How diabetes-specific insurance plans offer coverage and benefits

Policies assist those already suffering from the disease and most cost only around 20% more

November 14 is World Diabetes Day. Around 77 million people suffer from diabetes in India, according to the National Library of Medicine’s website. In addition, there are a large number of pre-diabetics. If the considerable pool of undiagnosed cases were also considered, the actual burden of this disease would be much higher.

An increasing number of people are contracting this ailment at a young age. The situation may worsen as the country’s demography alters. “India is still a young country, but as the population ages the burden of this disease will multiply,” says Bhabatosh Mishra, director-underwriting, products and claims, Niva Bupa Health Insurance. According to the India Diabetes Report 2000-2045 (diabetesatlas.org), the number of diabetic persons in India is expected to touch 124.9 million by 2045.

Misconceptions and obstacles

People who suffer from diabetes harbour a misconception. “Both in my clinical practice and in my interaction with other clinicians I am asked: Can diabetics get a health insurance cover? The answer is yes,” says S. Prakash, managing director, Star Health and Allied Insurance.

When people already suffering from diabetes try to buy a regular health insurance policy, they may be turned down or may get it only with a heavy premium loading. Moreover, these regular plans are offered to diabetics with a waiting period of two-four years for this condition.

It is these issues that diabetes plans now offered by several insurers address. Some offer these features in the main plan while others do so in a rider.

Curtailed waiting period   

Diabetes plans are targeted at people who don’t have a health insurance policy and suffer from diabetes. In a regular health insurance plan (indemnity cover), a person already suffering from diabetes would have to undergo a long waiting period. “But people with diabetes tend to get infections and injuries often. Episodes of fluctuations in sugar levels are frequent. They are also at high risk of complications arising due to diabetes,” says Mishra.

The most powerful feature of these plans is that they enable early coverage of diabetes. “A diabetes-specific cover has little or no waiting period for this ailment,” says Apaar Kasliwal, executive director, PolicyBoss.com. In some policies, there may be a waiting period but it is usually much shorter than the two-four years they would face in a regular cover.

“Earlier, many people who had diabetes wouldn’t buy health insurance because they had to face a two-four-year waiting period.  Insurers have started offering diabetes plans to incentivise such people to buy health insurance,” says Siddharth Singhal, business head-health insurance, Policybazaar.com.

Some of these plans also waive the waiting period for hypertension. They also cover other ailments and accidents, just like a regular health plan.

These policies are not prohibitively expensive. “Their premiums, on an average, are around 20 per cent more than that of a regular health insurance cover,” says Nayan Goswami, head-sales & service, SANA Insurance Brokers.

Many of these covers also nudge customers to undergo quarterly screening and work on managing their condition. “Customers get discounts on their base and rider premiums for both getting themselves tested regularly and for managing their health situation well. If they do both, the discounts they earn can be sizeable,” says Mishra. (Niva Bupa offers the waiver of waiting period on diabetes as a rider.)

Players like Niva Bupa also offer acute care facilities. In case a situation arises, a diabetic person can consult a specialist online. The patient doesn’t have to rush to a hospital. At the same time, the frequent issues diabetics are prone to don’t get ignored.  

Health check-up usually waived

Usually no health check-up is required while purchasing the policy. “In around 95 per cent of cases, there’s no health check-up. The policy gets issued on the basis of self-declaration and recent diagnostic reports,” says Singhal.

Adds Goswami: “Nowadays many insurers issue policies based on tele medicals and the latest reports. If the tele medical check-up throws up adverse findings, then tests may be required.”

Kasliwal says depending on age, current status (severity or complexity) of pre-existing ailment, and medical history, some insurers may ask for a medical check-up for better risk profiling.

Watch out for exclusions

Prakash informs that if a person has already developed organ damage (say, damage to the kidney) due to diabetes by the time of buying the policy, that will not be covered.

Acute cases may at times be excluded from coverage by some insurers. “Many insurers exclude diabetes type II or uncontrolled type II diabetes. But plans that cover both are also available,” says Goswami.

Points to check

Prior to purchasing one of these plans, go through the customer information sheet or the prospectus. “Check whether the offer to waive the waiting period applies only to outpatient department (OPD) consultations for chronic diseases or to in-patient treatment also,” says Goswami.

Adds Singhal: “As with any health cover, make sure there is no copayment or room rent capping.” Policies that have disease-specific sub-limits should also be avoided.

If the insurer asks for a health checkup, go for it. Some insurers waive the waiting period on diabetes if you undergo a health checkup, but impose it if you refuse to submit to it.

If you already have a health indemnity cover, don’t buy one of these plans. But make sure your existing plan has a substantial OPD cover. If not, port to a plan that has one since ailments like diabetes require a considerable amount of expenditure on OPD consultation and pharmacy.