Critical Illness Insurance for Organ Transplant

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We catch illnesses and recover in due time after taking some precautions and due course of medicine. But some illnesses are so dire that our organs fail to regain their full potential and keep deteriorating once afflicted. These illnesses are categorised as critical illnesses. A critical illness is essentially a life-threatening illness. Many critical illnesses leave lingering effects which can give rise to further complications in the concerned organ. And, since all organs in our body are dependent on each other to function properly, even a single one lacking to complete its operation can lead to severe complications and may require a transplant. Since these illnesses are not covered by basic health insurance in Dubai, a special kind of insurance is designed to do so – critical illness plans. Let’s understand how critical illness plans can help with organ transplants and what do they cover. 

What is Organ Transplant?

Organ failure can happen due to a critical illness, physical injury to the organ or genetic conditions. In case of any of these three occurrences, organ transplants are required. As the name suggests, when an organ in our body refuses to function properly due to damage, it is replaced with a healthy organ in transplant surgery. The most commonly transplanted organ is the kidney. The organ transplant can include complete organs, like in the case of the heart, and healthy tissues only, like in the case of the liver. The healthy tissues transplanted in the body grow into full-fledged organs on their own in due time. Other organs that can be transplanted can include lungs, pancreas, intestine, bone, bone marrow, corneas, parts of middle ear, skin, connective tissues, uterus, muscles, etc.  

Health Insurance Coverage for Organ Transplant

Generic health insurance in Dubai does not cover organ transplants. However, critical insurance plans offer a significant level of coverage for them. Critical illness plans are designed specifically to cover life-threatening conditions only. Since organ transplant is only required when life and bodily functions are at risk, critical illness plans often cover them. The coverage can differ as per the comprehensiveness of the insurance plans. There may be an initial waiting period of 30-120 days for the coverage to begin after buying the plan. Basic critical illness plans may cover up to 12 critical illnesses while the more comprehensive ones may cover up to 38 critical illnesses. Organ transplant is often covered mostly by the more comprehensive versions of critical illness insurance plans. So, check the covered diseases to see if the plan has what you need. 

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How Does Critical Insurance Plan Work?

Critical illness insurance is a little different from generic health insurance in Dubai. Where your health insurance plans simply pay for the treatment expenses of a covered condition, critical illness insurance plans offer a lump sum compensation amount. You can use this compensation for the transplant expenses or simply to cover the loss of income and support your family and dependents. The compensation is offered when you are diagnosed with a critical illness, organ transplant in this case. Once the compensation has been paid, the insurance plan expires. You have to buy new coverage again afterwards if you still desire to be covered by a critical illness insurance plan. 

What is the Survival Period? Does it Apply to Organ Transplant?

A special condition that applies only to critical illness insurance plans, survival period is the amount of time you must survive after the diagnosis of your critical illness to get the benefit. This period is generally capped at 30 days for most health insurance providers. You may even find critical insurance plans with a survival period of 15 days. In the case of an organ transplant, you can file the claim once your doctor has recommended the transplant. You do not have to go through it to be eligible for the benefit. Just collect the required documents and submit them for claim settlement. The claim may be processed after the survival period has been completed, counting from the initial date of the recommendation. 

Exclusion of Critical Insurance Plans 

Critical illness plans do not offer the generic benefits of a health insurance plan, i.e., hospitalisation cost, etc. Hence, the inclusions are pretty clear – a compensation lump sum amount for the included illnesses. The exclusions of critical illness plans are listed below: 

  • Critical illness that developed due to negligence on the policyholder’s part.
  • Illnesses developed due to lifestyle habits such as drinking and smoking. 
  • Cosmetic treatments where skin cell transplant is concerned.
  • Pregnancy-related conditions and complications. These are covered only by maternity insurance plans covering pregnancy-related complications. 
  • Illnesses due to radioactivity or wars and acts of wars. 
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How to Claim Critical Insurance Plan for Organ Transplant 

You are eligible to submit a claim against your critical illness plan as soon as you are recommended to have an organ transplant. Collect the required documents such as radiology tests, lab tests, prescription for related medications and the doctor’s written recommendation for organ transplant as the medically necessary procedure for your condition. Attach them with the claim form and submit it. Once the claim has been settled and you have received the claim amount, you can use the amount to cover the expenses of the transplant.

Factors to Consider When Buying Critical Insurance Plans

  • Covered Critical Illnesses: Since organ transplant is not the most common critical illness or condition covered by critical illness plans, you must check the list of covered illnesses carefully. Ideally, the more comprehensive versions of critical illness plans would have organ transplants as an inclusion of the plan. Make sure that the plan you choose not only has organ transplant but also a few related diseases as well. 
  • Assured Sum: The compensation offered as a lump sum amount can also differ for each plan and provider in the critical illness insurance segment. Since you can probably use your compensation amount to cover the transplant directly, try and find a cost-effective plan with a high assured sum. But do not compromise on covered illnesses for a better lump sum amount if the difference can affect the overall coverage significantly. Dropping one or two covered illnesses to which you are least susceptible should be acceptable here. 
  • Survival Period: Chances are that you will get 30 days minimum as the survival period of your critical insurance plan. Still, go ahead and scout for options that can provide lesser days as a survival period. Search for plans with a survival period of 15 days instead. But only buy once you confirm that both assured sum and covered illnesses are all that you need. 
  • Waiting Period: Needless to say, look for a plan which offers the least amount of waiting period. 60 days can be the bare minimum to assume here. Avoid going for plans with 180 days waiting period unless they offer outstanding coverage and you can afford to wait that long. Plans with a waiting period of 30 days may also be available. If you are taking critical illness insurance as an add-on, the waiting period may increase several folds for you. Research these aspects well before you finalise the purchase. 
  • Sub-Limits of the Plan: Just like basic health insurance in Dubai, there may be sub-limits applicable to the benefits offered in critical illness insurance for an organ transplant. Make sure you have thoroughly examined these additional limits and additional terms and conditions attached to them. It will work in your best interest to know all the limitations of your critical illness insurance plan. 
  • Post-Hospitalisation Cover: While it is rare for a critical illness plan to cover services and benefits like post-hospitalisation, some plans may offer to do so for organ transplants. In some cases, newly transplanted organs may respond negatively and start showing side effects. Hospitalisation becomes necessary in such cases. Many critical insurance plans offer to cover the expenses for this particular time frame up to 180 days. There may be other additional benefits like this one that critical illness insurance plans come with. Keep an eye out for them when you are researching. 

In a Nutshell 

Being diagnosed with a critical illness can take a toll on your mental and physical health. Even more so if the damage caused to an organ is severe enough to require a transplant. However, being a little proactive is the key to making sure that you not only recover ideally but also get to have full advantage of your insurance cover. Apply for a claim as soon as the doctor recommends an organ transplant so that the survival period is completed as soon as possible. Choose comprehensive plans to make sure your expenses are properly compensated for. Tackling your organ transplant expenses will be simplified with these easy steps. 

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