give you the benefit of having no room rent cap, as long as it is below your Sum Insured..
Health insurance covers medical expenses only for hospitalisations exceeding 24 hours. Day care procedures refer to medical treatments undertaken in a hospital, requiring less than 24 hours due to technological advancement such as cataract, dialysis etc.
Get a world class treatment with the Worldwide Coverage! If your doctor identifies an illness during your health examination in India and you wish to get a treatment abroad, then we’re there for you.You’re covered!
We pay for your health check-up expenses upto the amount mentioned in your Plan. No restrictions on the kind of tests! Be it ECG or Thyroid Profile. Make sure you go through your policy schedule to check the claim limit.
There may be emergency life-threatening health conditions which may require immediate transportation to hospital. We absolutely understand this and reimburse for expenses incurred for your transportation to a hospital in airplane or helicopter.
Co-Payment means a cost sharing requirement under a Health Insurance Policy that provides that the Policyholder/Insured will bear a specified percentage of the admissible claims amount. It does not reduce the Sum Insured. This percentage depends on various factors like age, or sometimes also on your treatment city called zone based copayment. In our plans, there is no age based or zone based Co payment involved.
Get reimbursed for the expenses of road ambulance, in case you are hospitalised.
This cover is for all expenses before and after hospitalisation such as for diagnosis, tests and recovery.
Other Features
The disease or condition that you are already suffering with and have disclosed to us before taking the policy and has been accepted by us has a waiting period as per plan opted and mentioned in your Policy Schedule.
This is the amount of time you need to wait for, until you can make a claim for a specific illness. At Digit it is 1-3 years and starts from the day of policy activation. For the full list of exclusions, read Standard Exclusions (Excl02) of your policy wordings.
If You sustain an Accidental Bodily Injury during the Policy Period, which is the sole and direct cause of Your Death within twelve (12) months from the date of accident, then We will pay 100% of the Sum Insured as mentioned in Policy Schedule against this cover and as per plan opted.
Your organ donor gets covered in your policy. We also take care the pre and post hospitalisation expenses of the donor. Organ donating is one of the kindest deeds ever and we thought to ourselves, why not be a part of it!
Hospitals can go out of beds, or the patient’s condition may be rough to get admitted in a hospital. Don’t panic! We cover you for the medical expenses even if you get treatment at home.
Obesity may be the root cause of so many health issues. We absolutely understand this, and cover for Bariatric Surgery when it is medically necessary and advised by your doctor. However, we DONOT cover if hospitalisation for this treatment is for cosmetic reasons.
If due to a trauma, a member has to be hospitalised for a psychiatric treatment, it will be covered under this benefit, upto INR 1,00,000. However, OPD consultations are not covered under this. The waiting period for Psychiatric Illness Cover is same as Specific Illness waiting period.
Before, during & after hospitalisation, there are many other medical aids & expenditures such as walking aids, crepe bandages, belts, etc.,which need your pocket’s attention.This cover takes care of these expenses that are otherwise excluded from the policy.
Nowadays, many health insurance providers in India are stepping up and offering insurance products with an in-built organ donation benefit or ones that have it as an add-on for an extra premium. These health insurance plans cover only a limited number of expenses that you must check before opting for the particular policy.
Here are 6 expenses that are involved in organ transplantation and covered by most of the health insurance policies.
Of the above costs, most insurance policies in India do not cover the donor's pre and post-hospitalisation expenses and costs due to post-surgery complications. Therefore, you must read the policy document to know what is covered under organ transplant health insurance.
Yes, many health insurance plans offer coverage for organ donor expenses, but it depends on your specific policy.
Suppose you have a health insurance policy and you are an organ donor, in such cases, it is possible that your health insurance may not cover the cost involved in donation.
However, suppose you have a health insurance plan covering organ transplantation, and you are an organ recipient. In that case, your health insurance will pay for the donor's organ transplant operation as well, up to the policy's maximum amount.
As a result, the organ donor won't have to pay anything out of pocket. Also, please be aware that organ donor insurance might not cover some costs. Thus, before choosing a health insurance plan, review the list of benefits for organ donors.
This coverage typically includes the medical costs associated with the organ donor’s hospitalization, surgery, and necessary tests related to the transplant. However, it does not cover the cost of procuring the organ or any non-medical expenses. It’s always best to check your policy details or consult your insurer to understand the exact coverage and any limits or exclusions.
Would you like me to make it more detailed or simpler?
You might have noticed that health insurance plans with donation coverage are mostly for the organ recipient, which covers a few expenses of the organ donors as well. But why is health insurance not solely for organ donors?
Well, the entire process of organ donation can take weeks and be quite expensive, involving a number of tests and treatments both before and after the surgery. Therefore, health insurance coverage does not cover organ donors.
Some reasons why insuring organ donors increases strain on the insurance provider include:
But the good news is, with Digit’s Organ Donation Cover, we will cover the organ donor along with the receiver in your policy. We will also take care of the pre and post-hospitalisation expenses of the donor based on a few T&Cs. 😁
The claim process for organ donation costs is the same as any other health insurance claim but with some exceptions. To file a claim under organ donor expenses coverage under health insurance, you must submit the organ donor's hospitalisation summary.
Here are two methods for submitting a claim to your health insurance:
To be eligible for a cashless claim, the insured and his donor must be admitted to a network hospital for the transplant. At the time of admission, the patient can notify the insurance provider and perform the required steps to submit a claim.
Here are the steps for Cashless Claim:
Step 1: Choose any 9000+ network hospitals at Digit for a cashless claim.
Step 2: Notify us within 24 hours of being admitted to the hospital in case of an emergency or at least two to three days before any scheduled hospitalisation.
Step 3: Present the e-health card to the hospital's help desk or insurance support desk and get the pre-approval paperwork.
Step 4: Complete the form, sign it, and turn it in at the support desk.
Step 5: If everything is verified, you can proceed with the treatment using the cashless facility.
You can claim through the reimbursement process if you are not admitted to a network hospital. However, the insured must disclose the treatment to the insurance provider. In this case, the insured will pay the full hospital charge and then submit a reimbursement claim to receive the authorised amount.
Here are the steps for a Reimbursement Claim:
Step 1: Download the Digit Insurance App or use the website's "File a Health Insurance Claim" option.
Step 2: Log in and click on the "Health Claim Filing" option on the home page.
Step 3: On the next page, select the type of claim you want to file from your active policies.
Step 4: Fill out the policy details such as name, relationship with the policyholder, mobile number, etc.
Step 5: Enter a few details about the illness, such as the starting date of the symptoms, the first consultation date, the consultation hospital, etc.
Step 6: Upload all the documents, such as the bill, discharge summary, test reports, valid ID proof, etc.
When it comes to organ transplant insurance, knowing the fine print is just as important as the procedure itself. Policies often have specific conditions, such as coverage limits, donor-related expenses, and waiting periods, before claims can be made.
Here are some conditions that you should keep in mind before getting health insurance with organ transplant coverage.