Best health insurance for weight loss surgery

India is getting thicker day by day. In 2001, there were 4-5 bariatric surgery cases in India (yes, single digits) and today, the number of weight loss surgeries has increased to 30,000 (articles). You can ask Insurance or no insurance, this is certainly a cause for concern as obesity leads to a host of other health complications including hypertension and diabetes.Best health insurance for weight loss surgery.

Is obesity a disease? Perhaps earlier, but today it is more of a man-made complexity. A survey conducted on 10th to 12th grade students in a public school showed that 33% of them were obese. Another study of 4,000 students in Delhi found that 22% of them are overweight. It is a function of changing lifestyles, malls, fast food, stress, long working hours, etc. – all leading to more inquiries on “insurance cover weight loss surgery”.

In this article, we will identify the best health insurance plans in India that cover weight loss surgery. To be honest In addition to bariatric surgery health insurance coverage, we will look at terms and conditions, exclusions and other important components in insurance plans.

BMI, Bariatric Surgery and Health Insurance

It all starts with your body mass index or BMI.

Simply put, the body mass index (BMI) is a measurement of body fat based on your height and weight.

BMI is generally calculated by dividing your weight (in kilograms) by the square of your height (in meters). E.g – I weigh 77 kilograms and 1.65 meters. So my BMI is 77 / (1.65) ^ 2 = 28.28.

A BMI of 28.28 is called “overweight” and you are considered obese when the BMI is over 30. Use the Religare BMI calculator to calculate your BMI and table of values, which gives you rates ranging from underweight to very obese.

Doctors recommend bariatric surgery for BMI over 40. Insurance for bariatric surgery in India is more available than before

Doctors usually recommend weight loss surgery when a patient’s BMI is 40 or more (very high). This is not a firm rule and doctors may recommend bariatric surgery at a BMI of 35 or more if there are complications related to obesity such as type 2 diabetes, asthma, high blood pressure, sleep apnea, etc.

Best health insurance for weight loss surgery

Changes in diet and exercise to lose weight are the first line of defense for overweight people. And on other hand where it does not work, bariatric surgery becomes the only option. The procedures performed under weight loss surgery include gastric bypass (open and laparoscopic), gastric sleeve, laparoscopic adjustable gastric banding, and billiopancreatic diversion. The idea of   these processes is to dramatically restrict the ability to eat, which leads to weight loss.

BMI and health insurance are heavily related. All health insurance companies have started an investigation on a person’s BMI (and that’s why all proposal forms include height and weight questions). A high BMI i.e. 30 or more insurance company is an indication to investigate the matter whether to accept the risk or not. Health insurance offers with high BMI almost always undergo a round of underwriting i.e. tele-medical or physical therapy.

Does health insurance cover bariatric surgery?

Yes, some insurance plans pay for bariatric surgery

Yes, some insurance plans pay for bariatric surgery.

These are all health insurance plans, which do not allow any weight loss treatment.

The primary issue is conflict in Outlook. In other words, bariatric surgery is a cosmetic or a medically necessary treatment.

Insurance companies consider weight loss surgery to be cosmetic because obesity is not a disease or ailment or illness, but a product of one’s lifestyle, diet, sedentary nonactivity, sugary foods, stress, etc., that is why losing weight Processes are included. It is explicitly listed as a permanent exclusion by insurance, if the condition is life-threatening, it will be held as an exception.

In an article published by The Times of India, Dr. An interesting quote from Pravij Raj was found which says:

Many insurance policies will refer to any bariatric surgery as one of the exclusives, or cite an Arctic 1970 clause, which calls for weight loss surgery as a cosmetic procedure that covers it. Will go away.

By saying all this, it is interesting to note that the Central Government’s Health Scheme (CGHS) has been reimbursing patients for bariatric practice since 2013.

So why are some plans covering bariatric surgery?

The increasing incidence of bariatric surgery has caused health insurance companies to consider these in their medical insurance plans. The cost of bariatric surgery in India is between ric 2 lakh to ric 5 lakh. Offering bariatric surgery in their medical insurance plans (with certain conditions), allows insurance companies to sell more plans.

IRDA has standardized the definition of bariatric surgery in insurance plans.

A second catalyst to promote weight loss surgery insurance comes from the IRDAI Guidelines on Standardization in Health Insurance Contracts (Circular) issued on 27 September 2019.

This circular applies to all health insurance schemes and comes into effect from 1 October 2019. Under the provisions of this circular, bariatric or weight loss surgery will be covered under health insurance cover.

