Is Bariatric Surgery Covered by Insurance?

09 Dec Is Bariatric Surgery Covered by Insurance?

Bariatric surgery is a procedure performed on an individual with morbid obesity or on individual with Class II obesity (BMI between 35 kg/m² and 39.9 kg/m²) along with associated comorbidities. The two major factors that prevent a patient from undergoing bariatric surgery are fear of surgery and the cost of the surgery. With advancement of technology, surgeries have become safer and with surgical material being manufactured in India, the cost of surgery has considerably reduced. Due to these factors, now India has become one of the most sort of destination for bariatric surgery for foreign nationals.

Bariatric surgery is now covered by insurance but it is on case to case basis. As per the new IRDI Guidelines,  all the insurance providers will now offer bariatric surgery under their schemes to the  clients who have purchases policy after 1^st October 2019. For existing policyholders this will be  active with effect from 1^st October 2020.

A working group has been constituted by IRDAI to review the practices and make appropriate recommendations. One of the important suggestions from this Working Group is listed in Chapter III, point “F” of this circular. This explains, while every insurance company may want to enhance the availability of health insurance coverage to bariatric patients, the insurance policy contracts may allow for expenses related to the surgical treatment of obesity that does met the below conditions:

1. Surgery conducted is upon the advice of a Doctor
2. The surgery/procedure conducted is supported by clinical protocols
3. The member is 18 years of age or older and
4. Body Mass Index (BMI):
   1. greater than or equal to 40 or
   2. greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight loss:
      1. Obesity-related cardiomyopathy
      2. Coronary heart disease
      3. Severe Sleep Apnea
      4. Uncontrolled Type2 Diabetes

Source: https://www.irdai.gov.in/ADMINCMS/cms/Search_Results.aspx (Chapter III, point “F”)

This positive move by IRDAI in restructuring the health insurance in India, in favor of bariatric surgery will now enable  people who are fighting with obesity and its complications to avail treatment and remain healthy.

To know more and understand how we can help reduce your obesity, reach us at codsils.info@gmail.com