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Does Health Insurance Plan Cover Rare Diseases?

Published On May 02, 2022

Rare diseases are specific conditions that affect a small fraction of the population. According to the World Health Organisation (WHO), a rare disease can be defined as a disease that affects one or fewer persons per 1000 people. However, in India, uncommon illnesses are defined as those that affect fewer than one person among every 2500 people.
Research suggests that nearly 72% of uncommon diseases are hereditary. Also, such diseases are life-threatening, and those who suffer from such diseases must live with them for the rest of their lives. According to the reports, nearly 96 million individuals in India or about one-fifth of the population suffer from rare diseases.

Does Health Insurance Plan Cover Rare Diseases?

Treatment For Rare Diseases

According to medical experts, about 95% of rare diseases do not have any treatment. Apart from the unavailability of treatment, since the diagnosis of such diseases are not timely, patients go through immense suffering. Even if the treatment for a rare disease is available, it can be expensive. For example, the treatment of Gaucher Disease can easily run up toRs.40 lakhs or more.

Additionally, rare diseases are chronic in nature, and therefore the treatment extends to a long period, and in turn, costs more. This is one of the reasons why rare diseases are also referred to as ‘orphan diseases.’

Do Health Insurance Policies In India Cover Rare Diseases?

Yes, many health insurance plans in India cover the treatment cost of rare diseases. No matter if the rare disease is genetic or not, you may file a claim for the treatment expenses under your healthcare policy. Generally, most insurance plans provide coverage for the medical expenses such as surgeries, hospitalisation expenses, diagnostic tests, pre-hospitalisation consultation and post-hospitalisation recovery, etc.

You can choose a health insurance cover for rare diseases to suit your budget. It is better to choose a higher coverage amount so that you have enough financial cushion. You must be aware that the insurer may not cover all the rare diseases under the health insurance plans. Hence, you must check the list of rare diseases covered under the policy, before signing the policy papers.

Waiting Period To Cover Rare Diseases Under Health Insurance Policy

Although many medical insurance policies cover rare diseases, the coverage may not be available immediately after you buy the plan. There may be a waiting period for it before you become eligible to file a claim.

Generally, all health insurance plans have an initial waiting period of 30-90 days, the coverage for rare diseases may be available after a waiting period of two to four years. This means you have to keep the policy active and pay the premium diligently for a specific period before the insurance company covers the cost of treatment for rare diseases.

If you are diagnosed with a rare disease at the time of or before buying the policy, the insurer will consider it as a pre-existing condition. In such a case, a pre-existing disease waiting period will be applicable, which could be up to four years.


Although rare diseases are not widely prevalent, they can be life-threatening. Since the treatment for such diseases is expensive, buying a health insurance plan for rare diseases is the only way to keep your savings safe and get quality medical care without worrying about the costs involved. However, make sure to compare the plans online to find the best policy to suit your needs.

Also read- Frequently Asked Health Insurance Questions, Answered!

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This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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