This inclusion falls under the standardization of exclusions in the provisions of health insurance policies (which are different for different health insurance plans).You can say Here, surgical treatment of obesity / weight control can be excluded only if it does not fulfill the below conditions –

Best health insurance for weight loss surgery

Surgery should be done on doctor’s advice

Conducted surgery / procedure should be supported by clinical protocols

As usual the minimum age of the member is 18 years

Body mass index (BMI) should be:

Greater than or equal to 40

Over or above 35 in combination with the following severe comorbidity following the failure of less invasive methods of losing weight:

Obesity related cardiomyopathy

coronary heart disease

Severe sleep apnea

Uncontrolled Type 2 Diabetes

Health insurance plan which includes weight loss surgery in India

Best health insurance for weight loss surgery

We discussed earlier that insurance companies cannot randomly dismiss insurance claims for bariatric surgery (weight loss surgery) and if this confirms the conditions I have previously described. All health insurance plans should follow these IRDAI developed definitions for bariatric surgery.

However, there is some conflict or lack of knowledge on the part of the consumer or his agent which will be for the benefit of the policyholder. Therefore, it is better to trigger the health insurance portability option in your existing policy and switch to a new plan that gives you these benefits.

Here are some of the best health insurance for bariatric or weight loss surgery:

  • Magma HDI OneHealth Insurance Policy
  • Digit Health Care Plus Health Insurance Policy
  • Edelweiss health insurance policy
  • Tata AIG Medicare Health Insurance
  • Star Health Comprehensive Insurance Policy
  • Bajaj Allianz Health Guard Gold Plan

Magma HDI OneLateral Insurance Policy

Magma HDI Vanhas Insurance Policy with Bariatric and Weight Loss Surgery Insurance

The Magma HDI Vanthalis Insurance Policy provides a generous bariatric surgery cover across all insurance amounts up to 1,00,000. And all this means, even if you opt for a 2 lakh insured health insurance plan, you are entitled to up to 1 lakh of bariatric surgery claims. Best health insurance for weight loss surgery.

The above points seem quite unbelievable as other health insurance plans seem to offer this only to highly insured insurance plans. Therefore, it is important for us to examine the provisions closely.

Policy terms only allow reimbursement of expenses incurred on undergoing medically necessary bariatric surgery. The conditions are as follows:

Surgery should be prescribed by a specialist doctor

BMI of the insured must be above 35

Bariatric surgery should be non-cosmetic in nature

There is a waiting period of 3 years from the policy commencement date to apply to claim under this benefit.

Digit Health Care Plus Health Insurance Policy

Digit Health Care Plus Health Insurance with Bariatric and Weight Loss Surgery Insurance

The Digit Health Care Plus Health Insurance policy pays for bariatric surgery which is medically necessary if the insured meets the following conditions: Best health insurance for weight loss surgery.

The insured is 18 years of age or older

The medical practitioner or bariatric surgeon confirms that the BMI and health status of the insured falls under the eligibility requirements given below:

Class III obesity (extreme obesity) ie BMI> = 40

Class II obesity ie BMI is 35 to 39.9 kg / m2 with any of the following combinations:

Uncontrolled diabetes

Heart disease such as stroke, myocardial infarction, etc.

History of coronary artery disease with surgical intervention

Cardiopulmonary problems

Claims under bariatric surgery insurance benefits are available for the following procedures:

gastric bypass

Roux-en-Y Gastric Bypass

Duodenal switch (BPD / DS) with or without gastric bypass bilateral diversion

sleeve gastrectomy

Laparoscopic gastric banding

Bariatric surgery benefits begin only after a waiting period of 24 months

Best health insurance for weight loss surgery

Digit health insurance plans are highly customizable. One of the plans that I saw on my website is the maximum coverage allowed for bariatric surgery insurance limited to 5% of the sum insured. Thus for a sum insured of ₹ 5 lakh, you will have a bariatric surgery limit of ₹ 25,000, which is highly inadequate. Best health insurance for weight loss surgery.

In the Digit General Insurance claim process, you must present a detailed history of your obesity-related health problems, difficulties, and treatment efforts. So beware and careful of some paperwork and start collecting and keeping records of your obesity issues. Although other insurance companies have not mentioned this, please assume that there is heavy paperwork for all insurance companies.

Finally remember that the insured person has to get permission before Digit Insurance before performing weight loss surgery. And surgery is excluded from coverage for the following reasons:

  • Cosmetic or aesthetic reasons
  • Medication-induced obesity treatment
  • Severe untreated hormonal imbalance
  • Psychiatric and eating disorders induced obesity

Edelweiss health insurance policy

Best health insurance for weight loss surgery

Edelweiss Health Insurance Policy with Weight Loss and Bariatric Surgery Insurance

The Edelweiss Health Insurance policy compensates for hospitalization expenses incurred on bariatric surgery procedures. Pleasantly, the insurance company pays pre-hospitalization and post-hospitalization expenses within the permissible limits for surgery.

The plan only provides for bariatric or weight loss surgery expenses for Gold and Platinum plans (not Silver plans) and is limited to 10% of the sum insured. The Gold Plan starts at ₹ 5 Lakh Sum Assured. Best health insurance for weight loss surgery.

