Congenital Disease Covered Under Health Insurance –  Yes Or No?

Health is wealth, literally, and this is not a meaningless cliché. And to keep your health and wealth intact, it is essential to lead a healthy lifestyle so that you can avoid medical expenses. 

However, there might be a situation where one is born with congenital disease and must incur impending medical expenses for the treatment.

The treatment of congenital disease can be expensive since it may be long-term. However, it depends upon the disease type and how early it has been diagnosed. Now, the question that arises here is, can someone suffering from a congenital disease purchase insurance? Let’s find the answers. But first, let us explain in detail what is a congenital disease.

Congenital diseases are those that are present at birth or are diagnosed shortly after birth. These diseases can be caused by genetic factors, environmental factors, or a combination of both. While some congenital diseases may have minimal impact on a person’s health, others can be life-threatening and require extensive medical care. In such cases, having health insurance coverage can provide financial assistance to families dealing with the costs associated with the treatment of these conditions.

Many health insurance policies cover congenital diseases, but the specific coverage and limitations may vary depending on the plan. Some policies may only cover specific congenital conditions, while others may have a limit on the amount of coverage for treatment or may require prior authorization for certain treatments.

Common congenital diseases that may be covered under health insurance include heart defects, cystic fibrosis, Down syndrome, spina bifida, and sickle cell anemia, among others. Treatment for these conditions can include surgery, medication, therapy, and ongoing monitoring and management.

It is important to carefully review the terms of a health insurance policy to understand the extent of coverage for congenital diseases. Families with children who have a congenital disease may want to consider a policy with comprehensive coverage, including specialist care and ongoing support to help manage the condition.

What is Congenital Disease?

Congenital diseases are health disorders that are present in individuals by birth. They are structural or functional birth defects that form during the intrauterine life of a baby. It is also known as congenital anomalies. 

Some examples of these diseases are Down syndrome, congenital heart disease, club foot, Thalassemia, Sickle cell disorder, Congenital hypothyroidism, Cerebral palsy, etc. 

Common Causes of Congenital Diseases

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

According to a report by WHO in 2016, approximately 1.7 million of the population in India suffer from congenital diseases, which is 6-7% of the total population. While internal congenital diseases are not visible, external congenital anomalies can be easily identified.

Congenital Diseases and Health Insurance 

Congenital diseases are covered by health insurance plans. Many health insurance plans cover the medical expenses incurred on the diagnosis as well as treatment of congenital diseases. These expenses include in-patient hospitalisation, day-care procedures, surgeries, pre & post-hospitalisation, etc. 

However, the coverage amount and the diseases can vary from one policy to another depending upon the plan you choose. 

Remember all congenital diseases are not covered under the health insurance plan. You must go through the policy terms to be sure of the diseases that are covered since each plan may have a specific disease covered. 


Waiting Period and Congenital Diseases

It’s true that health insurance policies cover congenital diseases but there is a clause of waiting period attached to the policy. The waiting period in health insurance plans is the period for which you need to wait before getting the insurance benefits. It is the duration during which certain diseases will not be covered by the policy. Make sure you check for the waiting period mentioned in your policy about congenital diseases.

Usually, there is a waiting period for specified diseases or procedures in all policies. Hence, you may not be able to raise a claim for expenses arising from congenital diseases during the waiting period if any.

To sum up, congenital diseases may exhaust one’s savings during the treatment process. This makes it crucial to have a health insurance plan that gives you the financial security that is most needed to tide over such medical expenses. 

Additionally, if you are purchasing a health insurance policy make sure congenital diseases are covered. If you want to get more details on health insurance coverage or wish to buy a plan, you can visit the Bajaj Finserv. 


Anywhere, Anytime insurance with the Bajaj Finserv

The Bajaj Finserv is a high utility that takes care of all your financial needs including insurance. On the , you can explore benefit-rich health insurance plans from our trusted partners. Here you can view product features, compare prices and purchase a plan that is best suited to your needs. All this in a matter of minutes and from the comfort of your home. It truly is becoming the new way to buy insurance. If you or your family are still to experience the security of health insurance, login to the Bajaj Finserv and get started now!


Disclaimer: T&C Apply. Bajaj Finance Limited (‘BFL’) is a registered corporate agent of third-party insurance products having IRDAI composite registration number CA0101.Please note that, BFL does not underwrite the risk or act as an insurer. Your purchase of an insurance product is purely on a voluntary basis after your exercise of an independent due diligence on the suitability, viability of any insurance product. Any decision to purchase an insurance product is solely at your own risk and responsibility and BFL shall not be liable for any loss or damage that any person may suffer, whether directly or indirectly. For more details on risk factors, terms and conditions and exclusions please read the product sales brochure carefully before concluding a sale. 


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