Health insurance cover eludes many organ donors

Organ donors are life savers when they gift a part of themselves to others but they often find it difficult to get health insurance thereafter. Firms either refuse to provide them cover or do so with multiple riders.

Their existing insurance covers the cost of transplant and post-operative treatment, but a new enhanced insurance post-surgery is difficult, donors and recipients said.

Shivraj Arekar, 31, operations manager in a real estate company in Pune, will participate in athletics at the World Transplants Games at Perth next year. He donated part of his liver to his father on January 15, 2019, and the transplant cost was covered by his company’s corporate insurance.

“After leaving the organisation in 2020, I sought a health cover. I was told no policy can be issued under Insurance Regulatory and Development Authority of India (IRDAI) guidelines because of my surgery,” he said.

Arekar said he had applied for 8-10 insurance companies and all rejected his plea. “When government insurance companies too refused my application, I fi led a complaint with IRDAI. Then, a firm offered cover without the donated organ. The second company agreed after we took special approval and resubmitted my case. After five months, several calls and visits later, I got a Rs five lakh cover, including my liver (as a pre-existing illness) after the two-year resting period,” he added.

Recipients too face the same trouble. Heart recipient Karhun Nanda, who will captain the football team for the Games, underwent surgery in England. “I had a cover for many years, and I was an active football player until 2015. I underwent surgery the same year and stents were inserted. A month later, doctors found that I had a weak heart, and was declared a high-risk patient. I had to undergo another surgery. When the hospital sent an e-mail to the insurance company, they refused to cover it stating that I had hidden my medical history even though my hospital said that they were not connected. I paid Rs 10 lakh. I tried getting medical cover but my applications were declined. As of now, I have no cover. I need Rs 30,000 to Rs 50,000 for medicine, but I can afford it,” Nanda said.

Software engineer Vijay Bahadur Yadav from Mumbai swapped his kidney with a patient to get one for his wife. He underwent the transplant in June 2018 and will represent India at the World Transplant Games in several athletic events.

He said, “I am fi t to participate in a global sports competition, but insurance companies won’t cover me. Thankfully, my workplace covers my health insurance under the corporate scheme. ”

Bhaskar Nerurukar, head of health administration team at Bajaj Allianz General Insurance, said organ donor cases are not treated differently for underwriting and premium, and there is no differential pricing.
They may review a case based on a medical condition post organ donation and detailed medical tests will be advised before arriving at a decision in such cases, he said.

Amit Chhabra, business head of health insurance, Policybazaar. com, one of thelargest insurance marketplaces, said most health insurance policies have an inbuilt cover for organ donor transplants.

“An existing policy will cover the cost of a transplant, with terms and conditions. But a new one will come with the complexity of the disease. The insurer may issue the policy for a minor transplant. If it is a major surgery such as a kidney transplant, you may not get health insurance benefits,” he added.

He added that some companies follow a loading-based calculation for such customers which could increase the premium.

Several calls and emails to IRDAI officials were not responded to till Thursday.

Dr Rajneesh Sahai said organ donors and recipients do face problems post-transplant, and insurance companies may discriminate against them.

“The IRDAI is under the finance ministry. We could request the health ministry to take it up with the finance ministry to direct IRDAI to stop any discrimination against organ donors and receivers,” he said.