What are the Scope of Coverage for Birth Defects under Health Insurance?

As per the March of Dimes (MOD) Global Report on Birth Defects, 7.9 million births globally occur with serious congenital abnormalities. Among these, 94% of children born with defects belong to countries that have middle to low income. According to a report by the joint World Health Organization (WHO), the birth defects in India range from 61 to 69.9 per 1000 live births.

In India, one child is born every two seconds; however, not every child is fortunate enough to lead a healthy life or even survive. Among the myriad of severe birth disorders, the neural tube disorder is the most serious defect, which occurs when the brain and spinal cord of the central nervous system do not fully develop during the development of the embryo. Read on to know more about the different kinds of birth defects, what are the root causes, and the role of health insurance in this regard.

What is a Birth Defect? 

Generally, birth defects are described as abnormalities that are present from birth, either structurally or functionally, including metabolic disorders. There are both mild and severe types of birth defects,these can be broadly categorised into the below given types: 

Structural Abnormality

Structural congenital abnormalities are attributed to a problem with the structure of the body parts, generally referred to as a disorder. This includes heart defects, limb reduction, neural tube defects affecting the spinal cord and the brain, cleft lip or palate, gut and stomach anomalies, and diaphragmatic hernia. 

Developmental Abnormality

If a congenital abnormality is developmental, it indicates that it has an impact on a child’s senses, learning process, or physical functioning. This includes spina bifida, down syndrome, visual impairments, hearing impairments, cerebral palsy, muscular dystrophy, genetic disorders, or specific speech impairments.

What are the Causes of Birth Defects? 

While some congenital abnormalities have unclear causes, certain birth defects are inherited, and some are associated with the health of the expectant mother. Many times, environmental factors play an important role, too. 

Sometimes, certain genes or genetic alterations can result in birth abnormalities. Genetic problems can arise from abrupt changes in the DNA, or they might be inherited from the  mother or father. 

Birth defects may also occur as a result of the mother's prenatal exposure to radiation, medications, chemicals, infections, or a mix of these. Nonetheless, the causes of birth defects are usually unknown in 70% of cases. 

Most mothers who give birth to children with birth congenital abnormalities are in good health, have a normal pregnancy, and do not show/have any significant risk factors.

Are Birth Defects Common?

Numerous types of birth defects exist, making them quite prevalent. Notably, not all defects necessarily impact the child adversely. In India, birth defects hold the fifth position among the leading causes of death for newborns. Statistically, around 2-3% of babies worldwide are born with defects. Approximately, 1-3 out of 100 newborns have birth defects, which accounts for up to 27 million fetal congenital abnormalities each year in India.

Causes of Fetal Congenital Abnormalities in India

The prevalence of early marriage, high fertility, high number of unplanned pregnancies, inadequate prenatal care coverage, low nutritional status of mothers, high rate of consanguineous marriages, and high hemoglobinopathy carrier rate are some of the risk factors for birth defects that Indians face. 

Given the high number of birth defects in newborns each year, it is imperative for couples to be aware and alert and undertake necessary actions to ensure the birth of a healthy child.

How are Birth Defects Identified in a Child?

Symptoms of birth defects are identified based on the baby’s external features, clinical examination reports, medical history of the mother, or other risk factors. Generally, a newborn is thoroughly examined immediately after to check for probable birth defects like palate, cleft lip, abnormalities in the legs, limbs, face, or open spinal deformities. 

However, fetal congenital abnormalities in the heart, eye, brain, internal organs, bone deformities, or hearing loss require specialised testing like X-rays, echo scans, ultrasound scans, or hearing evaluations. Potential abnormalities in the internal organs are suspected on the basis of the external features of the baby. Women who have abnormal screening tests and risk factors need to undergo confirmatory tests for details. Despite this, few birth defects are difficult to identify. Hence, it cannot be diagnosed until the baby is born. 

