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Kidney disease can progress rapidly, leading to frequent hospital visits and high treatment costs if not treated promptly. Having health insurance specifically for kidney patients is essential to ensure continuous medical care and shield your savings from unexpected expenses.
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Kidney disease happens when the kidneys are damaged, impairing blood filtering and causing waste and fluid buildup. Mainly caused by diabetes and high blood pressure, it worsens if untreated.
The kidneys regulate toxins, fluid, blood pressure, and hormones. Reduced function raises failure risk. A study by the NIH shows that only 32.1% of patients with chronic kidney disease have insurance, with 83% paying out of pocket, underscoring the need for coverage.
Kidney diseases include Chronic Kidney Disease (CKD), Acute Kidney Injury (AKI), Polycystic Kidney Disease (PKD), glomerulonephritis, diabetic nephropathy, kidney stones, lupus nephritis, and renal artery stenosis. They result from diabetes, high blood pressure, infections, or genetics and damage the kidneys through inflammation, obstruction, or reduced blood flow, risking failure if untreated.
Note: Kidney diseases vary in severity and progression, making it crucial to understand their types and causes to enable early diagnosis, prompt treatment, and effective management.
Yes, health insurance typically covers kidney-related conditions; however, coverage varies by policy type and whether the condition predated the policy purchase. Most comprehensive plans and critical illness coverage include treatment for CKD, kidney failure, and kidney stones, depending on the policy terms and waiting periods.
What Kidney Treatments are Typically Covered?
Dialysis: Typically conducted as a day-care procedure or inpatient treatment, based on medical needs.
Note: Coverage details, sub-limits, and waiting periods might differ based on the policy's terms and conditions.
The cost of treating kidney disease in India varies with disease severity, treatment type, and hospital type (public or private). From early management to advanced procedures, kidney conditions incur substantial expenses.
Kidney stone disease is common in India. Early diagnosis through kidney symptoms like back pain, blood in urine, nausea, or frequent urination can enable medication. Advanced cases often need medical procedures.
Kidney stone treatment costs may include:
Medication and basic care: ₹10,000 to ₹50,000
Lithotripsy (stone-breaking procedure): ₹40,000 to ₹1.5 lakh
Surgical removal (if required): ₹80,000 to ₹2 lakh
The overall cost depends on the stone size, complications, hospital type, and city.
For patients with advanced chronic kidney disease (CKD) or kidney failure, a transplant may be necessary.
Estimated Overall Cost:
Other Cost Components:
For patients not undergoing transplantation, dialysis is a recurring expense in the management of advanced kidney disease (per session cost).
Note: The above figures are indicative and may vary by hospital, location, patient condition, and complications. Kidney stone disease, chronic kidney disease, or advanced kidney failure often involves recurring or high one-time expenses. Early diagnosis and treatment can prevent complications, but health insurance is crucial to avoid high out-of-pocket costs.
Purchasing health insurance for patients with kidney disease in India is vital because CKD and kidney failure require ongoing, expensive treatments that can quickly deplete savings. Tailored plans cover costs like dialysis, transplants, and medical treatments, helping patients access quality care without financial hardship.
Health insurance coverage for kidney-related conditions is crucial for individuals at higher risk of renal issues or those already receiving treatment. The following groups should strongly consider obtaining suitable coverage:
Not all insurance plans are suitable for every stage of kidney disease. Plan selection depends on the stage and progression of kidney disease. For instance-
Note: Waiting periods for kidney-related treatments differ depending on the policy, so it’s essential to review the terms and conditions thoroughly before buying a plan.
