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. 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.
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 critical insurance companies define a major organ transplant. Also, what are the parameters by which the insurance 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.
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, if you are wondering whether you can get critical illness cover once you already have 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.
Recommended useful information to read:
- Are you at risk? Critical Illnesses you may be susceptible to
- Things to consider before getting a critical illness insurance policy
- What you should know about Your Critical Illness Cover: The exclusions to your policy
- Save Up on Premiums: factors that affect Your Critical Illness Insurance premiums
- Dos and Don’ts When Making Critical Illness Insurance Claims
