What is a congenital anomaly?

One of the biggest prayers on any expectant mother’s lips is for their baby to be born in good health. This is because not every child comes out of their mother’s womb in the pink of health. Some are born with deformities that can cripple them for the rest of their lives. These deformities are known as congenital anomalies. Here’s what you need to know about this disorder and how health insurance can help you with it.

One of the biggest prayers on any expectant mother’s lips is for their baby to be born in good health. This is because not every child comes out of their mother’s womb in the pink of...

One of the biggest prayers on any expectant mother’s lips is for their...

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Does health insurance cover congenital anomalies?

Yes, health insurance does cover congenital anomalies. This is thanks to the 2019 guideline issued by the Insurance Regulatory & Development Authority of India (IRDAI). This coverage includes the diagnosis and treatment of the disease. Coverage should be provided for surgeries, hospitalisation, day-care procedures, and pre- and post-hospitalisation expenses. But this could vary from insurer to insurer, so as a policyholder, you must understand what the policy covers and excludes when it comes to congenital anomalies before committing to one.

Insurers also make a distinction between internal and external congenital anomalies when it comes to coverage. They provide coverage only for internal congenital anomalies, while there is no coverage provided for external ones

Is there a waiting period for coverage when it comes to congenital anomalies?

Yes, there is a waiting period for coverage. This is usually 2 years for most insurers and is applied if the disease is diagnosed after you have purchased the policy. During this period, the expenses incurred due to any treatment related to an internal congenital anomaly will have to be borne by the policyholder. After the waiting period, coverage will be provided by the insurance company.

If the congenital disease was diagnosed before the policy was purchased, it falls under the pre-existing conditions category. And this comes with its own waiting period, and it can be anywhere between 1 and 3 years. This period is entirely dependent on the insurance company. If you are looking for a health insurance plan, always do research and pick a plan that comes with a lower waiting period for congenital diseases and pre-existing diseases compared to others. This can reduce your out-of-pocket expenses considerably.

How to prevent congenital disorders

Here are some tips for expectant mothers and women who are looking to get pregnant that help prevent congenital diseases from taking root:

Certain medications can cause congenital diseases. Ensure that you are aware of the side effects of the medication you take during your pregnancy and discuss the same with your doctor
Ensure that you eat a balanced diet rich in good micro- and macronutrients, including essential vitamins and minerals like folic acid
Maintaining the right weight throughout your pregnancy is a great way to ensure that your child remains healthy during your pregnancy
Make sure you are up-to-date with all the required vaccines, including those for rubella
Avoid contact with hazardous substances such as heavy metals and pesticides during pregnancy
If you have diabetes or have been diagnosed with gestational diabetes during your pregnancy, it is very important to have this condition under control through weight management, diet and medication if required
Screen for diseases such as rubella, varicella and syphilis, and get treated for them if results are positive
Avoid travelling to regions which have a high risk of infections that could result in congenital diseases if you are pregnant or are planning to have a child soon

Congenital diseases are difficult to deal with as a parent. Being aware of what health insurance can do for you in this case can come in very handy. Reach out to your insurer and get a clear picture for a better outcome.

Frequently asked questions

Written by Roocha Kanade

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Reviewed by Dr. Harshita Dahiya

Health Insurance content enthusiast who turns complex topics into easy, binge-worthy reads—fueled by SEO, creativity, and way too much chai! Loves juggling multiple projects, cracking impossible deadlines, and sprinkling humor into the mix. When not geeking out over digital trends, you'll find her lurking on Quora and Reddit, planning the next getaway, or passionately decoding all things health and insurance!