India's First Money Back Health Insurance Plan
Care Health Insurance for kidney patients provides specialised coverage tailored for chronic conditions and associated pre-existing diseases. It offers financial assistance for long-term treatments, along with lifelong renewal and restoration benefits.
| Sum Insured on Annual Basis (in ₹) | 3 Lakh / 5 Lakh | 7 Lakh / 10 Lakh |
|---|---|---|
| In-patient Care | Up to Sum Insured | |
| Day Care Treatment (for selected ailments) | Up to Sum Insured | |
| Recharge of Sum Insured | 100% of Original SI upon exhaustion of SI | |
| Annual Health Check-up | All Adult Insured Members | |
| Ayush Treatment | Up to Sum Insured | |
| Consumable Allowance (Max. 7 days per hospitalisation covered after 3 days) | ₹750 per day, Max 7 Days after 3 days of first hospitalisation. | ₹1000 per day, Max 7 Days after 3 days of first hospitalisation. |
| Companion Benefit (if hospitalisation exceeds 10 days) | ₹10,000 if hospitalisation exceeds 10 days | ₹15,000 if hospitalisation exceeds 10 days |
| Pre-hospitalisation and post-hospitalisation expenses | Up to 7.5% of payable hospitalisation expenses. | Up to 10% of payable hospitalisation expenses |
| Ambulance Cover | Up to ₹1000 per Hospitalisation | |
| Domiciliary Hospitalisation | Up to 10% of SI is covered after 3 days | |
| Tenure | 1 year/2 years/ 3 years | |
| Recharge of Sum Insured | Upto 100% of SI | |
| Dialysis Cover | Upto ₹1000 per sitting. Maxi. 24 months | |
| Annual Health Check-up | All adult insured members | |
Note: The plan mentioned above is part of Care Freedom, designed to support individuals with pre-existing conditions. For full details and conditions, please see the PDF of Terms and Conditions. Other options, such as Critical Illness Plans, provide lump-sum payouts for sudden diagnoses, while Comprehensive Health Policies cover ongoing medical needs based on health and finances. Review the policy Terms and Conditions PDF to understand coverage, waiting periods, sub-limits, and exclusions before deciding.
Health insurance for kidney patients provides vital financial support for managing renal conditions and related medical expenses. Reviewing coverage highlights and exclusions ensures the policy matches the condition's stage and needs.
Note: Certain coverage benefits may vary between policies. Be sure to thoroughly review your specific plan details before purchasing.
Health insurance for kidney patients is available to those who meet particular age, health, and policy requirements. Below are the key eligibility criteria to determine who can apply for coverage:
| Feature | Details |
|---|---|
| Minimum Entry Age | Individual Plan: 5 Years for SI 3 or 5 Lakh 46 Years for SI for 3/5/7/10 Lakh Family Floater Plan: 91 days with at least 1 insured member above 18 years of age for SI 3 or 5 Lakh 91 days with at least 1 insured member above 46 years for SI 3/5/7/10 Lakh |
| Maximum Entry Age | Adult: No Age Limit | Child: 24 Years |
| Renewal | Lifelong |
| Pricing | Zone 1: Delhi NCR, Surat, Mathura, Aligarh Zone 2: Telangana, Mumbai (MMR), Ahmedabad, Vadodara, and Nashik Zone 3: Pune, Indore, Bengaluru Urban, Rest of Gujarat Zone 4: Rest of India |
| Co-payment | 20% for all customers enrolling in the policy 30% for all customers enrolling in the policy after attaining Age >= 71 years |
| Initial Wait Period | 30 Days for all illnesses except accidental injury |
| Named Ailment Wait Period | 24 months |
| Pre-existing Disease Wait Period | 24 months |
Note: The eligibility criteria mentioned above apply to Care Freedom plan. Eligibility conditions may vary by policy based on specific plan terms and requirements. Please review the policy wording carefully before making a decision.
Selecting health insurance for chronic kidney disease (CKD) or End-Stage Renal Disease (ESRD) demands careful assessment, as these are usually considered pre-existing conditions with substantial long-term treatment expenses. The key factors to evaluate are:
Kidney disease is a pre-existing condition with a 2-3 year wait. Seek plans with shorter waiting times for treatments. Always give a full medical history to avoid claim denials or cancellations.