The symptoms of birth defects can be identified during pregnancy depending on several factors. Screening tests done in the first and second trimesters can detect congenital birth defects indirectly. Under extreme cases, women with riskier screening test results are offered advanced tests involving taking samples of the amniotic fluid or placenta.Herein, structural defects that can significantly affect the baby before delivery are identified.

The symptoms of birth defects also vary depending on the body part impacted, the degree, the function of the affected area, etc. Hence, each baby might face different problems. Although internal birth defects can show up after birth, external deformities are typically detected earlier, during standard examinations. 

How to Avoid Birth Defects During Pregnancy? 

Although several congenital birth defects are often unavoidable, there are certain things that should be taken care of to lower the risk of fetal congenital abnormalities. Listed below are some measures that can be taken to avoid birth defects during pregnancy. Keep in mind that you should consult your doctor before you bring any changes to your routine:

1. Folic acid supplements should be started by women who are actively trying to conceive.
2. It is advised to take prenatal vitamins when pregnant.
3. Women should abstain from consuming alcohol, drugs, tobacco, or any other harmful substances. 
4. The doctor must be made aware of any over-the-counter medication or supplements being used by the expectant mother.
5. Although most vaccines are safe, studies suggest that certain live-virus vaccines can cause a potential risk to a growing fetus. Hence, such vaccines should be avoided. 
6. Maintaining a healthy weight lowers the chance of complications during pregnancy. 
7. Expecting mothers with certain pre-existing conditions like diabetes must take utmost care of their health, lifestyle, and well-being. 
8. Attending prenatal visits on a regular basis is crucial. Under no circumstances should an expecting mother avoid checkups. 
9. In case the pregnancy is deemed high risk, the doctor will have to perform additional prenatal screening to ensure the baby is not born with defects. Depending on the type of birth defects, the doctor might be able to treat them before delivery. 

Role of Health Insurance

The diagnosis of birth defects depends on the type and part of the impacted area. Structural defects like cleft palate or club foot are identified and treated immediately after birth. However, for other conditions, medical treatments like newborn screening, prenatal screening, noninvasive prenatal testing (NIPT), Chorionic Villus Sampling (CVS), and amniocentesis are the only way to detect and diagnose a congenital abnormality during pregnancy. 

For all parents, their baby’s health is paramount. But, the way healthcare costs are soaring, ensuring good quality treatment seems to be getting out of reach. However, having a healthcare insurance policy can help you handle the treatment expenses with ease. When it comes to treating birth defect gastroschisis or babies born with defects, healthcare insurance can be extremely helpful. Most health insurance plans cover children, typically after the age of 91 days. If you are planning to start a family soon, you must surely consider investing in a suitable health insurance plan so that you can get the right coverage for the mother as well as the newborn. Most maternity insurance plans offer coverage for the new baby. 

However, please note that healthcare insurance policies in India do not cover all birth defects. As per the IRDAI guidelines, insurance products that cover newborns/unborns are only allowed to cover internal congenital diseases from day 1 of their birth. Bear in mind that the scope and coverage will depend on the insurance policy that you have chosen. The level of coverage varies from plan to plan. Some factors affecting the coverage involve the premium, sum insured, policy inclusions and exclusions, add-on benefits, etc.

In a Nutshell

The effects of congenital disorders can last for a lifetime. A child born with defects will not only have to deal with health issues throughout, but the cost of medical care will also be exhausting. However, the good news is that internal congenital defects are covered by health insurance plans in India. Nevertheless, it is advised to take the necessary actions, precautions, and care to secure your child from developing a congenital abnormality.

Joy by Care Health Insurance offers coverage for the mom-to-be and the newborn, including the medical costs involved in the diagnosis and treatment of congenital birth defects. This comprehensive plan also includes in-patient hospitalisation, daycare procedures, surgeries, pre-hospitalisation, post-hospitalisation, and other medical costs. For more information kindly connect with our experts or visit the official website. 

>> Also Read: How to Get Newborn Baby Health Insurance Cover?

Disclaimers: The above information is for reference purposes only. Kindly consult your general physician for verified medical advice. The health insurance benefits are subject to policy terms and conditions. Refer to your policy documents for more information.