Living with diabetes or borderline sugar is quite commonplace nowadays. Moreover, watching your lifestyle and managing your sugar intake is no longer limited to diabetics alone. So have you wondered how medical cover through health insurance for diabetics in India works? Take a look.
On an outing with friends, the choice for sugar-free drinks and pro-diabetic alternatives in the menu like brown rice and low-carbohydrate foods has become routine. Not just the elderly, when some of the younger members of the family too become regular users of the diabetics test strips at home, one wonders how prevalent this disease is in our country.
Going by studies published by WHO and Lancet in 2016, India is one of the top 3 countries in the world with a high diabetic population. Staggering figures (65 million afflicted with diabetes in 2013, according to the Indian Diabetes Federation) indicate the high prevalence of this disease among Indians. That is surely a huge number to be considered when designing insurance policy plans.
So, what is diabetes? It is widely understood as a group of diseases in which one suffers from high blood glucose (blood sugar) levels owing to inadequate insulin production and/or due to the inability of the cells of the body to respond adequately to insulin. Symptoms that help identify diabetes – include excessive thirst, frequent urination, fatigue, blurry vision and sudden weight loss, and the longer duration taken by the body to heal a wound, as well as its vulnerability to eye, nervous system and kidney damage.
How do medical insurance companies treat those afflicted with diabetes in India? Most insurance plans treat it as a pre-existing illness denying coverage to the insured for a few years – something that takes away from the supposed benefits of health insurance.
With such huge numbers among the Indian population suffering from and at risk of acquiring diabetes, it demands to be looked at as integral to health insurance policies. Though, most health insurance plans keep not just diabetes out of the medical cover but also complications due to it. Even those plans that include diabetes do not provide coverage generally before a four-year waiting period, post diagnosis; or with a shorter waiting period, a very high premium is asked of the insured in some policies.
Group health insurance offered to employees of a company can take care of diabetics as diabetes is generally covered in most such plans, though one can avail of these benefits only during employment with the same company.
In order to address medical costs arising out of diabetes in India, one must explore the health plans that are specific to diabetics. A boon to those suffering from diabetes, these plans take care of medical emergencies owing to diabetes. But, one must make an effort to understand the details of these health plans ahead of choosing the one that is best for you.
According to the kind of diabetes, and suited to different age groups, several plans have been launched by the various insurance companies:
An autoimmune diabetes condition usually found in children and teenagers requires insulin injections. This is a rare kind of precarious diabetes affecting a relatively small group among the large diabetic population, and finds fewer takers among health insurers.
This is the more common form of diabetes affecting a majority of the diabetic population in our country. With a relatively easier treatment, it finds more takers in the health insurance sector.
While in earlier days, diabetes affected more people in the middle and senior age groups, it is no longer limited to them. The younger generations too are afflicted with the fast-paced lifestyle of the 21st century. On the basis of the type of diabetes covered, and how apt these plans are for the old and the young, here is a look at the health insurance plans.
Diabetes is no longer a disease of the aged. It is becoming quite common among youngsters too. Yet, as the risk of contingency is lower, it means less hassle, especially while choosing a health insurance plan. Young adults are not bound by diabetes-specific plans. Going for a regular health plan that covers diabetes as a pre-existing illness, with a waiting period of three or four years, one can benefit from other features of the chosen plan as well as tackle diabetes-related costs which may be impending in the future.
Some health insurance plans which cover diabetes after a brief period and still offer attractive features:
A plan which covers diabetes after 4 years and promises various benefits like auto recharge of the Sum Assured, health check-ups every year, no sub-limits on room rent, no claim-based loading on premiums, facility of increasing the Sum Assured to 200% through no claim bonus increase in Sum Assured @10% along with a 50% super no claim bonus, organ donor and domiciliary expenses and others.
In this plan, diabetes is covered after a “waiting period” of two years. In its features, one can benefit from: no sub-limits on room rent, refill of Sum Assured, AYUSH treatment, etc.
This is a plan that covers diabetes after a 3-year “waiting period”, and is supplemented by features such as Sum Assured restoration, any age entry and lifelong renewals, maternity and new-born baby cover, Ayurvedic treatment coverage, unlimited day care procedure coverage and so on.
This one has a 4-year “waiting period”. Its features include up to 100% Sum Assured restoration with extra restoration of up to 30% of the Sum Assured, health check-up benefit once every 3 years, cover for new-borns, 400 day care treatments, among others.
With growing age the immunity decreases. Along with the age if the individual has been a diabetic for many years the immunity decreases and the probability of complications are high. With growing age the options to buy health insurance plans also decreases. Here are a few good options for senior citizens or parents with Diabetes
It is a plan available only to senior citizens. Herein, even pre-existing diabetes is covered right from the inception of the policy (at a 10% additional premium).
Covering both Type 1 as well as Type 2 diabetes, this plan offers additional useful features as well. Take a look at its Plan A and Plan B:
Plan A – The one to be insured needs to undergo a pre-entrance medical examination, for which the cost would be reimbursed by the company if the policy is issued. Here, there is no requirement for a “waiting period” for any diabetes-related problems and instant coverage is applicable as the policy is issued.
Plan B – Here, one does not need to undergo a medical examination ahead of the issue of the policy. But, there is a 30-day “waiting period” once the plan starts before coverage of any diabetes-related problems. One would also need to wait for 15 months for any cardio-vascular, renal complications, diseases of the eye and foot ulcers to be covered by the policy.
This plan is ideally suited for elder individuals above 65 years and available till 75 years of age with lifelong renewability which treats diabetes as a pre-existing illness and covers it after a “waiting period” of 12 months.
This health insurance plan covers only Type 2 Diabetes and Pre-Diabetics (IFG/IGT). The policy holder gets a fixed policy term of five years.
This health insurance plan covers only Type 2 Diabetes and has two offerings: Gold and Silver. The Gold version takes care of the cost of pre-entrance medical tests (which are paid for by the company), whereas the Silver version puts the cost on the proposer.
The plan provides immediate coverage of diabetes related complications without the applicability of any waiting period, no sub-limits on room rent, diabetes management program complete with doctor’s consultation, premium discounts as rewards for proper health management among other features. However, the underwriting rules for the plan are stringent and people ailing with other related conditions along with diabetes may or may not be covered.