Out of various health issues emerging in the human body, one that stands out as mysterious, puzzling, and most difficult to deal with is a ‘coma’. This is because the exact mechanism of why coma occurs can be highly complex and varied.
When a patient suffers from this critical illness, the physical, emotional, and financial toll can be overwhelming. Such patients require extensive medical care, round-the-clock monitoring, and specialized treatment to navigate their path toward recovery. In such challenging times, having a health insurance plan that covers coma-related expenses becomes crucial. Coma health insurance plans are designed to help people during a coma by covering many things, such as treatment, rehabilitation, and recovery costs. Note there is not a separate health insurance exclusively for coma. Instead, various health insurance providers cover coma under their critical illness coverage. However, for easy discussion, we will refer to such plans as ‘coma health insurance’.
In this post, we will delve into the core aspects of such plans, unraveling their significance, benefits, functioning, and more.
What’s Coma & Its Major Symptoms?
A coma is a complex medical condition that causes an individual to be in a state of deep and prolonged unconsciousness. The condition can also be referred to “partially dead state” because the individual suffering from a coma is unresponsive to external stimuli and does not experience wakefulness as other normal human beings.
Coma can be caused by various factors, including strokes, traumatic brain injuries, metabolic disorders, infections, brain tumors, or other severe medical conditions. The severity and duration of a coma depend on the underlying cause and the individual’s overall health.
Some of the major symptoms of coma are as follows:
- If a patient shows no response to external stimuli, such as they do not open their eyes, respond to verbal commands, or exhibit purposeful movements.
- When life support measures become necessary for the patient’s survival.
- When there are limited reflexive movements, such as limited responses to pain, pupils not responding fully to light, and so on.
- Irregular or abnormal breathing patterns.
- Irregular blood pressure (may be higher or lower than normal).
Top Health Insurance Plans Covering Coma Patients
| Plan Name | Entry Age | Number Of Critical Illnesses Covered (Including Coma) | Sum Assured |
| Aditya Birla Capital Active Secure Critical Illness Health Insurance | MINIMUM ENTRY AGE For Plan 1 & 2: 5 Years For Plan 3: 18 Years
MAXIMUM ENTRY AGE: 65 Years | Plan 1: 20 Plan 2: 50 Plan 3: 64 | Rs. 1 Lakh To Rs. 1 Crore |
| Bajaj Allianz Criti Care Policy | For Adults: 18 To 65 Years For Children: 3 Months To 30 Years | 43 | Rs. 1 Lakh To Rs. 2 Crores |
| Future Generali Criticare Insurance Plan | 6 To 65 Years | Up To 12 | Rs. 1 Lakh To Rs. 2 Crores |
| SBI Critical Illness Insurance Plan | 18 To 65 Years | Up To 13 | Up To Rs. 10 Lakhs |
| HDFC Ergo My Health Critical Suraksha Plus Plan | 18 To 65 Years | More Than 59 | Rs. 1 Lakh To Rs. 5 Crores |
Benefits & Features Of Coma Health Insurance
Below are some of the key features and benefits of health insurance plans covering coma:
Waiting Period:
The majority of coma health insurance plans come with a waiting period. This period refers to a set duration during which the policyholder must wait before certain benefits of insurance become active. Here are some common types of waiting periods under health insurance for coma:
- Initial waiting period
- Specific-illness waiting period
- Pre-existing conditions waiting period
Provides Financial Support:
The treatment, as well as recovery of comatose patients, can be incredibly expensive. In such cases, health insurance for comp coverage offers financial assistance and protection by covering the medical expenses directly related to the coma, such as hospitalization, specialized tests, surgeries, therapies, and long-term care, to name a few.
Moreover, coma insurance can serve as a supplement to other basic health insurance policies, thus, bridging gaps or covering expenses that may not be addressed by standard health insurance plans.
Lumpsum Payout On Detection:
Various health insurance plans covering coma, like Aditya Birla Activ Secure Critical Illness Health Insurance, may offer the financial benefit of paying a lump-sum amount upon the detection of coma.
It is a one-time, predetermined amount of money that is given to the policyholder or their beneficiaries, who can use it to cover medical expenses, living expenses, rehabilitation recovery costs, or any other financial needs arising from the coma.
