Is Crohn’s Disease Covered by Health Insurance Plans in India?

What is Crohn’s Disease?

Crohn’s disease is a chronic type of irritable bowel disease (IBD) that affects the digestive system, causing inflammation in the lining of the digestive tract. The inflammation can affect different areas of the gastrointestinal tract in different people, spreading gradually into deeper layers of the bowel. The disease is painful, progressive and can have life-threatening implications.

The following are the symptoms of Crohn’s disease:

1. Diarrhea
2. Abdominal pain and cramps
3. Fever
4. Mouth sores
5. Blood in stool
6. Loss of appetite
7. Weight lose
8. Kidney stone
9. Anaemia
10. Nausea and vomiting

As per a 2021 study in the Journal of Gastroenterology and Hepatology, the prevalence of Crohn’s disease in India is around 0.4 to 0.6 per 1,000 population, and the numbers are increasing due to urban sedentary lifestyles and dietary changes. Yashoda Hospital mentions that IBD affects nearly 2.7 lakhs of people in India.

Coverage for Crohn’s Disease in Health Insurance Plans in India

Most comprehensive health insurance plans in India provide coverage for Crohn’s disease. However, it is considered a pre-existing health condition in case of diagnosis before the policy purchase. Hence, the waiting period clause gets applied to the coverage of Crohn’s disease. Here are some important factors that affect the coverage of Crohn’s disease.

1. Crohn’s disease has no cover from day one. An initial waiting period of 30 days ( from the date of commencement of the policy) is applicable for the same.
2. A waiting period of 24 months to 48 months for pre-existing illnesses is applicable
3. Subject to strict underwriting, leading to a hike in premiums depending on the severity of the symptoms of Crohn’s disease.

Generally, the following are the coverages offered for Crohn’s disease under a health insurance plan. However, the coverage will start after completion of the waiting period for pre-existing health conditions, depending on the terms and conditions of the policy. Coverage includes:

1. Hospitalisation expenses during the severity
2. Diagnostic procedures and tests, including colonoscopy, CT enterography, MRI, etc.
3. Doctor consultations and follow-ups, if the policy includes cover for outpatient hospital expenses.
4. Surgery, if required
5. Steroids, biologics, and immunosuppressants as prescribed by the doctors
6. Nutritional therapy, if the policy exclusively includes the cover

Some critical illness insurance plans may provide Crohn’s disease cover. However, it is important to check the list of illnesses covered in the policy. Life-threatening complications of Crohn’s disease, like colorectal cancer, are generally covered in most critical illness insurance plans.

How Much Does It Cost to Manage Crohn’s Disease in India?

Crohn’s disease is a long-term and progressive illness, requiring regular treatment. The cost of medication (biologics or immunosuppressants) can vary from INR 60,000 to INR 2,00,000 in a year. If the condition requires surgery, the procedure cost can go up to INR 5,00,000 or more. Regular doctor consultation, diagnostic tests, and nutritional therapy together can go up to INR 1,00,000 a year, depending on the severity of the condition.

The disease is debilitating and often progressive in nature if the lifestyle and diet are not properly managed. Considering the cost, it is important to have the right health insurance policy that covers most of the expenses to reduce the financial burden of this medical condition.

Tips to Choose the Right Health Insurance for Crohn’s Patients

Here are some of the important tips for Crohn’s patients to choose the right health insurance coverage:

1. Consider the health insurance policy with a shorter waiting period ( less than 24 months), as Crohn’s disease is considered a pre-existing health condition
2. Ensure to read the health insurance policy exclusion, as certain policies exclude chronic IBDs.
3. Make an honest disclosure regarding your health condition while buying a health insurance plan to avoid claim complications in future.
4. Buy health coverage at an early and young age to get comprehensive coverage.
5. Go for policies with higher coverage and add-ons for disease-specific or chronic illness cover to manage the continuous treatment expenses of Crohn’s disease.
6. Choose insurance plans that come with wellness programs
7. Consider the sublimit before signing on the dotted lines
8. Crohn’s disease management requires frequent doctor consultation, diagnostic tests and sometimes day-care procedures. Hence, buying a health insurance plan with outpatient department cover and day care cover can be more beneficial.

At Jio Insurance Broking, you can explore health insurance plans as per your specific insurance needs and affordability. You can compare various health insurance plans that provide Crohn’s disease cover and choose the right policy after analysing various factors. An informed decision can provide you with peace of mind and with the necessary financial protection against the medical condition.

Conclusion

To conclude, with the growing awareness of chronic irritable bowel diseases (like Crohn’s disease) in India, buying the right health insurance plan is an important necessity. While most health insurance plans provide coverage for such pre-existing health conditions, it is vital to consider factors like waiting period, exclusions, limitations and requirements of specific coverage. Buying at a young age can also ensure comprehensive coverage, and a rational decision can fetch you maximum disease-specific benefits.