Does Health Insurance Cover Congenital Diseases in India?

Congenital disease is a medical condition developed since childhood. These diseases are disabilities in children caused by either genetics or inheritance. It can develop in the pre-birth months or a little while after delivery.

A congenital disease can be categorised into two parts: external and internal congenital disease. All types under the congenital external disease category cause visible anomalies or abnormalities in the physical body, making it easy to detect and diagnose.

All types under the congenital internal disease list impact the organs and other body systems from within, making diagnosing difficult without medical tests and doctor consultation.

For better understanding, let us list internal and external congenital diseases below:

** Internal Congenital Diseases**

Heart Problems- Under this category, the impact of the disease causes structural abnormalities in the child at birth. Due to this, the different parts of the heart, like chambers, valves, blood vessels, etc., can be different from normal people, inviting a long list of heart function-related problems in the future.

Kidney Defects- Kidneys are an important organ in the human body, and due to congenital diseases, the functionality of this organ can be compromised. This leads to issues relating to waste removal, imbalanced fluid intake and filtration. These issues can lead to other severe health problems in future.

Haemophilia- Blood disorders are also part of external congenital diseases, and haemophilia is a common aftermath. This causes blood clots within the bloodstream and impacts children from birth.

Endocrine Defects- Under this category, the impact of the disease is on the hormone production ability of the body, causing issues like hypothyroidism in children since birth.

** External Congenital Diseases**

A child can be born with clubfoot, a medical condition where either one or both feet are turned downward and inward. This makes it difficult for anyone to walk normally.

The roof of the mouth or lip can show visible physical malformations due to congenital disease, impacting the self-confidence of individuals.

The back or spinal cord can be targeted by a neural tube defect called Spina Bifida that restricts the development of the spine fully, showing visible back abnormalities.

Children can be born with more fingers or toes than normal due to polydactyly.

According to the guidelines by the Insurance Regulatory and Development Authority of India released in 2019, many different types of congenital diseases are covered in most health insurance policies.

However, it is important to note that the scope of coverage might be limited to only some congenital diseases. Health insurance plans commonly cover internal congenital diseases like heart abnormalities causing health problems.

For external congenital diseases, health insurance coverage might not be available at all, meaning all treatment charges will have to be paid by the policyholder.

As part of congenital heart disease insurance, individuals can get coverage for hospitalisation, diagnostics and some other medical expenses to help cure or treat the disease.

An important thing to note is that the level of coverage available varies from policy to policy. The factors impacting the coverage can include premium, sum insured, policy inclusions and exclusions, add-on benefits, etc.

For the applicability of health insurance claims, you need to be aware of the waiting period clause. Most health insurance plans come with a 2-year waiting period, which means you cannot file for a claim for congenital diseases until 2 years are over for the policy cycle.

This only stands true if the diagnosis is done after purchasing a policy. For any diagnosis made before the health insurance policy purchase, the waiting period clause does not come into play.

Maintain a proper BMI by consuming a balanced diet.

Take active precautions to reduce the risk of diabetes or maintain sugar levels in diabetes.

Consume foods rich in vitamins and minerals.

Do not consume too much alcohol or tobacco during pregnancy.

Avoid travelling to infection-prone areas.

Avoid taking medicines that can cause abnormalities in the baby.

The impact of congenital diseases goes on for life, so getting the right treatment in time is necessary. Investing in a health insurance plan is, therefore, a top priority, especially for internal congenital diseases, to receive financial assistance for medical expenses.

When choosing health insurance, look for providers that offer a well-developed hospital network to facilitate cashless treatments for congenital diseases. Also, always remember to read and understand all the terms and conditions of any policy and compare different plans to make the right decision.

With Tata AIG, you can buy various health insurance plans for yourself or your loved ones and get cashless treatment for the covered expenses at our 10,000+ network hospitals. The exhaustive list of our health plans includes senior citizen health insurance, group health insurance, critical illness health insurance, etc.

Find all the relevant information for each health insurance plan on the website and gift yourself and your loved ones a safety net for the future with us.

Can you list some disease exclusions for health insurance plans in India?

Most sexually transmitted diseases like HIV, infertility treatments, and dental procedures are some of the diseases not included in a health insurance plan in India.

What are the 5 common types of congenital diseases?

The 5 common types of congenital diseases include Spina Bifida, iniencephaly, microcephaly, craniorachischisis, and anencephaly.

Can the father of the child do anything to avoid congenital diseases?

The only role of the father in preventing congenital diseases is to take care of a list of things that can otherwise cause issues with the baby at birth. The list includes ensuring all vaccinations are completed on time, food intake is monitored, and safety precautions are taken to avoid infections.