What is the status of bariatric and metabolic surgery insurance coverage in india​?

As per the IRDAI’s (Insurance Regulatory and Development Authority of India) latest guidelines, bariatric or weight loss surgery will be included under health insurance cover with effect from 1st October 2019, offering some relief to morbidly obese people suffering from the disease. The inclusion will help lakhs of patients in India who cannot afford the treatment, that is spread 8-38% in rural areas and 15-30% in urban areas. As per the experts, “Barring a few, the surgery was not covered by many insurance firms as it was considered a cosmetic procedure rather than a life-saving treatment.”

Who is Bariatric Surgery Insurance suitable for?

Anyone who is morbidly obese or those who tip the scales at 100 kg or more over their normal body weight. Also, if anyone has a history of obesity in the family or has a tendency of gaining abnormal weight in a small span of time.

So, how does Bariatric Surgery Insurance work?

Few years back, bariatric surgery was a standard exclusion across the industry. However, with the changing needs of the world and the technical advancements, bariatric surgery is considered by many insurance companies now. If you are hospitalized for a Bariatric Surgery which is medically necessary, on the advice of a Medical Practitioner, we cover the related medical expenses. However, it is to be kept in mind that Bariatric Surgery Insurance benefit can be availed only when it is medically necessary and not for cosmetic purposes.

What are the conditions that should be kept in mind to avail Bariatric Surgery Insurance?

To cover the expenses of your bariatric surgery in health insurance, these are the conditions that needs to be kept in mind:

• The insured person undergoing the surgery is at least 18 years old.
• BMI more than >=40 or Conditions like morbid obesity (BMI 35-39.9) with heart disease or diabetes or stroke or disease involving heart and lungs are mostly covered under bariatric surgery.

What are the procedures that can be undertaken in a Bariatric Surgery Insurance?

Some of the common procedures that are covered under Bariatric Surgery:

• Gastric Bypass
• The Roux-en-Y Gastric Bypass
• Biliopancreatic Diversion with or without Duodenal Switch (BPD/DS) Gastric Bypass
• Sleeve Gastrectomy
• Laparoscopic Gastric Banding

Does Bariatric Surgery Insurance have a waiting period?

Yes, bariatric surgery in health insurance has a waiting period of usually 2 to 4 years. Which means, if you want to cover your expenses for bariatric surgery you will have to wait for 2 years from the start of your policy. So, it is always advisable to opt for such a benefit with your first health insurance policy itself.

What happens to your Bariatric Surgery benefit if you are porting your health insurer?

If you are porting an existing policy from some other General or Health Insurance Company or if you are adding this cover while renewing your health policy, a fresh waiting period will be applied for bariatric surgery benefit.

What is not covered under Bariatric Surgery Insurance?

Bariatric surgery for the following reasons is not covered:

• For cosmetic/aesthetic reasons
• For treating drug-induced obesity, for severe untreated hormonal imbalance, psychiatric and eating disorders-induced obesity.

What are the documents required to avail bariatric surgery in health insurance?

What is required is a documented detailed history of your obesity-related health problems, difficulties, and treatment attempts demonstrating that a multidisciplinary approach with dietary, other lifestyle modifications (such as exercise and behavioural modification), and pharmacological therapy, if appropriate, have been unsuccessful, at least for past 6 months.

Do you have to pay anything extra to avail Bariatric Surgery Insurance?

Bariatric Surgery is usually not covered with most insurers in the base policy. However, health insurers nowadays provide an option where you add this benefit to your health insurance policy by paying a little extra premium. So, before buying a health insurance policy, do your bit of the research. Bariatric Surgery Insurance is a fresh take at how health insurance is gradually becoming completely customer friendly, with plans that can be personalized according to relevant needs!