The Bariatric Surgery Allowance of Edelweiss Health Insurance is subject to the following conditions:

The minimum age of the insured at the time of surgery should be 18 years

Benefits do not include:

And another thing reversible endocrine or other disorders that can cause obesity

Current drug or alcohol abuse

Uncontrolled, severe psychosis

Risk, benefits, expected outcomes, choice and lack of lifestyle changes with bariatric surgery

Indications for bariatric procedure should be found appropriate by two qualified surgeons

The insured must meet the following criteria:

BMI must be greater than 40 or greater than 35 with co-morbidity

another point is unable to lose weight through traditional methods like diet and exercise

Interestingly, I did not find any special waiting period for bariatric surgery which means that expenses are claimed after the initial waiting period (30 days) unless the disease is already present.

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Tata AIG Medicare Health Insurance

Tata AIG Medicare Health Insurance with Weight Loss and Bariatric Surgery Insurance

The TATA AIG MediCare Health Insurance Policy provides compensation for expenses incurred for weight loss surgery under bariatric surgery cover. Best health insurance for weight loss surgery.

Bariatric surgery covers reasonable and customary expenses if the following conditions are met:

  • Surgery will be done on the advice of the doctor
  • Minimum age of the member must be 18 years
  • BMI greater than or equal to 40
  • BMI is equal to or greater than 35, with any severe comorbidity following the failure of less invasive methods of losing weight:
  • Obesity related cardiomyopathy
  • Severe sleep apnea
  • Uncontrolled type 2 diabetes, or
  • coronary heart disease

Star Health Comprehensive Insurance Policy

This policy is Star health insurance with weight loss and bariatric surgery insurance

The Star Health Comprehensive Insurance Policy provides for coverage of ₹ 2,50,000 per policy period for expenses incurred on hospitalization for bariatric surgical procedure and its complications. This -250,000 spending limit is includ-ed towards pre-hospitalization and hospitalization towards bariatric surgery. Also, claims under this benefit can only be process-ed on a cashless basis. Best health insurance for weight loss surgery.

The policy applies a waiting period of 36 months before claiming under this benefit.

Additional conditions applicable to this benefit are:

The minimum age of the insured at the time of surgery should be more than 18 years

The benefit will not apply where surgery is perform-ed:

First of all reversible endocrine or other disorders that can cause obesity

Current drug or alcohol abuse

Uncontrolled, severe psychosis

Risk, benefits, expected outcomes, choice and lack of lifestyle changes with bariatric surgery

Bariatric surgery done for cosmetic reasons

Indications for the procedure should be found appropriate by two qualified surgeons

The insured will obtain prior approval for cashless treatment from Star Health Insurance Company

The insured must meet the following criteria:

BMI must be greater than 40 or greater than 35 with co-morbidity

And lastly unable to lose weight through traditional methods like diet and exercise

Bajaj Allianz Health Guard Gold Plan

This policy is Bajaj Allianz Health Guard with Weight Loss and Bariatric Surgery Insurance

This Bajaj Allianz Health Guard Insurance Policy was launch-ed in February 2017. The plan offers bariatric surgery under the Gold variant and is limit-ed to 50% of the sum assur-ed, which is the maximum. 5,00,000.

This important Bariatric surgery coverage comes with a waiting period of 36 months

Under the terms and conditions of bariatric surgery insurance cover, Bajaj Allianz will pay reasonable and customary expenses related to bariatric surgery under the following conditions:

Adults 18 years of age or older

The presence of severe obesity document-ed in contemporary clinical records is defin-ed as one of the following:

BMI is greater than and equal to 40 in combination with any of the following severe co-morbidities.

coronary heart disease

Clinically refractory hypertension

Type 2 diabetes mellitus

Surgery is also an option for people with a body mass index between 35 and 40 who have health problems such as type 2 diabetes or heart disease. Best health insurance for weight loss surgery.

As is true with all other health insurance plans, bariatric surgery should be performed for non-cosmetic reasons and the indication for the procedure should be found appropriate by two qualified surgeons. Remember to get pre-approval from Bajaj Allianz for cashless treatment before starting weight loss surgery.

The conclusion

Does insurance cover weight loss surgery? This is a fantastic yes because we have featured many health insurance plans that cover bariatric surgery.

Along with we also looked at which insurance covers bariatric surgery in India and found that the Indian consumer has many options. Care should be taken when comparing health insurance plans that cover weight loss surgery during coverage, conditions, and waiting periods.

Another important thing the recent guideline change by IRDAI is a welcome step and will ensure that more health insurance plans introduce bariatric surgery and procedures into their products. Best health insurance for weight loss surgery.

Thank you for your time.

Stay safe and be healthy!

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