Health Insurance for Unproven and Experimental Treatments

Dealing with a medical issue is tough. It affects not just the patient but their whole family. But, there exist diseases so rare that mainstream treatment may not be developed yet. These diseases often defy conventional treatments, leaving patients and families grappling with physical, emotional, and financial burdens that seem insurmountable.

This is why purchasing comprehensive insurance earlier provides a financial safety net even for expensive, last-resort procedures. For patients fighting rare diseases or trying unvalidated cures, adequate insurance brings much-needed peace of mind by mitigating the mental stress over costs.

Those seeking experimental treatments may need to personally get in touch with the insurance company to figure out if the entire treatment or at least some aspects can be covered under health insurance. 

A Family Health Insurance plan provides comprehensive coverage. It ensures that both primary breadwinners and dependents, such as children and elderly parents, receive financial protection. With rising medical costs, such policies may help shoulder enormous expenses of experimental therapies should the need arise. 

Tax benefits under section 80D also prove beneficial. You can save on taxes by buying health insurance. You can claim a deduction of up to Rs. 75,000 for money spent on medical costs. This limit may change over time. This tax benefit helps make insurance even more affordable.

Here are some examples of unproven/experimental treatments and potential insurance coverage:

Most regular health plans do not cover unapproved or investigational procedures. However, some insurers provide cashless access to network hospitals, which can help patients avail innovative therapies in clinical trials. It's best to check exact policy wordings as coverage varies greatly for experimental treatments.

Costs are generally higher in urban than rural areas due to the better availability of new research facilities and expertise.

However, costs of unapproved treatments, experimental drugs, and setting up home medical equipment are not covered and require out-of-pocket payment. Cashless coverage is provided for hospitalisation and surgeries if the procedure is included in the policy. Follow-up costs are reimbursed if policy terms allow.

Note: The prices mentioned above don’t depict the true nature. Prices may vary depending upon several factors. 

Premiums vary based on age, plan, sum insured and underwriting factors. For ₹10 lakh sum insured, the individual premium is around ₹9,000 per year usually. Opting for higher ₹25-50 lakh covers, the premium rises to ₹25,000 on average annually.

While costs are more than regular plans, a higher sum insured provides solid protection against expensive therapies over a lifetime. Even a single high-cost claim could offset multiple annual premiums.

Given long-term risks, investing in a ₹50 lakh or 1 crore individual or family plan is prudent. It ensures comprehensive coverage through different phases of research and rising medical inflation. The premium costs are relatively lower compared to the potential value of benefits in case of medical difficulties.

Estimate your health insurance costs with Health insurance premium calculator

As a fully digital insurance provider, ACKO has developed an intuitive mobile app that acts as a one-stop destination to facilitate insurance claims. Through the ACKO app, policyholders can effortlessly buy, renew, and raise health claims. Real-time claim tracking is also available. ACKO's digital operations lead to lower premiums as well. 

Having a comprehensive health insurance plan can provide crucial financial support and peace of mind for those exploring unproven or experimental treatments for themselves or their family members. With features like zero deductibles, no waiting periods, and the option to add extensive coverage through a super top-up plan, patients can focus on their health without worrying about the financial burden of their medical care. Investing in a health insurance plan with a higher sum insured is wise, ensuring comprehensive protection against the unpredictable expenses of cutting-edge treatments.

Disclaimer: The plans, services, features, processes, and other details mentioned on this page are subject to availability and changes. Please check the applicable policy wordings before making any insurance-related decisions. Feel free to reach out to us at [email protected] for any queries.