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All You Need To Know About Health Insurance with Organ Transplantation Cover

Organ transplantation is a medical procedure where an organ is removed from the body of one human being and placed into the recipient’s body. This medical procedure is helpful for those human beings who are facing health issues due to damaged or missing organs.

Transplantations are usually done for organs such as the kidney, lungs, heart, liver, and many more. Advancements in the field of medical sciences have led to the smooth replacement of malfunctioned internal organs with the functional ones but at a price. This price is usually in the form of the risks and complications involved in the procedure. Moreover, from the monetary expense perspective organ transplantations are very expensive and can range approximately between Rs.5 lakhs to Rs.20 lakhs.

These unprecedented medical expenses can create a hole in your pocket, drain your savings, and make you borrow funds. However, to meet these unexpected expenses it is advisable to purchase a health insurance policy that provides organ transplantation cover.

Organ Transplantation Expenses

In an organ transplantation surgery, there would be several expenses that would be at the ground level and would not be considered as a part of the surgery. These comprise expenses on medicines, expensive drugs, ambulance charges, etc. A health insurance policy can help to cover these expenses.

In earlier times, the recipient of the organ had to cover the medical expenses for the donor involved in organ transplantation. However, with the increasing number of organ transplant surgeries in India, many insurance providers have now introduced health insurance plans, which can provide cover for the expenses incurred by both donor and recipient in organ transplantation.

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Now, let us have a look at the major expenses, which would be incurred during the organ transplantation surgery.

  • Expenses during organ screening - The right organ of the patient must be found out before the actual hospitalisation for organ transplant begins. There are a large number of factors that are involved in finding the right organ for transplantation and this involves a lot of expenditure.

  • Expenses before hospitalisation - Once the person with the right organ is found out for transplantation, the person undergoing the transplantation must be brought to the accurate medical condition by the use of some medication.The cost of this exercise will fall under pre-hospitalisation expenses.

  • Expenses during hospitalisation - The hospitalisation expenses would include the fees of doctors, nurses, and room charges as well.

  • Expenses for the organ transplant surgery - This will be the actual procedure of the surgery and it includes the surgery and the surgeon’s fees.

  • Expenses during monitoring and post-surgery hospitalisation - After the surgery, the recipient and donor both would be monitored and their condition would be tracked.

  • Expenses during rectification of post-surgery complications - Post-surgery complications are quite common and rectifying these complications can be alengthy and expensive procedure.

These expenses are the basic coverage features that must be provided by a health insurance policy offering organ transplant cover. However, most health insurance providers would have various restrictions and would mainly cover hospitalisation charges. If you are purchasing a health insurance policy with organ transplant cover, you must check if there is a comprehensive coverage available for all the incurred expenses or not.

Critical Illness Insurance

Your health insurance plan would help in covering emergencies such as accidents or ailments, which need hospitalisation. However, there are certain critical illnesses such as heart transplant, kidney failure, paralysis, cancer, etc., which would not be covered under the scope of the basic health insurance plans. For these illnesses, you must have a separate financial reservoir known as the Critical Illness Insurance and one such critical health condition can be the need for organ transplantation.

  • During organ transplantation, complicated medical procedures are carried out and these procedures are highly expensive. A critical illness plan would be your saviour in such unprecedented circumstances because of the lump sum amount you receive after the diagnosis of the need for organ transplantation surgery.

  • This lump sum amount obtained would act as an add-on to the basic health insurance plan, which you already have.

  • The lump-sum amount obtained can be utilised for care and treatment during surgery, availing aids for recuperation, or to overcome the loss of income.

  • Moreover, a critical illness plan can help you in availing of the tax benefits under Section 80D.

How to Choose a Critical Illness Plan?

Some of the major points which you must keep in your mind while purchasing a critical illness plan for organ transplantation surgery are

  • Once your critical illness insurance policy is issued, there is an initial waiting period of 90 days.In this period your claims are not admissible. But once you complete this period, you can make a claim easily.

  • You should also remember that there is a 15 to 30-day survival period after the first diagnosis of the illness to receive the lump sum amount.

  • You can also have the choice of either a cashless reimbursement or a benefit policy. So, you must opt for an insurance provider who would offer you the liberty to choose amongst these two options.

  • You must check with your insurance provider on whether organ transplantation is being considered as a critical illness or not. According to the IRDAI guidelines for health insurance plans, at least 12 critical illnesses must be covered under the plan and organ transplantation cover would be included in the list. However, it is better to be sure before purchasing the policy.

  • Organ transplantation cover is usually subject to sub-limits and different insurance providers have different sub-limits for organ plantation. You must get the details about the sub-limits before you buy the policy.

  • You should opt for a floater policy i.e. one policy that covers you, your spouse, and two kids.


Hence, you should opt for a balanced plan, which consists of a combination of comprehensive health insurancepolicy and critical health insurance. With this combination, you would obtain a decent balance between the pricing and coverage. Your indemnity (base) health insurance would cover your basic medical expenses and the lump sum amount provided by critical illness insurance would help you face the tough times financially.

This  blog is written by Kavita Ganesh Asst. Vice President, Health & Accident Product Underwriting

About The Expert Dr. Kavita Ganesh holds over 15 years of work experience in health insurance industry. She highly recommends buying health insurance for securing finances in case of a medical emergency. Looking at the current pandemic situation, she enforces the idea of having a higher sum insured for covering the entire family.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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