17% below age of 45 don't get health cover because of uncontrolled diabetes

Health insurance is still out of reach for a large section of the people in India especially the elderly. A survey by tech-based health insurance provider platform Plum observed that 98 per cent of India’s senior citizen population remains devoid of health insurance coverage, while 17 per cent of Indians below the age of 45 don't get access to a health insurance policy because of uncontrolled diabetes, according to data provided by Policybazaar. 

Diabetes is a condition wherein the insulin level of a human body drops to such an extent where the blood sugar level simply cannot be managed naturally. With time, this condition sometimes also leads to other disorders and ailments if not managed carefully and properly.

Uncontrolled diabetes can increase the risk of complications such as heart ailments, kidney issues, nerve damage, etc.; and the person may be considered at a higher risk by insurance providers due to the on-going management and potential complications associated with the condition thus leading to difficulties in insuring the risk. 

"Such conditions develop over the years and hence it is advisable for the insured to disclose his health condition while taking up the policy. If this condition develops after the purchase of taking up an insurance policy, then the policy will be well valid. However if this is a pre-existing condition while taking up the insurance policy and in case the insured has not been transparent in disclosing his/her health conditions, then the insured will run at a risk of getting any claim towards this policy forfeited," said Parthanil Ghosh, President- Retail Business, HDFC ERGO General Insurance.

Some common reasons why insurers deny health insurance policies to diabetic patients are:

1. HbA1c levels above 8 are not accepted, except for diabetes-specific plans, which can allow levels up to 10

2. Usually, diabetes patients on insulin are rejected by insurance companies, but a few diabetes-specific plans do accept them.

3. Type 1 diabetes is usually not covered but some diabetes-specific plans cover it along with Type 2 diabetes.

4. The early onset of diabetes is typically rejected.

"Rejection rates in health insurance is very low, meaning it’s much easier for people to get health insurance. However there are a few scenarios where Health insurance may be rejected. These are largely due to serious health conditions. For example while a person with Diebetes can get a policy but a diabetic with major complications like kidney failure, with poor sugar control etc may not be able to get a policy. Similarly people with major health conditions or history of major health conditions like stroke, heart disease, organ failures, cancers etc may not be able to get a policy," said Dr. Bhabatosh Mishra, Director Underwriting, Products & Claims, Niva Bupa.

What should one do and which plan can one opt for if they have type one and type 2 diabetes?

There are many plans one can opt for in the case of diabetes. The plans available for Type 1 diabetes may be limited as compared to those available for Type 2 Diabetes.

"People with Diabetes can go for comprehensive indemnity health insurance plans available to them or opt for diabetes specific plans. It’s is also possible to customize comprehensive indemnity health insurance plans though Dibetes specific Riders. The customized plans usually come with Day 1 coverage for Diabetes and complications, Out-patient coverage and elements of disease management," said Mishra.

What is covered in diabetes-specific plans?

Diabetes health insurance plans typically include coverage for essential services like doctor consultations, diagnostic tests, medications, insulin, glucose monitoring devices, and other necessary medical supplies. Additionally, these types of plans may offer coverage for diabetes-related complications such as kidney diseases, retinopathy, neuropathy, and cardiovascular conditions. Some plans also provide additional features like regular health check-ups, diabetes education programs, and lifestyle management support. 

"Diabetes health insurance plans cover hospitalization expenses for Type 1 and Type 2 diabetes and related complications of diabetes. It covers the cost of doctor's consultation, diagnostic and medical expenses. Diabetes on Insulin, Type 1 diabetes, and early onset of diabetes are all included in diabetes-specific plans. These plans include wellness programs such as diabetes reversal, so you can take control of your health and feel your best," said Siddharth Singhal, Business Head - Health Insurance, Policybazaar.com

 Every insurer has different terms and conditions towards such cases and for more details, it is advised to carefully read the terms and conditions of the plan, before taking up the policy.  But research showed that Star Health Diabetes Plan covers both type 1 and type 2 diabetes. 

Factors to consider while opting for a diabetes health cover

When opting for a diabetes health cover, there are several important factors to consider. Ghosh explains some of them:

Coverage for Diabetes Complications: Diabetes can lead to various complications over time, such as kidney diseases, retinopathy, neuropathy, and cardiovascular conditions. Make sure your policy offers coverage against these potential complications to provide comprehensive protection. 

Coverage for Diabetes-Related Expenses: Check the coverage provided specifically for diabetes-related expenses, such as doctor consultations, diagnostic tests, medications, insulin, and other supplies. Ensure that the policy covers the necessary treatments and services required to manage diabetes effectively. 

Network of Healthcare Providers: Consider the network of healthcare providers associated with the insurance plan. 

Claim Settlement and Payout Ratio: Claim is the moment of truth for any insurance policy. So, it is important to check the claims settlement and payout ratio of the insurer. Besides, to ensure a hassle-free experience during such times of emergency, it is also important to be mindful of processes involved for filing the claim.  

Additional Benefits: Look for any additional benefits offered by the policy, such as diabetic education programs, nutrition counselling, fitness programs, and preventive screenings. 

16% don't get cover because of cardiovascular diseases

At least 16 per cent have not got health cover because of cardiovascular disorders, while 13 per cent were rejected because of chronic liver diseases. 12 per cent in India don't get cover because of chronic lung diseases and another 11 per cent due to cancer. 

At least 10 per cent don't get health insurance due to chronic kidney diseases. 

Any three or more of the following combinations- diabetes mellitus, hypertension, lipid disorders, obesity ( High BMI) results in higher percentage of rejection, showed data from Policybazaar. 

"Claims are often rejected due to (i) non-disclosure of pre-existing conditions in the policy or (ii) failure to complete waiting periods for specific illnesses, as stated in the policy. For example,  it's important to keep in mind that there's typically a waiting period of two years for specific illnesses and a PED waiting period that's based on any disclosures made," said Singhal.

Insurers typically avoid providing health insurance policies to those with pre-existing illnesses such as cancer, diabetes, or a history of heart attacks due to their higher likelihood of filing a claim, which poses a greater financial risk to providers.