Guillain-Barré Syndrome Cases Rising: Will Your Health Insurance Cover it?

Guillain-Barré Syndrome (GBS) has been making headlines in India amid an outbreak in Maharashtra, particularly after a suspected death in Pune recently. The state has reported over 100 cases to date and the government has been now trying to contain the situation by sending health teams on the ground.

The cases are under investigation by the Indian Council of Medical Research to identify the root cause of this outbreak. But as the numbers climb, one pressing question remains: If you or a loved one were to be diagnosed with GBS, would your health insurance cover the costs?

What is Guillain-Barré Syndrome?

GBS is a rare but serious condition where the patient's immune system starts attacking its own nerves. It usually begins with weakness or tingling in the legs that can spread to the arms and even lead to paralysis.

Some patients may even experience difficulty breathing, speaking, or swallowing. While there is no known cure for this yet, treatments like immunotherapy can help manage the symptoms and improve recovery.

According to some reports, Maharashtra’s public health department has reported around 111 suspected cases of GBS till now. The majority of these cases have been identified in Pune, with others in Pimpri Chinchwad and surrounding districts.

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Will Your Health Insurance Cover It?

According to health insurance experts, standard health insurance policies typically cover the treatment of Guillain-Barré Syndrome. Here’s what you should know;

Says Priya Deshmukh, Head Health Products, Operations & Services, ICICI Lombard, “GBS is an autoimmune neurological disorder which can affect individuals of any age or gender. However, adults and people older than 50 years are more susceptible to this condition. Since it is a condition that is acute in nature, it is covered by a standard and comprehensive health insurance policy.”

Adds Ashish Yadav, Head Products and Operations, Product Development, ManipalCigna Health Insurance, “GSB is covered under a standard health insurance coverage without requiring a special critical illness policy. This classification enables patients to receive the medical care they require. Even though GBS is regarded as a serious illness, standard health insurance covers its treatment, including hospital stays and associated costs.”

Similarly, Amitabh Jain, Chief Operating Officer, Star Health & Allied Insurance Co. Ltd informs that “As long as a policyholder has a standard health insurance plan, their medical expenses for ICU admissions, and ventilator support as required for your treatment for GBS should be covered, subject to the limits specified under the terms and conditions of your policy.”

Let’s get you answers to some critical questions regarding coverage of GSB in your health insurance plan;

1) Would any prior neurological or autoimmune conditions affect your claim eligibility (for GBS)?

Yes, it could impact claim eligibility. Says Jain, “If someone had a pre-existing neurological or autoimmune condition before purchasing the health insurance policy and did not disclose it at the time of purchase, the claim for GBS-related treatment could be affected.”

“However, if the condition was declared while buying the policy and accepted by the insurer, coverage would be available, though it will be subject to a waiting period as specified in the policy. It’s always important to be transparent about your medical history to avoid claim disputes later,” Jain adds.

Deshmukh opines that “The causes of GBS are not fully understood. It is mostly caused by infection with a bacteria or virus. Hence it may not be related to any prior neurological or autoimmune conditions.” She states that in case there is any definite co-relation with prior neurological or autoimmune conditions, insurers shall cover the basis of the accepted pre-existing disease and the waiting period be completed by the customer for such pre-existing disease.

2) Would a standard health insurance cover long-term rehabilitation (such as physiotherapy) after a GBS diagnosis?

After suffering from muscle weakness or paralysis, rehabilitation is essential in helping individuals restore their strength and movement.

“Coverage for long-term rehabilitation depends on the terms of your health insurance policy,” Jain states.

According to Yadav, “For those rehabilitating from GBS, long-term rehabilitation services like physical therapy are essential and are typically covered by regular health insurance plans.”

Depending on their illness and recovery requirements, many patients may need extensive physical therapy, which can be provided in a variety of venues, such as outpatient clinics or inpatient rehabilitation facilities. “This clause guarantees people access to necessary therapies that aid in their recuperation and enhance their quality of life after receiving a diagnosis,” Yadav adds.

3) Are there any exclusions or waiting periods for neurological disorders like GBS in most health policies?

Most health insurance policies have an initial 30-day waiting period for hospitalisation due to any illness. However, says Deshmukh, “We have not seen any specific exclusion or waiting period for neurological disorders like GBS in most health policies.”

Jain notes that, generally, there are no specific exclusions for this illness unless it is categorised as a pre-existing disease in your policy.

Says Yadav, “Before submitting a claim for treatment related to GBS or comparable diseases, people must wait at least 30 days, starting from the date the coverage is purchased. Policyholders must be aware of this waiting period because any treatment received during this time may not be covered.”

5 Key Takeaways for Policyholders

1) GBS is covered under standard health insurance policies and does not require a separate critical illness plan.

2) Hospitalisation costs, including ICU and ventilator support, are typically covered, subject to policy terms.

3) Pre-existing neurological conditions must be disclosed at the time of policy purchase to avoid claim disputes.

4) Long-term rehabilitation and physiotherapy are covered under most plans but may have limits.

5) A waiting period of at least 30 days applies, with longer durations for pre-existing conditions.

With the rising cases of GBS in Maharashtra, ensuring adequate health insurance coverage is crucial.

Lastly, it is important to understand your policy’s terms, including waiting periods and coverage limitations, can help mitigate financial stress in the event of a GBS diagnosis. If you are unsure about the coverage of GSB check with your insurer and review your policy details to be prepared ahead of any medical emergency.