Why cover?
  • affects 1 in 4 women / 1 in 5 men before retirement
  • 94.1% of the critical illness claims are paid
  • protect yourself and your family if you get seriously ill
Why us?
  • get the cover that will pay when you need it
  • save up to 35%, cover from £5 a month
  • free, fast and without obligation quotes
Insurers: Aviva, Legal & General, Liverpool Victoria, Scottish Widows, Vitality, Zurich

What is defined as a major organ transplant and what does critical Illness insurance cover?

Critical illness insurance provides a lump sum in the event that the insured person needs a major organ transplant.

How many major organ transplants are done?

For the period between April 1, 2011 and March 31, 2012, there were close to 4,000 organ transplants carried out.

Source: http://www.organdonation.nhs.uk

The cost of a major organ transplant

  • Heart transplant only: £580,000 to £620,000
  • Single lung transplant: £360,000 to £400,000
  • Double lung transplant: £400,000 to £520,000
  • Kidney transplant: £32,500 to £65,000
  • Bone marrow transplant: using own stem cells (£32,500 to £65,000) or using bone marrow donor (£97,500 to £130,000)

Please note: These are only estimates and may change depending on the hospital selected, as well as other factors.

In this case, the organ (usually the heart, the lungs, the liver, pancreas or bone marrow) is so diseased that it stops performing its functions and becomes a threat to the person’s life. There comes the need to take out the diseased organ and replace it with a healthy one.

However, a major organ transplant can be very costly. It will involve expensive testing to see whether an organ is a match for the patient, the expenses related to the surgery itself, as well as the expenses you will need during your recovery.

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This is where critical illness insurance can help – both with the expenses for the operation, as well as to provide for your family’s needs at this point.

Now, what you may want to know is how insurance companies define a major organ transplant. Also, what are the parameters by which the company will pay your claim?

Definition of a Major Organ Transplant

Well, let’s start with saying that policies and insurance companies may define how major organ transplants are payable. So it is best to check your policy to see under what conditions the policy will pay.

Generally, though, the criteria will be:

  • Transplants of the heart, lungs, liver, kidney, pancreas or bone marrow. However, there are some policies that exclude bone marrow transplants.
  • The transplant should be necessary due to the fact that the organ has experienced an irreversible failure. For the claim to be payable, the doctor must rule that the transplant is medically necessary.
  • The diagnosis for the need for a transplant must be given by a specialist, particularly one that is accredited by the insurance company.
  • When the doctor has declared that the only effective treatment for your medical condition is a major organ transplant, you can claim against the policy and you will receive the full sum insured. However, you as the insured must survive for the next 30 days after the transplant for the claim to be payable.

The Cost of a Transplant

A transplant can cost hundreds of thousands of pounds (or even reach a million pounds, depending on some factors such as the kind of hospital, the organ type and the surgeon performing the transplant). When you undergo a major organ transplant, you need to consider the cost of both the medical and non-medical aspect.

  • Medical costs
    • Evaluation and testing prior to the transplant
    • Insurance co-payments or deductibles
    • Surgery costs (surgeon’s fee, operating room fee)
    • Recurrent lab testing fees
    • Hospital fees
    • Expenses of procuring the organ
    • Fees for other professionals: doctors, radiologist, anaesthesiologist
    • Anti-rejection medication, which can cost more than £1,000 monthly
    • Cost of therapy or rehabilitation
  • Non-medical costs
    • Transportation costs going to and fro the transplant hospital (for you, your carer and loved ones)
    • Board and lodging for your loved ones, especially if the transplant hospital is not near your house
    • Communication costs
    • Housekeeping or childcare costs, while a spouse acts as the carer
    • Lost income

Can’t health insurance cover the costs of a major organ transplant?

If you have health insurance, it can help considerably in paying for a portion of the expenses involved in having a major organ transplant. Health Insurance can cover services such as:

  • Laboratory tests
  • Doctor’s Fees
  • Surgeon’s Fees
  • Anaesthesiologist’s Fees
  • Operating Room Fee
  • Prescription medication

Limitations of Health Insurance. It should be noted that health insurance has maximum benefit limits per sickness. This means that if the cost of your major organ transplant exceeds the maximum limit, health insurance will only pay up to the maximum limit. Also, health insurance usually has co-payments or co-insurance requirements where you pay a portion of the expenses out of pocket.

Learn more about the comparison of health insurance and critical illness insurance in our article Critical Illness vs. Hospitalization and Surgical Plan.

Why get critical illness cover to protect against the expenses of a major organ transplant?

Critical illness cover can provide a good supplement for your existing health insurance. The proceeds from the critical illness cover can:

  • Cover out-of-pocket expenses related to the operation (This can include travel costs, food and accommodation costs of the carer, as well as the cost of hiring child care or housekeeping.)
  • Pay for the co-payments or co-insurance portion of the Health Insurance
  • Provide for the needs of the family (since the patient is unable to earn an income during his hospitalization and recovery)
  • Pay for expenses related to the recovery, including therapy costs
  • Pay to install adaptive equipment on one’s home

The great thing about critical illness cover is that you have the freedom to spend the proceeds of your insurance however you like.

Critical Illness Cover After a Major Organ Transplant

If you are already covered, then you can expect a lump sum payment for the major organ transplant.

Now, what about if you want to buy critical illness cover after you have had a major organ transplant?  The chances of your getting one may be very hard. In some instances, you may find an insurance company that is willing to take the risk, but this may be unlikely.

Even if you have fully recovered from the operation, the insurance company may consider you uninsurable. This is because your health has been sufficiently impaired in such a way that the health risk is always there.

Insurance companies will evaluate you based on the risk of your claiming against your policy. The higher the risk of claims, the harder it is for you to get a policy, especially for critical insurance. You may be able to get a life insurance policy, but your premium rating will be higher than normal.

Thus, while you are still healthy (and premiums are more affordable), we recommend that you get a critical illness cover.

Last updated on: 18.1.2013

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