Do Health Insurance Plans Cover Rare Diseases?

What are Rare Diseases?

Rare diseases refer to the diseases that are found in only a small percentage of the total population. According to World Health Organization (WHO), a disease that affects 1 or less people per 1000 people is referred to as a rare disease. But in India, diseases that affect less than 1 individual for every 2500 individuals are categorized as rare diseases.

About 72% of rare diseases are genetic and thus, are present in a person right from childhood. Hence, rare diseases are life-threatening and people suffering from them have to live with them throughout their lives. At present, about 96 million people in India are living with a rare disease, which comes about 1/5^th of the total population.

Common Types of Rare Diseases

Currently, more than 7000 rare diseases have been identified across the world. Some of the most common rare diseases are:

Pompe
Haemophilia
Sickle Cell Anaemia
Cystic Fibrosis
Gaucher Disease
Haemangioma
Osteopetrosis
Tyrosinemia
Fabry Disease
Maple Syrup Urine Disease
Hurler Syndrome
Wolman Disease

Treatment of Rare Diseases

A cure for most rare diseases is not available. About 95% of rare diseases do not have any approved treatment. Not just the treatment, even the diagnosis of such diseases are not timely leading to increased sufferings of the patient. In case the treatment for a rare disease is available, it is very expensive. For example, the treatment of Gaucher Disease can easily go beyond Rs 40 lakh. Similarly, the treatment of Pompe can cost you more than Rs 35 lakh.

Moreover, rare diseases are mostly chronic in nature. Thus, their treatment will go on for a long time and in turn, will cost you a lot of money. Moreover, patients may be required to go through regular diagnostic tests and put on medications for a long time. Since very few pharmaceutical companies across the world manufacture drugs for the treatment of rare diseases, they are highly expensive. This is the reason why rare diseases are also known as ‘orphan diseases’ and the drugs used in their treatment are referred to as ‘orphan drugs’.

Are Rare Diseases Covered by Health Insurance Plans in India?

Yes. Several health insurance plans in India cover the treatment cost of a rare disease. Irrespective of whether a rare disease is genetic or not, you will be able to claim the treatment expenses under your health insurance policy. The policy will provide coverage for the medical expenses incurred on hospitalization, surgeries, post-hospitalization consultations and diagnostic tests, day care treatments, etc. Depending on your budget, you can opt for health insurance for rare diseases with a coverage amount of up to Rs 6 crore.

However, all rare diseases may not be covered under health insurance plans in India. Moreover, the coverage provided by all health plans are not the same. Hence, it is recommended that you check the list of rare diseases covered under a health insurance policy before buying it. Also, make sure to opt for a health plan that will adequately cover your medical expenses in case you are diagnosed with a rare disease.

Waiting Period to Cover Rare Diseases Under Health Insurance

Although rare diseases are covered under health insurance, the coverage is not available as soon as you buy the plan. You need to first spend a waiting period, post which the coverage will be provided to you. While all health insurance plans come with an initial waiting period of 30 days, coverage for most rare diseases will be available after a waiting period of 2 years. This means only after your health insurance policy is consecutively renewed twice, the treatment cost of a rare disease is covered by your insurance provider.

However, the 2-year waiting period will be applicable only if you are first diagnosed with a rare disease after buying the health insurance policy. In case you were diagnosed with a rare disease before purchasing the policy, the disease will be considered as a pre-existing disease. In such a case, a pre-existing disease waiting period will be applicable. Most health insurance plans cover pre-existing diseases after 2 to 4 years of continuous coverage. Thus, you may be required to wait for up to 4 policy renewals to get your pre-existing rare disease covered.

Tips to Prevent the Occurrence of Rare Diseases

Although the exact causes for various rare diseases are not known, you can follow the precautionary tips given below to live a healthy life and prevent rare diseases:

Eat a healthy diet rich in green vegetables and fruits
Avoid smoking
Avoid regular consumption of alcohol
Avoid exposure to harmful chemicals
Stay active and exercise regularly
Get appropriately vaccinated

Summing It Up

Rare diseases may not be widely prevalent but can be life-threatening. Since their treatments are expensive and long-term, buying health insurance for rare diseases is the only way to prevent your savings from getting exhausted. However, make sure to compare health insurance online to find an ideal policy that fits within your budget.