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Critical Illness Insurance for Organ Transplant

Team AckoNov 29, 2023

A critical illness can leave you physically, mentally and financially exhausted due to the complexity and high cost of medical treatment. Such conditions can also lead to organ failure. A good health insurance plan with comprehensive coverage can come to your rescue to cover such medical expenses.

Read on to know all the information about Critical Illness Insurance for an organ transplant. Before opting for a Critical Illness cover for your health insurance plan, you need to know what does critical illness mean? In simple words, life-threatening or serious illnesses and diseases such as kidney failure, heart attack, stroke, cancer, organ transplant, Alzheimer's disease, paralysis, etc. are classified as critical or serious illnesses.

organ donation expenses



Organ Transplant:

A critical illness, may lead to organ failure, or such conditions may arise due to the failure of a vital organ. If any of the major organs do not function properly, it affects the entire body, and it may have a drastic impact on your lifestyle. In such scenarios, an organ transplant is necessary. With the technological advancements in medical science, major organ transplant can be done successfully. Major organs such as kidney, lung, heart, liver, pancreas, cornea, bone marrow, etc., can be transplanted. The process of organ transplant involves harvesting a healthy organ from the donor's body (living or dead) and transplanting it inside the recipient's body. The procedure is complicated, and it is a very expensive medical procedure. The recipient may also require medical attention after the transplant is completed successfully. So, the overall cost of treatment runs very high.

Critical Illness Insurance Plan for an Organ Transplant:

Critical illness cover in a medical insurance covers unexpected medical emergencies caused due to life-threatening illnesses. Especially for complicated procedures such as organ transplant, the medical expenses are too high. You may end up draining your savings during such conditions if you do not have a health insurance plan that offers comprehensive coverage.

Critical Illness Insurance provides coverage against life-threatening illnesses and diseases, which includes major organ transplant. The insurance cover can be a life-saver as it provides a financial backup if you are diagnosed with a major organ failure or any other critical illnesses. You can opt for such cover when you purchase a health insurance plan, and with an online policy, the purchase process is simple and hassle-free.

How Critical Illness Insurance Works?

The Critical Illness cover is a one-time benefit plan, and it works differently from a conventional health insurance policy. If you are diagnosed with any life-threatening illnesses which are covered by the policy, you can avail of the policy benefits. You need not be hospitalized to file a claim.

The insurer will pay you the one-time lump sum amount equal to the sum insured in a single transaction provided the insured survives for at least 30 days (survival period may vary from one insurer to another) after the diagnosis. You can utilise the amount for medical treatment or any other financial requirement.

In the case of an organ transplant, if the doctor recommends that a particular organ needs a transplant, you can file a claim against the Critical Illness cover with the required documents. You will receive a lump sum amount, and you can use it to carry out the medical procedure.

Inclusions and Exclusions of Critical Illness Insurance for Organ Transplant:

Critical Illness Health Insurance cover provides coverage against up to 36 major life-threatening diseases and illnesses. The coverage may vary from insurer to insurer. Some of the commonly covered illnesses are kidney failure, heart attack, paralysis, organ transplant, cancer, stroke, etc.

Below are the exclusions of the Critical Illness insurance cover:

  • Life-threatening diseases developed due to lifestyle habits (smoking, consumption of drugs, alcohol, etc.)

  • Cosmetic and dental treatment.

  • Pregnancy-related illnesses.

  • Illnesses developed or caused due to terrorism, war or civil war.

Tax Benefit:

The Critical Illness cover also provides tax benefits under the Income Tax Act, 1961. The insured can avail of tax exemption of up to Rs. 15,000 under Section 80D, and senior citizens can get a tax exemption of up to Rs. 20,000. Note that the benefits are as per the current tax regime and may change in the future.

Key Factors to Consider While Purchasing Critical Illness Insurance for an Organ Transplant:

Listed below are some of the key factors you should consider if you are opting for Critical Illness Insurance for organ transplant surgery:

  • Coverage: Make sure that the Critical Illness Policy covers organ transplant. The coverage may vary from insurer to insurer, so it’s better to go through the policy wordings before purchasing the cover. As per IRDAI (Insurance Regulatory and Development Authority of India), an insurer must provide coverage against at least 12 life-threatening illnesses. So, in most cases, the organ transplant is covered.

  • Waiting Period: The waiting period can vary from one insurer to another. Typically, it ranges from 60 to 120 days from the date of commencement of the policy. So, choose a plan which has a minimal timeframe for covering life-threatening diseases.

  • Post-Hospitalization Cover: Usually, the Critical Illness Policy covers the medical expenses incurred due to organ transplant surgery. The policy does not provide coverage if the donor suffers from a side effect or falls ill due to an organ transplant. But some insurance companies offer extended coverage, including the post-hospitalization cover of up to 180 days. So, always look out for the additional expenses covered by the policy.

  • Sub-Limits: Usually, the organ transplant cover is subject to sub-limits. It varies from insurer to insurer. So, make sure that you go through the policy brochure or policy wordings to know the exact coverage benefits for an organ transplant. Purchase a plan which offers maximum coverage for such complicated medical procedures.

Frequently Asked Questions:

Below are some of the most commonly asked questions and their answers related to Critical Illness Insurance for organ transplant:

1. What is Critical Illness cover in health insurance?


A Critical Illness cover provides coverage against critical or life-threatening diseases or conditions such as kidney failure, cancer, stroke, heart attack, paralysis, major organ transplant, etc. The policy provides a one-time benefit if you are diagnosed with a life-threatening disease.

2. What does it mean by organ transplantation?


Organ transplant is a medical procedure in which a healthy organ is removed from the donor’s body and placed in the recipient’s body to replace a damaged/missing organ. The procedure of organ transplant is very complicated, and the cost of such procedures can run very high.

3. What does Waiting Period mean in Critical Illness Insurance?


The Waiting Period is the period wherein you cannot claim against the policy. In other words, you must wait for specific days before you can avail of policy benefits. The duration of the waiting period varies from one insurer to another.

4. Do I need to be hospitalized to avail benefits of Critical Illness Insurance cover?


No, you need not be hospitalized to claim against the insurance cover. If you are diagnosed with a life-threatening disease or illness, you can file a claim against the policy with all the required documents.

5. Does Critical Illness Insurance cover post-hospitalization cover?


Generally, a Critical Illness cover provides a one-time lump sum benefit during the policy period. But some insurers do offer extended coverage, which also includes coverage against post-hospitalization expenses.

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Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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