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My son was born with cleft palate, will it be covered by insurance?

Q: My son was born with Piere Robin Syndrome and a cleft palate. I work in a company, which has given me a mediclaim policy (under group policy with a total coverage of Rs. 6 lacs) that covers baby from the day one of birth. However, I am not able to get a decisive answer on whether or not the corrective surgery on cleft palate shall be covered. The available information says that congenital internal diseases are admissible. Is cleft palate a congenital internal disease? What is your opinion, based on your experience, about this surgery being covered?

A:As a matter of routine, this cleft palate is not covered by insurance claims. However, with some group insurances, this distinction may not be made, and the cover may be provided. You need to discuss this upfront with your insurance company. If there is a pre-authorisation involved, then fill up that form and send it. If they approve, then it clearly means your claim will be honoured.

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