Want immediate insurance coverage for diabetes? Apply for a customised plan

Though costlier, they offer coverage for both type I and II diabetes, and to those with high levels of HbA1C

A recent study published in The Lancet says that diabetes currently afflicts 101 million individuals in India. Another 136 million could be suffering from pre-diabetes. These figures considerably surpass the previous estimates of the World Health Organization, which had put the number of diabetics and pre-diabetics at 77 million and 25 million, respectively. Those suffering from the disease should consider purchasing customised plans offered by insurers.

Getting coverage becomes difficult

Insurers regard diabetics as high-risk. “If unchecked, diabetes can affect various organs such as the eyes, heart, nerves, and kidneys. Such persons need to see a doctor frequently for complications arising from diabetes. The chances of hospitalisation increase. Hence, they tend to make more claims with their insurers,” says Matilde Giglio, co-founder & chief operating officer, Even Healthcare.

Insurers are reluctant to cover diabetics under their standard health insurance plans, especially if they are above 50. Patients with high levels of HbA1C or those on insulin are likely to be denied coverage.

If a diabetic does manage to get covered by a standard policy, diabetes and its resulting complications get classified as pre-existing conditions, leading to a waiting period of two to four years. The premium also tends to get loaded.

Waiting period waived

Customised plans offer inclusivity: they cover people already suffering from diabetes and its associated complications. “They cover people who are on insulin, or have an HbA1C level above eight. Most plans cover both type I and type II diabetes,” says Siddharth Singhal, business head, health insurance, PolicyBazaar.

Another pivotal feature is the elimination of the waiting period for diabetes and associated conditions. “Coverage is available from day one,” says Bhabatosh Mishra, director-underwriting, products and claims, Niva Bupa Health Insurance.

Some insurers make coverage available from the first day if the customer undergoes certain tests. Says Madhumathi Ramakrishnan, senior vice president, Star Health & Allied Insurance: “If the customer undergoes a health checkup, he gets coverage from day one. If not, then basic diabetes is covered from day one but associated complications get covered after 12 months.”

Ramakrishnan adds that these plans also offer focused coverage for diabetes-related complications. These include dialysis, kidney transplant, and eye complications, among others.

These plans also offer outpatient department (OPD) coverage, encompassing consultations, diagnostics, and pharmacy expenses. “Diabetics, who are susceptible to frequent issues like hypoglycaemia, infections, injuries, etc., find this feature valuable,” says Mishra.

Furthermore, these plans offer routine health checkups. “Those who effectively manage their diabetes get discounts on their renewal premiums,” adds Mishra.

Besides covering diabetes and related complications, these plans also function as standard health insurance plans, offering coverage for other ailments.

Individuals with uncontrolled diabetes or associated complications such as renal failure or cardiomyopathy may not be eligible for coverage even under these plans.

All of the above-mentioned features could be offered as part of the main plan, or as a rider.

Higher cost

The premiums of these plans can vary significantly. “These plans could cost between 20 and 100 per cent more than a standard health insurance plan,” says Singhal.

Run these checks

The most critical point prospective customers must check is the waiting period for diabetes and related complications. The ideal situation is to obtain a plan that provides immediate coverage.

Customers should also scrutinise the plan for sub-limits on room rent, doctor’s fees, and specific procedures. Buying a high sum insured (Rs 10 lakh and above) is crucial as diabetes patients require multiple treatments and hospitalisations. The plan should also offer sufficient OPD benefit.

“Unchecked diabetes can impact organs like the kidneys, so the plan must offer robust coverage for organ transplant. It must also cover cataract,” says Giglio.

Apart from diabetes, check the waiting period for other pre-existing diseases too.

Make full disclosure

Compare the wide variety of plans available in the market before selecting one that suits your needs. “At the time of purchase, make a complete disclosure of your current health status and medical history, and submit past reports. Disclose other conditions besides diabetes as well,” says Ramakrishna. Any omission might lead to claim denial.