Is PCOS covered by health insurance?

 “Is PCOS covered by health insurance?”

PCOS covered by health insurance

As of 2018, women make up 22.1 percent of India's overall labour force. The growing demand for health insurance for women is fueled by rising medical inflation, rising lifestyle-related illnesses, and the rising cost of living. There are particular diseases that need to be emphasised while assessing health insurance policies for women. Women's health insurance is one such instrument that enables women to manage all of their existing medical issues, i.e., it assists financially in the treatment of certain diseases that are specific to women. While women's health insurance policies cover a wide range of diseases, PCOS is specifically mentioned.

What is PCOS?

PCOS, or Polycystic Ovary Syndrome, is a hormonal disorder that makes it difficult for a woman to become pregnant. PCOS is a condition that arises from small ovarian cysts and can have significant health consequences in the future. While hormonal abnormalities are among the most frequent issues, PCOS is also associated with physical changes. At a certain age, it is known to induce heart disease and diabetes.

The coverage for PCOS is more essential than anything else when it comes to choosing the best health insurance plan for women in India. Because PCOS causes a hormonal shift in a person's body, it's natural for women's bodies to begin generating male hormones, or androgen, which can prevent ovulation, cause excessive facial hair growth, or worsen acne.

Health Insurance Plans in India

Except for pregnancy and maternity insurance plans, there are virtually few targeted health insurance policies for women in India. There are, however, a variety of plans that cover conditions comparable to PCOS. Even the ones used for PCOS coverage, like other medical insurance schemes, get trustworthy validations before disbursing rewards. What has to be recognised is that this illness is more of a hereditary problem that is passed down through generations. Although irregular periods constitute a red flag, the insurance would expect the woman to provide other evidence in order to make a more convincing claim. If a woman wants to know if she has PCOS, she should check for symptoms including acne, excessive facial hair, weight fluctuations, reproductive difficulties, irregular periods, and more.

During adolescence or early adulthood, hormonal diseases such as thyroid, Polycystic ovary syndrome (PCOS), and others are frequently diagnosed in women. Because of the increased financial risk, insurance companies are hesitant to provide coverage, but women can still be insured after a waiting period.

The Importance of Diagnosis for PCOS

Before concluding, the doctor usually asks some important questions about menstrual cycles and other irregularities. The BMI must also be examined, as well as insulin, blood sugar, and hormone levels in the lab. This diagnosis aids in determining whether or not PCOS is present. The premium cost may increase depending on the severity of the condition after it is determined.

Health Insurance that covers Infertility Treatment

Infertility has progressively become a major concern among Indian couples. Infertility affects about 27.5 million couples in India alone. PCOS, or polycystic ovarian syndrome, is a hormonal disease that affects eight to thirteen percent of women of reproductive age. To begin, infertility may be divided into two categories: 

a) Primary infertility: When a woman hasn't become pregnant after at least a year of unprotected intercourse, she is said to have primary infertility.

b) Secondary Infertility: Someone who has gotten pregnant at least once but has never gotten pregnant again.

The reasons for infertility in females are:

  1. Ovulation disorder, or ovulating irregularly: 

  • Polycystic ovarian syndrome (PCOS), might be one of the reasons or causes in females. PCOS causes a hormonal imbalance that causes ovulation difficulties.

  • Dysfunction of the hypothalamus.

  • Ovarian failure that occurs too soon. This condition, also known as primary ovarian insufficiency, is caused by an immunological reaction or the early loss of eggs from your ovary (possibly from genetics or chemotherapy).

  • There's too much prolactin in the system. Hyperprolactinemia (excess prolactin) is a condition in which the pituitary gland produces too much prolactin, which decreases estrogen production and can lead to infertility.

  1. Damage to the fallopian tubes (tubal infertility) caused by: 

  • Pelvic inflammatory disease, a uterine and fallopian tube infection, or previous abdominal or pelvic surgery

  • Pelvic tuberculosis

  • Endometriosis, a condition in which tissue that typically develops in the uterus implants in other parts of the body. Scarring from this additional tissue development — and its surgical removal — can obstruct fallopian tubes and prevent an egg and sperm from joining.

  • Uterine or cervical causes.

In case of PCOS causing infertility and women decide to get infertility treatments, Infertility Treatment Insurance covers some of the most common treatments (some of which come under add-ons). Women may be confident that if they are hospitalised on the recommendation of a doctor for infertility/subfertility treatments, the insurance company will cover the medical expenditures. The stated techniques are for assisted conceptions. Once the problem has been recognised, such assisted techniques can be used.

1) IUI (Intrauterine Insemination): When a woman ovulates, sperm is injected directly into the uterus.

2) IVF (In Vitro Fertilization): Eggs from the ovaries are collected and fertilized with sperm from the spouse in a laboratory dish. The embryos that develop are implanted into the uterus.

3) GIFT (Gamete Intrafallopian Transfer): The eggs are extracted, fertilized with the spouse's sperm in a laboratory dish, and then inserted into the fallopian tubes.

4) ICSI (Intracytoplasmic Sperm Injection): In the laboratory, a single sperm is injected directly into a single egg, and the resultant embryo is implanted into the uterus.

In order to obtain Infertility Treatment Insurance, the insured must be informed of the following terms and conditions:

1) Eligibility - Eligibility is determined by the person’s age, medical history, and other health issues.

2) Waiting time - The waiting period for this insurance might be any time between two and four years.

3) Validity - This insurance coverage can only be used "Once."

4) Add-ons - This policy's add-ons come at a cost for premium.

Treatment Plans and the Role of Insurance

To begin, it's important to remember that PCOS may be mostly managed by engaging in regular workouts, eating a nutritious diet, keeping a weight-loss diary, and avoiding smoking. It is important to ensure that future diagnosis expenses, ultrasound fees, and even medications are paid for once the applicable health insurance plan is active. This is where comparisons of insurance policies and plans come into play. The insurance plan must cover the cost of follow-up visits to the doctor for women with PCOS. However, the flexibility can only be realised if different plans are evaluated before making a final decision.

The ideal PCOS health insurance plan for women is one that covers medication, diagnosis, and a variety of additional services. However, it is preferable to choose a broad medical cover that includes PCOS rather than focusing on a single hormonal disease that might lead to a slew of other serious issues in the future.

Purchasing health insurance is not just about protecting oneself, but also about investing in oneself. Individuals invest in vital things such as education, family, and house. But health is the most essential, since we need good health to take advantage of the wonderful opportunities that await us in the future. It is critical to have comprehensive health insurance that covers all of a woman's requirements. Women should consider their age, life stage, dependents, pre-existing ailments, and the city they live in when choosing a sum insured under a health insurance policy, according to experts.








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