People with obesity problems would not be alien to the term bariatric surgery. It is a medical procedure that causes weight loss by limiting the amount of food the stomach can hold or restricting theassimilation of nutrients or both. Some common procedures are gastric bypass, sleeve gastrectomy, adjustable gastric band, etc. Until October 2019, bariatric surgery was not covered by most insurance companies as it was treated as a cosmetic procedure as opposed to necessary medical treatment. This was based on an archaic 1970s clause that had termed bariatric surgery as a cosmetic one. However, with obesity becoming one of the biggest health challenges faced by people, covering this surgery under health insurance was necessary.

The Insurance Regulatory and Development Authority of India (IRDAI) released new guidelines in October 2019 instructing insurers to include bariatric surgery under health insurance plans. With more than 30 percent of urban residents suffering from obesity, this came as welcome news to lakhs of patients who could not afford the costs of bariatric surgery.

Bariatric Surgery – who needs it?

Typically, when all options like exercise, diet control, etc. fail, bariatric surgery is the only option to lose weight. The World Health Organization (WHO) measures obesity in terms of the body-mass index or BMI. Any person with a BMI of 30 or more is considered obese.

Obesity can be a serious health problem interfering with basic functions like breathing, sitting, sleeping, etc. If the BMI goes beyond 40 or if a person with a BMI of 35 has existing conditions like diabetes, high blood pressure, etc., then the person is said to be suffering from morbid obesity.Bariatric surgery is usually recommended to patients with morbid obesity or those weighing more than 100kg than their normal body weight (as per their height).

While the cost of the surgery can vary based on the type of surgery, hospital, surgeon’s fees, etc., the average cost of bariatric surgery in India is between ₹2.5 lakhs and ₹5 lakhs.

Health Insurance cover for Bariatric Surgery in India

Every insurance company defines terms under which it accepts claims for bariatric surgery. Usually, insurers cover the cost of this surgery if it is medically necessary and under the advice of a medical practitioner. Insurance companies do not cover bariatric surgery costs done for cosmetic purposes.

Some general terms and conditions that you must keep in mind are:

• The person insured must be at least 18 years of age
• Body Mass Index (BMI) greater than or equal to 40 OR 35 > BMI > 39.9 with co-morbidity conditions like diabetes, heart disease, etc.

The major insurance providers like Tata AIG cover reasonable and customary expenses for Bariatric Surgery. Some insurance companies have a waiting-period requirement before you can claim expenses for bariatric surgery, varying from 2-4 years.

Features of Health Insurance: Inclusions and Exclusions

• Every insurer provides a list of diseases or ailments that are not covered for a specified waiting period after buying the policy
• Pre-existing conditions usually have a longer waiting period
• Any medical condition arising out of the abuse of intoxicants or hallucinogenic substances
• Mental health treatments
• Plastic or cosmetic surgery
• Rehabilitation or sanatorium treatment
• Hospitalization for enteral feedings
• Unproven or experimental treatments
• Cosmetic dental treatments
• Pregnancy or the voluntary termination of pregnancy
• Any injury due to a war in the country
• Any consultation or diagnostic tests conducted at the hospital that is not incidental to the diagnosis and treatment of the positive existence or presence of any illness or injury, etc.

Apart from offering cover for bariatric surgery, the health insurance policies also offer the following benefits:

• In-Patient Treatment or hospitalization expenses
• Pre-hospitalization expenses that include consultations and medicines before being hospitalized
• Post-hospitalization expenses that include consultations and medicines after being discharged from the hospital
• Daycare treatment expenses
• If the insured person is the recipient of organ donation, then the policy will cover the expenses of the organ donor for harvesting the organ
• Domiciliary hospitalization benefits
• Ambulance expenses for transporting the insured person to the hospital
• Preventive health check-up expenses
• Expenses made for consumables like items of personal comfort, disposable medical equipment, etc.
• A certain amount of cover outside India
• Vaccination expenses
• Hearing aid expenses
• Second opinion expenses for pre-specified diseases/ailments

It is important to remember that these benefits might have some conditions that you need to fulfil. Also, some of these features might be charged extra by some insurers.

Summing Up

If you have purchased a policy before October 1, 2019, then you might want to contact your insurer and check if bariatric surgery has been added to the list of approved medical procedures covered by the policy. With most Indians suffering from obesity during the later stages of their lives and the chances of having other health problems increasing with age, having a health insurance policy that offers coverage for bariatric surgery is important.

Donna Devilson