Does Health Insurance Cover Congenital Diseases in India?

The only way to avoid catching a disease is to lead a healthy lifestyle, which includes a healthy diet, 7-8 hours of sleep and exercising regularly. But some people do not even get that choice and are born with congenital diseases. This makes a lot of people wonder if congenital diseases are covered under health insurance plans in India. Let’s find out.

Read More

Policybazaar exclusive benefits
  • 30 minutes claim support*(In 120+ cities)
  • Relationship manager For every customer
  • 24*7 claims assistance In 30 mins. guaranteed*
  • Instant policy issuance No medical tests*

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply

*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Find affordable plans with up to 25% Discount**
  • 1
  • 2
  • 3
  • 4

Who would you like to insure?

  • Previous step
    By clicking on “Continue”, you agree to our Privacy Policy and Terms of use
    Previous step

      Popular Cities

      Previous step
      Previous step

      Do you have an existing illness or medical history?

      This helps us find plans that cover your condition and avoid claim rejection

      Get updates on WhatsApp

      Previous step

      When did you recover from Covid-19?

      Some plans are available only after a certain time

      Previous step
      Advantages of
      entering a valid number
      You save time, money and effort,
      Our experts will help you choose the right plan in less than 20 minutes & save you upto 80% on your premium

      What are Congenital Diseases?

      Congenital diseases refer to the diseases that are present in people right from birth. They are structural or functional birth defects that develop during the intrauterine life of a baby. Also known as congenital anomalies or genetic disorders, they can be detected before birth, at birth or during infant years.

      Genetic mutations, environmental factors, maternal age, maternal nutritional status, infections and socioeconomic factors are some of the common causes of congenital anomalies in infants.

      As per a joint report by WHO and MOD in 2016, around 1.7 million people in India suffers from congenital diseases, which is 6-7% of the total population. While internal congenital diseases are not clearly visible, external congenital anomalies can be easily identified. Nevertheless, a baby suffering from a congenital disorder may have health problems or suffer from disability throughout his/her life.

      Common Types of Congenital Diseases

      Some of the most common types of congenital diseases are as follows:

      • Down syndrome
      • Congenital heart disease
      • Cleft lip and cleft palate
      • Cerebral palsy
      • Spina bifida
      • Club foot
      • Edward’s syndrome
      • Thalassaemia
      • Phenylketonuria
      • Fragile X syndrome
      • Cystic fibrosis
      • Sickle cell disorder
      • Congenital hypothyroidism

      Treatment of Congenital Diseases

      The treatment of a congenital disease depends on its type and diagnosis. Most functional congenital diseases in children can be treated at early stages through medication to manage symptoms and prevent complications.

      However, children suffering from a structural congenital anomaly may require paediatric surgery to correct the problem. Needless to say, both long-term medications and paediatric surgery will be an expensive affair.

      Moreover, doctors may require a pregnant mother to undergo various tests to detect a congenital disorder.

      Although some congenital diseases, such as down syndrome, can be detected prenatally through a blood test, others may require chronic villus sampling (CVS), ultrasound scans, amniocentesis, etc. to identify the disorder. The cost of these tests can also eat away your savings.

      Are Congenital Diseases Covered by Health Insurance Plans in India?

      Yes. All regular health insurance plans in India provide coverage for congenital diseases as per the 2019 guideline of IRDAI (Insurance Regulatory & Development Authority of India).

      They cover the medical expenses incurred on the diagnosis and treatment of congenital diseases, including the cost of in-patient hospitalization, day care procedures, surgeries, pre-hospitalization, post-hospitalization, etc. The coverage amount can range from Rs 50,000 to up to Rs 6 crore. Though, the scope of coverage and the coverage amount depends on the health insurance plan that you have purchased.

      However, not all congenital diseases are covered by health insurance plans in India. As per the IRDAI guidelines, only internal congenital diseases are covered by regular health insurance plans. If a person is suffering from an external congenital disease, the insurance company will not be liable to provide coverage for the treatment cost.

      Waiting Period to Cover Congenital Diseases by Health Insurance Plans

      Although health insurance plans cover internal congenital diseases in India, you cannot avail coverage unless the waiting period is over. Most health insurance policies cover congenital diseases after a waiting period of 2 years.

      This means that you cannot raise a claim for congenital diseases under your health policy until two consecutive renewals. Once the waiting period is over, you can easily get the treatment expenses for internal congenital diseases covered by your insurance company.

      However, the 2-year waiting period for congenital anomalies is applicable only if your child is diagnosed with the disease after buying the health policy. In case your child was diagnosed with an internal congenital disorder before you purchased the policy, it will be considered as a pre-existing disease.

       In that case, you will have to wait out for up to four renewals to be able to raise a claim for congenital diseases under your policy. This is because all pre-existing diseases are covered by health insurance providers after a waiting period of 2-4 years.

      Therefore, make sure to check your policy documents carefully to know the exact waiting period for congenital diseases and pre-existing diseases.

      Tips to Prevent Congenital Diseases

      As a woman, you can take the following precautions to prevent the onset of congenital diseases in your child. Take a look:

      • Eat nutritious food rich in vitamins, minerals
      • Maintain a healthy body weight
      • Take folic acid supplements during reproductive years and in the first trimester of pregnancy
      • Avoid consumption of alcohol, drugs and cigarettes during pregnancy
      • Avoid consuming medicines that can lead to birth defects
      • Avoid exposure to hazardous chemicals like pesticides and lead
      • Get appropriately vaccinated, especially against rubella
      • Avoid travelling to places with the outbreak of an infection like the Zika virus
      • Keep your diabetes under control (if applicable)

      Summing It Up

      Congenital diseases have lifelong ramifications. Not only will your child have to deal with various health problems throughout his/her life, but the treatment expenses will also evaporate your savings in no time. The good news is that health insurance plans in India provide coverage for internal congenital diseases. Nonetheless, it is better to follow the above-mentioned tips and do your best to prevent your child from developing a congenital disorder.

      Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

      Health insurance articles

      Recent Articles
      Popular Articles
      Surgeries Covered by Magma HDI Health Insurance Plans

      18 Apr 2024

      Magma HDI General Insurance Company offers a spectrum of
      Read more
      Surgeries Covered by Raheja QBE Health Insurance Plans

      17 Apr 2024

      Raheja QBE General Insurance Company offers a diverse range of
      Read more
      Surgeries Covered by Aditya Birla Health Insurance Plans

      16 Apr 2024

      Aditya Birla Health Insurance Company offers a range of
      Read more
      Surgeries Covered by Cholamandalam Health Insurance Plans

      16 Apr 2024

      Cholamandalam MS General Insurance Company offers a range of
      Read more
      Surgeries Covered by Future Generali Health Insurance Plans

      16 Apr 2024

      Future Generali India Insurance Company offers comprehensive
      Read more
      Best Health Insurance Plans for Senior Citizens
      Senior citizens are the most prone to diseases. Considering the medical inflation in India, buying health insurance
      Read more
      Does Health Insurance Provide Coverage for LASIK Eye Surgery?
      A vast majority of the Indian population is suffering from vision problems. For some of them, LASIK eye surgery is
      Read more
      Zero Waiting Period in Health Insurance Plans
      Every medical insurance plan comes with a few terms & conditions, and the waiting period is one of them. A
      Read more
      How to Apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)?
      Ayushman Bharat Yojana is a flagship health insurance scheme launched by the Government of India to offer universal
      Read more
      10 Major Benefits of Ayushman Bharat Yojana
      Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the second component under Ayushman Bharat Scheme. PM Narendra Modi
      Read more

      Download the Policybazaar app
      to manage all your insurance needs.