Is PCOD Treatment Covered Under Health Insurance?

Polycystic Ovarian Disease (PCOD) is a widespread hormonal disorder in women. Coverage by health policies, however, depends on policy terms and timing. PCOD/PCOS is usually considered a pre-existing condition by insurers.

This implies that in case you already have it when purchasing a plan, you will have to wait the waiting period (2-4 years) before the PCOD-related claims are given. Medically necessary PCOD treatments and surgeries are usually covered by most health insurers, but only after this waiting period. Keep reading to know more.

Pre-Existing Condition and Waiting Period

In case you are diagnosed with PCOD prior to taking a health policy, then the insurers will impose a period of waiting (usually 24 months) on any PCOD treatment. The expenses related to PCOD will not be reimbursed during this period. After the waiting period, the policy will cover PCOD complications under the hospitalisation benefits.

Insurers clearly state that PCOD is an insurable condition when it has become medically necessary and when the claim is inpatient. PCOD is covered, provided they meet the standard waiting period for pre-existing conditions.

Coverage Scope: Hospitalisation Only

Most plans cover only hospitalisation for PCOD. For example, surgeries (laparoscopy to remove cysts, drilling, etc.) or complications (endometrial, etc.) would be billed in case you are admitted to a hospital.

OPD visits (e.g. monthly hormonal therapy) specifically in PCOD are not typically covered unless your plan includes an outpatient benefit. In practical terms, if PCOD leads to a hospital stay (e.g. laparoscopic surgery), those costs are claimable after the waiting period.

Basic health plans do not typically cover routine PCOD management (tests, doctor visits, drugs without hospitalisation).

Cost of PCOD Treatments

To understand why coverage matters, consider typical PCOD-related costs:

An operation alone or a long hospital stay can easily cost lakhs. Health insurance would go a long way in alleviating these financial burdens in instances where the complications of PCOD necessitate hospitalisation.

Health insurance can cover PCOD, but with conditions. PCOD is considered a pre-existing condition by insurers (waiting of about 2 years). Subsequently, any treatment of PCOD on an inpatient basis is normally covered within the hospitalisation benefit of your policy. Always ensure that you reveal PCOD when purchasing insurance.

If disclosed, you just wait out the period, and then have protection for serious PCOD-related care. Always read your policy documents or consult the insurer to know exactly what treatments are included under “Women’s Health” cover.