Do not apply for health cover without revealing existing hypertension

Try bringing condition under control to improve chances of getting coverage

May 17 will be celebrated as World Hypertension Day. According to the World Health Organisation and the India Hypertension Control Initiative, around 25 per cent of Indian adults suffer from hypertension. This condition can lead to serious complications such as heart disease, stroke, kidney and eye disorders, and cognitive decline. “Hypertension can be the root cause of many diseases regarded as chronic or critical,” says Ashish Yadav, head (products and business operations), ManipalCigna Health Insurance.

Getting a cover becomes a challenge

Buying health insurance can be challenging for individuals with hypertension. “Such applicants have to undergo extensive medical testing, which can be time-consuming, stressful, and costly,” says Dinesh Mosamkar, senior vice president (consumer underwriting), TATA AIG General Insurance.

 

Insurers evaluate the proposal on multiple aspects. “They factor in the duration of the condition — whether it is recently diagnosed or chronic. The second is the blood pressure level — whether it is managed and kept within limits or out of control. They also check for comorbidities, or associated health conditions that may have arisen due to hypertension,” says Mosamkar.

 

If hypertension is uncontrolled, the policy proposal may get turned down. If it is issued, it may come with exclusions, sub-limits, or a longer waiting period.

 

Premiums may also be higher. “If medical tests reveal the person suffers from a high level of hypertension, then a loading could be applied,” says Yadav.

Policies have evolved

A decade ago, insurers often rejected applicants with hypertension. That has changed. “Today, with the availability of comprehensive data and better management of such conditions, insurers are willing to cover persons suffering from hypertension. If the level of hypertension is moderate or low, then the customer could be offered a comprehensive policy without any loading,” says Yadav.

 

If the condition is more severe, coverage may still be available, with loading. Some disease-specific products are available for such people though they offer limited coverage.

 

“Nowadays, almost 95 per cent of the people suffering from hypertension can buy a regular health insurance policy. They also do not have to face any exclusion or extended waiting period. Only in 5 per cent of cases, where the markers for hypertension are beyond acceptable limits, the insurance policy may be issued with a loading or co-payment,” says Siddharth Singhal, head (health insurance), Policybazaar.

 

Earlier, those with pre-existing conditions like hypertension faced long waiting periods. Some products may still carry a waiting period of 2–3 years. “Nowadays, many insurers offer products with zero waiting period,” says Yadav.

 

Singhal says that by paying an additional premium of 18–20 per cent, customers can reduce the waiting period from two-three years to zero (only the initial 30-day waiting period applies).

 

Insurers have also introduced cumulative bonus riders. “Due to the bonus given at the time of renewal, the sum insured can go up by 100 per cent. Also, there is no upper limit on how much the sum insured can increase. This feature can be highly beneficial for customers suffering from hypertension, who have a higher chance of a heart attack, stroke, etc. — conditions that are expensive to treat,” says Singhal.

 

Condition management programmes have been launched to help control hypertension. Insurers provide regular checkups, tele-consultations and in-person sessions with doctors.

 

Insurers also offer outpatient department (OPD) riders, which cover consultations, diagnostics, and pharmacy-related expenses, which can be useful for hypertension management.

Selecting the right policy

Customers should prioritise a zero waiting period. Check for sub-limits on the treatment of hypertension and conditions arising from it. As far as possible, avoid policies with sub-limits.

 

Singhal recommends opting for the cumulative bonus and OPD benefit riders. Mosamkar advises checking whether the insurer’s cashless hospital network includes hospitals the customer is likely to visit in a medical situation. He also recommends selecting a plan that offers wellness benefits, including preventive health check-ups.

 

Avoid policies with co-payment or caps on room rent. “Modern treatments may be required to treat the illnesses caused by hypertension. Look for policies that do not have a cap for modern treatments,” says Singhal.

Improving your chances of getting covered

Undertake regular blood pressure monitoring and adhere to prescribed medication. “People must make better lifestyle choices, such as reducing salt intake, engaging in regular physical activity, maintaining an optimal weight, quitting smoking, and managing stress better to improve their chances of getting a policy,” says Mosamkar.

 

Medical records that demonstrate your condition is under control can support your application.

How to reduce your premium

If the hypertension level is under control, there might be no loading.

 

Choosing a family floater can help. “If the other family members are not suffering from a similar condition, you could get the benefit of a better rate,” says Yadav.

 

Customers who find premiums high may opt for a deductible. Singhal suggests choosing a deductible of, say, Rs. 25,000, to lower premiums while retaining coverage for expenses above this level. Customers may also opt for a lower-grade room to keep the premium under control.

 

Using the insurer’s hospital network can help reduce premiums. “This can reduce your premium by up to 15 per cent,” says Singhal. Choosing monthly premium payments can also ease the burden on your pocket.

Common mistakes to avoid

Failing to disclose hypertension is the biggest mistake customers make. “While you may be able to get a policy by not disclosing, you could end up facing a claim rejection,” cautions Yadav.

 

Many customers do not take the trouble to understand the policy details like waiting periods or sub-limits, leading to expectations mismatch. “Many do not opt for wellness features, such as regular health check-ups and preventive screenings, which can lead to better health outcomes in the long run,” says Mosamkar.

 

Another misstep is choosing an insufficient cover. Today, especially for those living in metros, a sum insured of Rs 5 lakh could prove grossly inadequate. Not buying the Day One cover rider is another mistake as it can only be bought at the time of purchase of the policy, and not later.

 

India’s medical inflation ranges from 10 to 15 per cent annually. A cumulative bonus rider should be bought to help customers beat medical inflation.