What is the Coverage for Sickle Cell Disease in Health Insurance?

Choosing Health Insurance for Sickle Cell Disease: A Complete Guide

Sickle Cell Disease (SCD) is a genetic blood disorder affecting millions of people all over the world. The disease is characterised by the production of abnormal haemoglobin, leading to red blood cells becoming rigid and 'sickle'-shaped. These deformed cells can cause blockages in blood flow, leading to painful episodes, organ damage, and other serious health issues.

Managing sickle cell disease involves emotional and financial strain that has lifelong consequences. For those living with this condition, health insurance coverage becomes essential. Read ahead to understand how health insurance provides coverage for sickle cell disease and how to choose a proper plan according to your needs.

Is Sickle Cell Disease Covered by Health Insurance?

In the past, many insurers classified diseases such as sickle cell disease as permanent exclusions. However, recent regulatory changes and increased awareness have prompted insurance providers to reevaluate such exclusions.

Following an order from the Insurance Regulatory and Development Authority of India (IRDAI), health insurers are no longer allowed to deny coverage for genetic disorders across the board. A 2018 Supreme Court ruling solidified this by saying that health insurance should cover genetic disorders without automatic exclusions.

For this reason, many health insurance providers currently offer plans that include treatment and management of SCD. However, the extent of coverage can vary greatly from policy to policy.

How to Choose the Right Health Insurance Plan for Sickle Cell Disease?

If you or someone you care about has sickle cell disease, it is essential to carefully review the terms of a health insurance policy before purchasing. A few important things to consider are:

1. Pre-Existing Conditions and Waiting Periods : If the diagnosis occurs prior to the policy purchase, sickle cell disease is often considered a pre-existing condition. Most insurers have waiting periods ranging from 2 to 4 years before providing coverage for pre-existing diseases. Some comprehensive plans may waive or reduce the waiting period.
2. Inpatient Hospitalisation : Your policy must include hospitalisation expenses, such as ICU charges, room rent, and surgery costs. SCD can refer to emergency admissions, so you should look for a plan with no room rent cap and a large hospital network.
3. Daycare Procedures and OPD Coverage : There are some treatments or diagnostics for SCD which do not require hospitalisation. Sometimes, a plan covering frequent or smaller expenses, such as daycare procedures and outpatient department (OPD) expenses, can be immensely helpful.
4. Coverage for Blood Transfusions and Specialist Consultations : Verify that your insurance includes the cost of blood transfusions and hospital charges for sickle cell disease (SCD), as blood transfusions are a regular necessity for managing this condition. Policies covering specialist consultations, such as those with haematologists, as well as follow-up visits, can be beneficial.
5. Maternity and Genetic Counselling : If you have a family history of SCD or if you’re planning to have a family, see if the policy offers maternity benefits or genetic counselling and prenatal screenings.

Which Health Insurance is Best for Sickle Cell Disease?

Star Health offers coverage for sickle cell disease under the Star Health Premier Insurance Policy and Star Family Health Optima Insurance Policy. We have established an enviable portfolio of integrated health insurance products in India for individuals with chronic and lifestyle-related diseases.

Star Health provides a customer-first approach with:

• Plans that cover pre-existing conditions after specific waiting periods
• Daycare procedure coverage and OPD support
• An extensive network of hospitals to choose from
• Transparent policy wording and will continuously provide expert support in the claim processing

This proactive approach with policyholders prioritises healthcare access over paperwork obligations, making it a trustworthy ally for families coping with long-term conditions like sickle cell disease. By having the right health insurance plan in place, patients can ensure they get quality healthcare without worrying about mounting costs.