Health
Bariatric Surgery now covered under insurance in India- Know all the details
As per WHO guidelines, >35 BMI is morbid obesity. Bariatric surgery is an operation that helps individuals with obesity to lose weight.
Bariatric Surgery procedure permission/ reimbursement was approved by the central government of India in 2013. To know more click here.
Summary: 60 Second Read
This article covers-
- Who is Bariatric Surgery Insurance suitable for?
- How does Bariatric Surgery Insurance work?
- What are the conditions that should be kept in mind to avail Bariatric Surgery Insurance?
- What are the procedures that can be undertaken in a Bariatric Surgery Insurance?
- Does Bariatric Surgery Insurance have a waiting period?
- What happens to your Bariatric Surgery benefit if you are porting your health insurer?
- What is not covered under Bariatric Surgery Insurance?
- What are the documents required to avail bariatric surgery in health insurance?
- Do you have to pay anything extra to avail Bariatric Surgery Insurance?
- Some of the popular Health Insurance Companies in India
Tackling obesity may require more than healthy eating and exercise. Bariatric Surgery can be a logical solution in such times.
A bariatric surgery in India costs anywhere between Rs. 2.5 to Rs. 5.5 lakh, and the equipment and technology alone costs around Rs 1.75 to 2.5 lakh.(know more)
The good news is health insurers now offer a benefit for Bariatric Surgery, or you can avail Bariatric Surgery Insurance with your health insurance.
Who is Bariatric Surgery Insurance suitable for?
Anyone who is morbidly obese or those who tip the scales at 100 kg or more over their normal body weight. Also, if anyone has a history of obesity in the family or has a tendency of gaining abnormal weight in a small span of time.
How does Bariatric Surgery Insurance work?
Few years back, bariatric surgery was a standard exclusion across the industry. However, with the changing needs of the world and the technical advancements, bariatric surgery is considered by many insurance companies now. If you are hospitalized for a Bariatric Surgery (https://obesitydoctor.in/treatments/Bariatric-Surgery) which is medically necessary, on the advice of a Medical Practitioner, the related medical expenses are covered by such policies.
However, it is to be kept in mind that Bariatric Surgery Insurance benefit can be availed only when it is medically necessary and not for cosmetic purposes.
What are the conditions that should be kept in mind to avail Bariatric Surgery Insurance?
To cover the expenses of your bariatric surgery in health insurance, these are the conditions that needs to be kept in mind:
- Surgery to be conducted is upon the advice of the Doctor
- The surgery/Procedure conducted should be supported by clinical protocols
- The member has to be 18 years of age or older and
- Body Mass Index (BMI)-
- Greater than or equal to 40 or
- Greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight loss:
- Obesity-related cardiomyopathy
- Coronary heart disease
- Severe Sleep Apnea
- Uncontrolled Type2 Diabetes
What are the procedures that can be undertaken in a Bariatric Surgery Insurance?
Some of the common procedures that are covered under Bariatric Surgery:
Types of Bariatric Surgeries:
Sleeve Gastrectomy
Gastric sleeve surgery involves removing or reducing the size of your stomach which typically leads to rapid weight loss. Medical professionals usually call it vertical sleeve gastrectomy.
Gastric Bypass
Gastric bypass is surgery that helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, your stomach will be smaller. You will feel full with less food. The food you eat will no longer go into some parts of your stomach and small intestine that absorb food.
Mini Gastric Bypass
A mini gastric bypass surgery functions just like a traditional gastric bypass surgery but the stomach is divided into upper and lower pouches and the small intestine is rerouted. This allows for both restrictive and malabsorption weight loss.
Gastric Balloon Surgery
Gastric balloon placement is a weight-loss procedure that involves placing a saline-filled silicone balloon in your stomach. This helps you lose weight by limiting how much you can eat and making you feel fuller faster.
Biliopancreatic Diversion
Biliopancreatic Diversion (BPD) creates a smaller stomach (similar to gastric bypass surgery), but in addition there is less absorption of ingested food inside the intestine (malabsorption).
Does Bariatric Surgery Insurance have a waiting period?
Yes, bariatric surgery in health insurance has a waiting period of usually 2 to 4 years. Which means, if you want to cover your expenses for bariatric surgery you will have to wait for 2 years from the start of your policy. So, it is always advisable to opt for such a benefit with your first health insurance policy itself.
What happens to your Bariatric Surgery benefit if you are porting your health insurer?
If you are porting an existing policy from some other General or Health Insurance Company or if you are adding this cover while renewing your health policy, a fresh waiting period will be applied for bariatric surgery benefit.
What is not covered under Bariatric Surgery Insurance?
Bariatric surgery for the following reasons is not covered:
- Claims arising due to condition that commenced within 30 days of the date of policy commencement are not covered
- Claims for pre-existing conditions are also not covered.
- For cosmetic/aesthetic reasons.
- For treating drug-induced obesity, for severe untreated hormonal imbalance, psychiatric and eating disorders-induced obesity.
The best way to avail the benefits of bariatric surgery in your health insurance policy is by doing proper research before opting for health insurance.
What are the documents required to avail bariatric surgery in health insurance?
What is required is a documented detailed history of your obesity-related health problems, difficulties, and treatment attempts demonstrating that a multidisciplinary approach with dietary, other lifestyle modifications (such as exercise and behavioural modification), and pharmacological therapy, if appropriate, have been unsuccessful, at least for the past 6 months.
Do you have to pay anything extra to avail Bariatric Surgery Insurance?
Bariatric Surgery is usually not covered with most insurers in the base policy. However, health insurers nowadays provide an option where you add this benefit to your health insurance policy by paying a little extra premium.
Some of the popular Health Insurance Companies in India
- IFFCO Tokio Health Insurance Company- https://www.iffcotokio.co.in/
- Bajaj Allianz Health Insurance Company- https://www.bajajallianz.com/
- Care Health Insurance Company (Religare)- https://www.careinsurance.com/
- HDFC ERGO General Health Insurance Company- https://www.hdfcergo.com/
- Tata AIG Health Insurance Company- https://www.tataaig.com/
- Star Health Insurance Company- https://www.starhealth.in/
- ICICI Lombard Health Insurance Company- https://www.icicilombard.com/
- United India Insurance Company Ltd.- https://uiic.co.in/
Conclusion
There are certain exclusions to the policy coverage. The best way to benefit from bariatric surgery on your health insurance is to do proper research before choosing health insurance.
You may contact us to know at +91 88660 20505 to know more about obesity related information or book a consultation by clicking below.
Reference
- https://www.tataaig.com/knowledge-center/health-insurance/what-is-bariatric-surgery-how-can-health-insurance-help
- https://www.policybazaar.com/health-insurance/articles/health-insurance-for-bariatric-surgery/
- https://cghsmumbai.gov.in/sites/default/files/downloads_documents/Bariatric-Surgery.pdf
- https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3916&flag=1
- https://www.irdai.gov.in/ADMINCMS/cms/whatsNew_Layout.aspx?page=PageNo3916&flag=1
