Check Congenital Diseases Coverages Under Health Insurance

We often hear that eating healthy and exercising regularly promote a healthy lifestyle. However, despite following healthy habits, some individuals may not be able to overcome disease and bodily weaknesses. The reason behind this is “congenital diseases."  Some individuals are born with this genetic disorder and require proper treatment. The cost of treatment for congenital diseases may hamper your finances. Therefore, a health insurance policy is a tool that can help you financially in the event of a congenital treatment or any other medical emergency. In this article, you’ll learn all about congenital disease and if it is covered under health insurance. 

Meaning of Congenital Disease

The diseases that develop in a baby during intrauterine life and are present in them from birth are known as congenital diseases. These diseases are also called congenital anomalies or genetic disorders. Usually, these diseases can be detected in pre-birth, at birth, or during the infant stage of the child. 

The common reason for these genetic disorders among children is genetic mutations, environmental factors, maternal age, maternal health and nutrition, infections, and others. According to a collective report issued by WHO and MOD in 2016, 6-7% population in India, that is 1.7 million people are suffering from congenital diseases. Usually, a baby suffering from a congenital disease may suffer from health problems and disabilities throughout his life. Internal congenital diseases cannot be detected; however, external congenital disorders can be easily identified and treated. 

Treatment of Congenital Diseases

As there are numerous types of congenital diseases, the treatment may vary depending on their type and diagnosis. Children with functional congenital diseases can be treated through medication at an early stage. However, children suffering from a structural genetic disorder may have to undergo pediatric surgery. As a result, long-term treatment and pediatric surgery can be a financial burden.

In addition to this, doctors may suggest certain blood tests and medical examination procedures, such as chronic villus sampling (CVS), ultrasound scans, amniocentesis, and others, to pregnant mothers. Therefore, these expensive medical procedures and examinations can burn a hole in your pocket. 

Does Health Insurance Cover Congenital Diseases in India? 

As per the World Health Organisation (WHO), the birth defects referred to as congenital abnormalities are present structurally or functionally and include metabolic deficiency disorders as well plague almost 61-69.9 per 1000 live births in India while March of Dimes (MOD) Global report focusing on birth defects recorded a figure of nearly 7.9 million births suffering from congenital disorders across the world. Therefore, the role of suitable health cover catering the scope of congenital diseases becomes paramount and it should be kept in mind that in India, health coverages for the same are limited to internal birth defects which get covered from the first day of birth as per the guidelines charted out by IRDAI. The mandate permits insurance providers to offer coverage for hospitalisation, doctor’s consultation, lab diagnostic tests, treatment expenses etc for the congenital conditions. However, the purview of the benefits is affected by factors such as the provider, type of health plan chosen, sum insured, premium, waiting period, Inclusions and exclusions clauses etc.

Top Health Insurance Companies And Plans Offering Health Cover For Congenital Diseases

Enlisted below are few of the health policies offered by top-notch health insurance companies in India for congenital diseases:

Inclusions And Exclusions Under Congenital Disease Health Cover

Following are some of inclusions that are included in a health plan for congenital illnesses in India:

• Internal Birth Disorders: Congenital conditions and diseases commonly prevalent in our country include heart anomalies, CNS disorders related to spinal or brain dysfunction, neuromuscular conditions like cerebral paralysis, hypothyroidism, deafness etc. 
• Coverage As Per IRDAI: As highlighted in the above para too, IRDAI (Insurance Regulatory And Development Authority In India) issued coverage guidelines in its 2019 mandate stating that insurers will cover expenses incurred on diagnostic tests/lab reports, pre, in and post hospitalisation care, doctor’s visitation charges, medications, surgical and day care procedures etc. The coverage extent in terms of claim can vary between Rs 50000 to 6 Cr and depends on the health plan chosen by the customer
• Miscellaneous: Other factors which influence the extent of your coverage for  congenital diseases include the premium amount, type of health plan opted for, health insurance provider, sum insured, inclusions and exclusions clauses stated in the policy documents etc         

Exclusions in health plans for congenital illnesses in India are as stated below:

• Waiting Period: As mentioned above, a cycle of 2 policy renewals i.e, a waiting time of 2 years is a requisite norm before filing a claim on internal congenital diseases if diagnosed after buying the health plan and 4 policy renewals in the event of the diagnosis occurring prior to the policy purchase as it will be categorised under pre existing diseases for which the waiting time is 4 years 
• External Congenital Disorders: Common examples of the externally visible congenital illnesses such as Down syndrome, cleft lip, club foot etc are all not offered medical coverage in most health policies in India

Waiting Period Under Health Insurance For Congenital Diseases

By and large, all Indian health insurance providers offer medical cover for internal birth abnormalities post a waiting period of 2 years after which only you can claim coverage benefits. It is interesting to note that this waiting period of 2 years is applicable specifically if the baby presents with his congenital condition after the insured parent purchased the health plan. In case, the child was already diagnosed with the internal congenital condition before the parent bought the plan, it will be counted as pre existing illness. This implies that the insured will have to wait for upto 4 policy renewals before raising and availing any claim since all health providers cover pre existing diseases after a waiting period of 2-4 years in India.

Ways To Prevent Congenital Diseases 

Listed below are some ways to prevent congenital diseases in children. 

• Consume healthy foods that are vitamin and mineral dense.
• Keep your body at a healthy weight.
• Avoid consuming alcohol, drugs, and cigarettes during pregnancy.
• Do not take medications that can cause birth abnormalities.
• Avoid coming into contact with dangerous substances like lead and insecticides.
• Get the necessary vaccinations, including those for rubella
• Travelers should stay away from areas where an infection, such as the Zika virus, is prevalent.
• Take care of your diabetes (if applicable)

Conclusion

In conclusion, congenital diseases happen to individuals at the time of birth and stay with them their entire lives. In addition to suffering from numerous health problems, you may burn through a lot of your savings. However, a health insurance policy can safeguard you against internal congenital diseases. As a mother, you can above-mentioned preventive measures to safeguard your children.

Also read: What Happens to Health Insurance After the Death of the Policyholder?

FAQs

Ques 1.  What are the most commonly seen congenital diseases?

Ans. Most common congenital disorders that exist are valve defects in heart, Down syndrome, cleft lip, cleft palate, spina bifida, club foot etc.

Ques 2. Are congenital diseases provided health insurance coverage in India?

Ans. Unfortunately for external congenital disorders, it’s difficult to get medical cover under the restrictive policies of IRDAI sanctioned in 2019 which permit coverage only for internal congenital illness and the scope of cover too varies from one provider and your chosen plan to another.