What is Bariatric Surgery in Health Insurance: A Comprehensive Guide
Obesity is becoming the root cause of many diseases in today’s era, the main reasons for this are irregular lifestyle, bad eating habits and lack of exercise.
According to a study report by “The Lancet”, from 1990 to 2022, the obesity rate in India has increased from 1.9% to 9.8% among women, while it has increased from 0.5% to 5.4% among men, and it is likely to increase further in the coming times in India.
From a Health Insurance perspective, it is important to know what the obesity treatment surgery called “Bariatric Surgery” covers for each policyholder and stakeholder (Insurance Consultant, Insurance Industry Employees.)
As per the experience with the Insurance Company, the definition is when any person’s BMI (Body Max Index) reaches 30 then it is a sign of an initial level of obesity (It varies a little bit from Insurer to Insurer), Now real Curiosity what is the terms and conditions for Bariatric Surgery in Health Insurance, Yes there are always terms and conditions for any features and benefits in Health Insurance to prevent misuse and safeguard the Insurance Industry and other policyholders by the Regulator (IRDA) & Insurance Companies.
Terms and Conditions for Bariatric Surgery in Health Insurance:-
- Bariatric Surgery needs to be performed by an expert medical practitioner
- The surgery’s procedures need to be supported by the clinical protocol.
- Insured Person must be 18 years or above the age completed at the time of Surgery
- Body Max Index (BMI), should be 40 or above
- BMI should be accepted at 35 with the following medical conditions / co-morbidities
Some Basic Definitions for Bariatric Surgery Terms in Health Insurance
BMI– Measurement that helps determine if the person has a healthy weight based on their height and weight.
Co-morbidities– Additional medical conditions or diseases that occur alongside a primary health condition or illness.
Obesity-related cardiomyopathy – Heart condition caused by excessive weight, which weakens the heart muscle.
Coronary Heart Disease– Heart-related medical condition, where the heart’s blood vessels become narrowed or blocked, leading to reduced blood flow to the heart muscle.
Sleep Apnea– Sleeping Disorder where breathing stops/becomes very light during sleep, causing interruption and daytime feeling tiredness.
Frequently Asked Questions for Bariatric Surgery for Health Insurance
Q- If anyone is obese then can an Insurance company offer a health insurance policy?
Ans– It will depend on the company to the company and if BMI is equal to 40 or above, most probably the company will not offer the policy.
Q– How much higher BMI will accept and in what conditions?
Ans- Accepting the overweight/obese applicant for health insurance will depend on the other medical conditions / morbid / co-morbid if accepted then the extra premium will be charged by the insurance company.
Q- Whether the policyholder will pay the extra premium for all the renewals also?
Ans- Yes, Once the extra premium will apply for any reasons it will be charged by the insurance company for all the renewal premium, whether policyholders get cured with the medical conditions
Q- If the insurance company accepts the policy of an overweight/obese applicant, can bariatric surgery be performed immediately?
Ans-No, if the policy is issued then the pre-existing waiting periods of the insurance plan can be up to a maximum of 36 months and also fulfil all the requirements of “Bariatric Surgery”.
Q-So, can the policyholder get this surgery done after a few months/years of taking insurance if the policyholder fulfils all the conditions of bariatric surgery?
Ans- Yes, with all the terms and conditions fulfilled.
Conclusions – After the terms and conditions for Bariatric Surgery and the number of increasing obese persons in India, should get health insurance as early as possible, feel free to get in touch with us for more clarification and understanding of your existing company policy and the new policy.
Disclaimer – We are not suggesting any medical advice/treatment it is totally for education and awareness for the health insurance
