Are Regular Blood Tests, Serum Creatinine, and eGFR Monitoring Reimbursable?

Yes, routine blood tests, serum creatinine, and eGFR monitoring are reimbursable under specific policy conditions. Coverage for these health checkups is generally categorised into:

• Pre- and Post-Hospitalisation Claims

If a healthcare specialist prescribes these screenings as part of your illness that requires you to be admitted to the hospital, the expenses are covered. These diagnostic expenses are generally covered for up to 30-60 days before hospital admission and 90-180 days after discharge, subject to the specific policy terms. You can either undergo these screenings at an insurer’s network hospital for cashless benefits or pay out-of-pocket and later claim for reimbursement.

• Preventive Health Screening Benefits

If you are undergoing these screenings for regular monitoring without hospitalisation, they are only covered if your health plan includes a preventive health check-up benefit. Specific policies generally offer annual coverage for medical screenings, which generally include kidney function tests like creatinine and eGFR. You can also avail these benefits on a cashless basis directly through your insurer’s customer portal or via mobile application.

• Chronic Condition Management Program

For policyholders already suffering from diagnosed diseases like diabetes or hypertension, insurance providers in India offer a wellness or chronic condition management program. Regular monitoring of kidney functionality (like serum creatinine and eGFR), as advised by officially affiliated wellness experts, may be included, and adherence can also earn you reward points.

What is Generally Not Covered?

If you are not admitted to the hospital and your policy does not have an active preventive health screening or OPD rider, routine diagnostic tests are generally not reimbursable.

Causes of Chronic Kidney Disease

Chronic Kidney Disease (CKD) arises when the kidneys are damaged and are no longer able to filter blood properly. The main reasons behind this are high blood pressure and diabetes, which affect kidney functionality over time. Other causes include:

• Glomerulonephritis: Injury to the filtering structures of the kidney


• Polycystic Kidney Disease: A genetic disease forming cysts in the kidneys


• Membranous Nephropathy: An autoimmune disease attacking the kidney membranes


• Urinary Tract Obstructions: Enlarged prostate or tumours caused by kidney stones


• Vesicoureteral Reflux: Urine flowing backwards to the kidneys


• Nephrotic Syndrome: Indicating renal damage with a group of signs


• Recurrent Kidney Infections, Like Pyelonephritis


• Lupus and Other Autoimmune Disorders: Causes complications in the kidneys

These medical conditions can cause chronic damage to the kidneys if not treated earlier. So, one should receive appropriate treatment upon being diagnosed with chronic kidney problems.