Higher Sum Assured Options:
The majority of coma health insurance plans offer options of higher sum assured of up to Rs. 5 crores. This results in strong financial protection against a broader range of coma-related risks.
Since it increases the payout amount on diagnosis, it ensures that the policyholders and their beneficiaries have sufficient funds to address various medical needs.
Survival Period:
In coma insurance, there might be a survival period during which the policyholder must survive after the diagnosis of a coma to be eligible for receiving the benefits.
After the survival period expires, the policyholder or their beneficiaries can initiate the claims process to receive the benefits specified in the policy.
Offers Flexibility & Customization:
Be it coverage options, policy tenure, or payment methods, coma health insurance plans offer higher flexibility and customization.
Individuals can select parameters and options that align with their specific needs and budget. This tailored approach ensures that the policy provides the most appropriate level of support for the individual’s unique situation.
How Does Coma Health Insurance Coverage Work?
The functioning of coma health insurance varies from one provider to the other.
However, let’s take the example of Mr. Puneet Sharma, a 30-year-old male, who purchased the Aditya Birla Capital Active Secure Critical Illness Health Insurance plan for himself in January 2023. Other details of the plan are as follows:
- Plan Option: Plan 2
- Sum Insured: Rs. 20 Lakhs
- Premium: Rs. 13,151 (Annual)
- Policy Tenure: 2 Years (With 7.5% Discount)
After around 12 months from the date of the commencement of the policy, Mr. Sharma has now been diagnosed with a severe coma in January 2024. Now, since the survival period (15 days) and waiting period (90 days) for the plan option have expired, the coma health insurance will become active. This simply means that Mr. Sharma’s hospitalization bills will be covered by the hospital.
What’s Generally Not Covered Under Coma Health Insurance?
Coma health insurance holders cannot raise claims against the following:
- Suicide or attempted suicide
- Coma conditions arising due to overuse of intoxicating substances, such as drugs, alcohol, etc.
- Sexually transmitted diseases
- Congenital disabilities and anomalies
- Injury occurred while committing a breach of law
- Complications related to pre-existing conditions.
How To Select The Right Coma Health Insurance?
While selecting an appropriate coma health insurance plan, one should consider various factors or aspects. Some of them are listed below:
- Assess Your Needs: It is important to evaluate your past and present health conditions to understand your potential risks. This will allow you to choose a plan providing sufficient coverage. Also, consider your budget to determine how much coverage you can afford.
- Compare & Research: It is always better to invest time in comparing and researching before selecting anycoma health insurance. Pay special attention to factors, such as premium amounts, inclusions, exclusions, coverage options, waiting periods, and so on.
- Don’t Overlook Reviews & Ratings: Always research customer reviews and ratings of the insurance provider you are about to select. Pay attention to feedback regarding claim processing, buying process, and customer satisfaction.
- Seek Professional Advice: At any time if you feel that you are not able to decide the right coma insurance for yourself, don’t hesitate to take professional advice. By discussing your specific needs, budgetary conditions, and various other concerns with a professional, you may receive a more personalized recommendation.
- Always Read Terms & Conditions: It is highly advised to carefully read all the terms and conditions of a coma health insurance. If you avoid this step, you may not be able to clarify ambiguities regarding the policy, which may result in wrong decision-making.
Frequently Asked Questions
Yes, coma health insurance policies have specific criteria for coverage, including the duration and severity of the coma. These criteria are outlined in the policy terms and conditions and may include a defined period of unconsciousness for the coverage to take effect.
Yes. You can claim tax benefits on the premium payments for coma health insurance under Section 80 D of the Income Tax Act, 1961.
You can purchase the policy for yourself and extend the coverage to your spouse, your children, or your parents. The number and type of members covered under a coma health insurance varies from one plan to another.
To claim your coma health insurance, you or your family will need to contact the insurance provider and initiate the claims procedure. This typically involves submitting relevant medical documentation and fulfilling any requirements specified by the insurance company. Once the claim is approved, a lumpsum amount will be paid to the policyholders or their beneficiaries.
Yes. You can renew it. However, the renewability of your health insurance for coma coverage varies among providers. Some policies may offer easy renewal options, while others may have some terms and conditions that must be taken care of.
