(Last Updated On: June 19, 2023)

The occurrence of congenital diseases is increasing due to underlying shifts in lifestyles and socioeconomic issues in society that are having an impact on each new generation of children.  According to a WHO report in 2016, around 1.7 million people in India suffer from congenital diseases, which is 6-7% of the total population. Treating these diseases can drain one’s savings if one does not have health insurance. The Indian Association of Paediatric Surgeons has managed to shed light on this issue. Read further to understand if health insurance covers such diseases in our country and what it is in detail

What Are Congenital Diseases?

Congenital diseases are those diseases that are present in people from birth. During the intrauterine life of the baby, there are chances of structural or functional defects, also known as congenital anomalies or genetic disorders. This can either be detected before birth or during the infant years of the baby. 

There are two types of congenital diseases, internal and external. While congenital internal anomaly refers to issues that are visible and accessible on the outer parts of the body, congenital external anomaly refers to those diseases that are detected inside the body. Common causes of congenital anomalies are genetic mutations, environmental factors, maternal age, maternal nutritional status, socioeconomic factors, etc.

Does Health Insurance Cover Congenital Diseases?

As per the 2019 guideline of the Insurance Regulatory and Development Authority of India (IRDAI), all health insurance plans in India provide coverage for congenital diseases. Insurance companies cover medical expenses incurred on the diagnosis and treatment of such diseases, they cover pre-hospitalisation charges and post-hospitalisation charges, day-care procedures, in-patient hospitalisation, surgeries, etc. 

While each congenital anomaly requires a different treatment, the scope of coverage depends on the best health insurance plan that one has purchased. The coverage amount can range from Rs.50,000 to up to Rs.6 crore. Remember that as per the IRDAI guidelines, only internal congenital diseases are covered by regular health insurance plans

Waiting Period for Congenital Diseases

Just like any regular health insurance plan, policies that cover congenital disease also require the policyholder to complete the waiting period before they can make a claim. Generally, the waiting period is about 2 years, and this means that during this period, the policyholder cannot make any claims. The two-year waiting period is applicable only if the baby is diagnosed with a congenital disease after the policy is bought. If a policy is bought for a baby already diagnosed with a congenital disease, it will be considered as a “pre-existing disease”. In such cases, one will have to wait for longer and it can last from 2-to 4 years

Tips to Prevent Congenital Diseases

  • Eat nutritious food rich in vitamins and minerals
  • Maintain the right body weight
  • Avoid alcohol, cigarettes, and drugs
  • Avoid exposure to harmful chemicals
  • Avoid travelling unnecessarily

The congenital disease can be a lifelong struggle for the child and the parents. While treating the ailment can exhaust one’s life savings, health insurance can help take some financial burden off.