Ensure the policy covers all major renal treatments and hospitalisation costs, including daycare procedures. Check if transplant expenses, donor costs, and pre- and post-hospitalisation care are included. Watch for sub-limits on treatments that could reduce claims.
Kidney coverage premiums are higher due to increased risk. Watch for co-payment clauses, which may require paying 10–20% of claims. Ensure the sum insured covers ongoing and long-term treatment.
Choose an insurer with a broad hospital network, particularly for nephrology specialists. A cashless facility eases financial burden during ongoing treatments.
Seek value-added benefits such as coverage for alternative treatments, pre- and post-hospitalisation expenses, and lifelong renewability to ensure ongoing protection for chronic conditions. Thoroughly examining these factors helps ensure you choose a policy that aligns with your condition stage, treatment needs, and long-term financial goals.
Many people have misconceptions about health insurance coverage for kidney conditions, particularly regarding pre-existing conditions and eligibility. Recognising these myths can help individuals make more informed, confident insurance decisions.
Myth: Pre-existing kidney conditions automatically lead to rejection.
Fact: Although underwriting might be more rigorous, many policies offer coverage following a specified waiting period.
Myth: Dialysis is not covered because it is a recurring treatment.
Fact: Numerous comprehensive and specialised plans include it under day-care procedures, in accordance with policy terms.
Myth: Transplant-related expenses are fully excluded.
Fact: Certain policies cover transplant surgery and donor expenses, though restrictions and conditions may apply.
Myth: All kidney-related treatments are covered without limits.
Fact: Policies may include sub-limits, copayments, or waiting periods for certain treatments.
Myth: Cashless treatment is not available for kidney care.
Fact: Treatments can be paid for via cashless payments at network hospitals, subject to approval.
Myth: Hiding medical history helps in getting faster approval.
Fact: Lack of disclosure may result in claim denial or policy cancellation, so being fully transparent is crucial.
Buying health insurance with Kidney coverage is quick, straightforward, and completely online. Simply follow these easy steps for a smooth sign-up.
You can submit a cashless or reimbursement claim for kidney-related treatments through your health insurance by following these steps:
| Cashless Claim Process | Reimbursement Claim Process |
|---|---|
| Step 1: Visit a network hospital and be admitted for kidney treatment. | Step 1: Pay the hospital bills upfront and submit a completed claim form along with all necessary medical documents, prescriptions, discharge summary, and original bills. |
| Step 2: Notify the insurance company and complete the necessary pre-authorisation formalities at the hospital’s insurance desk. | Step 2: Your claim will be reviewed, and you will get an acknowledgement once the process starts. |
| Step 3: The insurance desk will send the finished documents to the insurer’s claims management team for approval. | Step 3: Provide clarification or additional documents if the claims team requests them. |
| Step 4: After verifying the claim, the insurer will send you an approval letter. | Step 4: Once the claim is evaluated and approved, the eligible amount will be reimbursed to your registered bank account. |
| Step 5: Respond quickly to any further questions. Once approved, the insurer will pay the hospital directly for covered expenses in accordance with the policy terms. | Step 5: If your claim is denied, the insurer will provide you with the specific reasons. |
My appreciation for your prompt service
Rahul Sangwan
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Soubhagya K Kulkarni
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Vaibhav Rai
Health Insurance
Yes, it includes coverage for kidney disease treatment, subject to the policy terms, waiting periods, and sum insured limits.
Expenses related to kidney stone symptoms are usually covered when hospitalisation or medically necessary treatment is needed.
Yes, most comprehensive plans include coverage for kidney stone treatment, including surgery and hospital costs, subject to policy terms.
Yes, kidney stones may be considered a pre-existing condition if diagnosed before the policy was purchased, which would result in an applicable waiting period.
Comprehensive health plans or specialised policies with sufficient sum insured and minimal waiting periods are the most appropriate options.
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