Health Insurance for Bariatric Surgery in India

Bariatric Surgery Coverage Under Health Insurance

Last year in October 2019, as per the IRDAI’s (Insurance Regulatory and Development Authority of India) guidelines, bariatric or weight loss surgery was included under health insurance cover. The move was to ensure coverage to obese people suffering from co-morbidities related. With this inclusion in both family health insurance plans and individual health plans or even a critical illness insurance policy, nearly 38% people were expected to benefit in the rural areas ad 30% urban population of India.

What is Bariatric Surgery?

Bariatric surgery refers to a set of surgical procedures that helps obese people to lose weight. These surgeries are typically recommended when other weight loss methods, such as diet and exercise, have not been successful, and a person has a body mass index (BMI) of 40 or higher.

People who are overweight and have a greater BMI even after walking and working out, losing weight can get challenging for them. Thanks to bariatric surgery, that can help people lose weight by undergoing a surgery. It is a safe procedure that aids in weight-loss and helps in shedding of the excess weight.

This surgery is suggested to people who are suffering from obesity and serious weight-related health issues like cardiovascular illnesses, type-2 diabetes, high blood pressure, etc.

The patient needs to follow a certain diet plan before undergoing the bariatric surgery, followed by exercise to avoid post-surgery weight gain. Though bariatric surgery is a safe alternative to lose weight but there are certain risks involved as well including infections, blood clotting in the lungs, and internal bleeding.

How Much Does Bariatric Surgery Cost?

A bariatric surgical procedure can cost around ₹2.5 lakh to ₹5 Lakh and the exact cost would depend on other factors including the type of surgery, hospital, gastroenterology surgeon’s fees, etc. Other additional costs would include the cost of surgical instruments, anaesthesia, and follow-up procedures.

Does Health Insurance Cover Bariatric Surgery?

Health insurance now covers bariatric surgery if you meet requirements. The coverage depends on the health insurance plan selected by you. Health insurance companies in India accept the claims for morbid obesity or co-morbidities or life-threatening conditions as mentioned in the policy. If the doctor advises bariatric surgery you can get compensation for the expenses. Generally, you need to furnish the proof to the insurer that the surgery is medically essential.

Until 2019, bariatric surgery was a standard exclusion in mediclaim policies. However, with technological advancements and new IRDAI guidelines, many insurance companies pay for bariatric surgery. However, the benefit is only available if it is medically necessary and is not being used for cosmetic purposes.

Types of Bariatric Surgery Procedures Covered in Health Insurance

Medical insurance covers the following bariatric surgery procedures:

• Biliopancreatic diversion
• Open or laparoscopic gastric bypass
• Sleeve Gastrectomy
• Laparoscopic adjustable gastric banding
• The Roux-en-Y Gastric Bypass

After the surgery, one's ability to eat is restricted, thereby causing weight loss. After the surgery, the person has a smaller stomach that can only hold a few ounces. Additionally, some weight-loss surgeries limit the absorption of nutrients and calories. If you are undergoing the procedure you will also need to take part in nutrition and behaviour classes to help you with post-surgery life.

Is there any Waiting Period for Bariatric Surgery in Health Insurance?

The waiting period in health insurance applies to bariatric surgical procedures and ranges from 2 to 3 years. So, if you want to claim your bariatric surgery expenses then you can do so after the completion of the waiting period post-policy purchase.

Health Issues Resolved After Bariatric Surgery

Obesity-related health issues that are resolved after the surgery are as follows:

• Fatty liver disease
• Gastroesophageal reflux disease
• Arthritis
• High blood pressure
• Breathing disorders
• Urinary stress incontinence
• Cholesterol
• Asthma
• Sleep apnea
• Venous stasis

What are the Exclusions Under Health Insurance for Bariatric Surgery?

Whether it is covered in a critical illness policy or a family health insurance plan, following exclusions apply to bariatric surgical procedures:

• Claims filed within 30 days of policy commencement are excluded
• Pre-existing conditions related claims are also not covered
• Cosmetic/aesthetic reasons
• Drug-induced obesity, psychiatric and eating disorders induced obesity, and untreated hormonal imbalance

The best way to avail health insurance benefits for bariatric surgery is by doing proper research before buying health insurance online.

How to Raise a Claim for Bariatric Surgery?

When filing claims for bariatric surgery under your health insurance policy, you need to meet the following conditions and submit the below-mentioned documents:

• Surgeons prescription for diagnostic tests and authorization to undergo the surgery
• The policyholder also need to submit the medical reports and descriptions to file a claim for bariatric surgery expenses
• The patient needs to have a BMI of 40 or higher
• In case your BMI is 35 or above, and you are facing health issues such as sleep apnea, type 2 diabetes and heart-related problems.

In a Nutshell

Expenses incurred on bariatric surgery are usually not covered in a basic medical insurance policy. However, insurers nowadays offer an option to get bariatric surgery insurance as an add-on cover by paying a little extra premium. But this would vary from one plan to another and from one insurer to another. In fact, coverage for bariatric surgeries is a fresh take at how medical insurance in India is gradually becoming more customer-friendly, by offering personalized and extensive coverage benefits.