Health Insurance Plans: Do They Cover Rare Diseases?
Human beings are susceptible to a range of diseases. While some diseases, like diabetes, hypertension, etc., are more common, there are many diseases that are relatively rare. In fact, most of us would not be aware of their names too. Do health insurance plans in India cover the treatment costs of such rare diseases? Let’s find out.
What are Rare Diseases?
The World Health Organisation (WHO) defines rare diseases as diseases that affect one or fewer people per 1000. In India, this definition is altered to ‘diseases that affect one or less people per 2500 individuals’. Another important observation about rare diseases is that around 72% of them are genetic and are present from childhood. Hence, people suffering from them live with them throughout their lives.
While there are over 7,000 identified rare diseases in the world, the ones more common in India are:
- Cystic Fibrosis
- Fabry Disease
- Gaucher Disease
- Hurler Syndrome
- Maple Syrup Urine Disease
- Sickle Cell Anaemia
- Wolman Disease
While buying a health insurance plan in India, we suggest you read the policy document to understand the considered rare diseases, the waiting period for certain diseases, and the exclusions.
Treatment of Rare Diseases
Usually, the cure for rare diseases is not discovered. Hence, more than 95% of rare diseases do not have an approved treatment protocol. In fact, on many occasions, identifying the rare disease can also take months (or years). Also, when treatment is available, the cost can be very high. To offer an example, Gaucher Disease is a rare disease where certain fatty substances build up in organs like the liver or spleen, causing them to perform sub-optimally. The cost of treatment of this disease can easily cross ₹40 lakh.
Further, most rare diseases are chronic in nature. Hence, their treatments, if available, tend to go on for a long time. This can cause a major dent in your finances. Since these diseases are rare, not many pharmaceutical companies manufacture the drugs needed for their treatment. Therefore, they are very expensive too.
Does a Health Insurance Policy Cover Rare Diseases?
Yes. Many health insurance policies offer coverage for the treatment of rare diseases. These policies offer coverage for various costs, including hospitalisation, daycare treatments, pre and post-hospitalization tests and consultation, surgeries, etc. When you buy health insurance policies online, you can go through the list of inclusions and exclusions to understand the rare diseases covered by the policy and the associated terms and conditions. For more clarification, you can talk to the insurer and understand all the benefits of health insurance. You can also opt for critical illness insurance to get coverage for the treatment costs associated with a pre-approved list of diseases that are categorised as critical illnesses.
Waiting Period Clause
Even if your policy offers coverage for rare diseases, it is important to remember that the insurer will not start the coverage immediately. You will have to spend the mandated waiting period before the coverage for rare diseases is activated.
Health insurance policies usually have a waiting period clause of around 30 days for any claim to be filed. This means that when you buy a health insurance policy, you will not be offered any coverage for the first month. For rare diseases, the waiting period is usually extended up to two years. Also, many insurers do not offer coverage for rare diseases that you are already diagnosed with. They treat them as pre-existing diseases with a higher waiting period. Insurers only cover the first instance of the rare disease being diagnosed.
There are many providers offering health insurance plans in India. When you decide to buy a health insurance policy, make sure that you understand the scope and extent of the coverage and go through the list of inclusions and exclusions carefully. Remember to compare providers and plans to find the best health insurance policy for your needs.