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How does health insurance for diabetes work?

That exclude 36 million plus people who remained undiagnosed. Diabetes happens when the bodycannot produce sufficient insulin or cannot effectively utilize the insulin produced. This resultsin high bloodAs per World Health Organization, 69.2 million people in India is diabetic as per 2015data and sugar level leading to various complications and threats to the different organ systemsin the body. Diabetes is generally two types, Type 1 (also known as Juvenile Diabetes) and Type 2,Gestational diabetes being a sub set of Type 2 diabetes that occurs during pregnancy.
Diabetics Health Insurance
Diabetes is a ‘high risk’ category of illness and the health insurance coverage for Type 1 israre (2-5% of all the diabetics patients) not covered by any insurance company as the cause ofthe disease is immune system failure. The only treatment is the daily injection of insulin andthat is not covered by insurance companies.
However, type 2 diabetes which is mostly a lifestyle disease and aggravated by eating pattern andsedentary life style, is covered by health insurance companies in India and it is the mostprevailing type of diabetes. Diabetic Health Insurance are basically as follows:
  • Individual Health Insurance where the traditional policies cover diabetics,often with a premium or there will be a 4 years waiting period for pre-existing diseases.
  • Group Health Insurance which is provided by employers to their employees with diabetes,either pre-existed or at the onset is another option. This is valid only as long as theemployment is there.
Diabetic Health Insurance Plans
Until recently there were very few companies who were willing to provide diabetic insurance inIndia. Even today very limited health insurance companies are there to provide comprehensivecoverage for the disease and its complications since many diabetics outlive the policy term inspite of health issues and the cost of insurers to provide comprehensive coverage makes it lessattractive for them. Though there are some variability, salient features of available diabeticcoverage in India are as follows:
  • Eligibility – A person with Pre-existing Type 2 Diabetes or Pre-diabetic. There is awaiting period of 4 years for pre-existing patients while an increased premium enablesthe insured to use the policy benefits right away.
  • Age Limit – 18 to 65 years. There are some variability in the age range for differentinsurers within this limit. There are some companies who cater the diabetic patients ofthe age group of 60 – 80. Moreover the renewal term is different from one company toanother. Some have yearly renewal of policy while others are limited years’ fixed policy.The renewal age cap differs from one insurance to another. Some can not be renewed after65 years while some can extend to 70. Some diabetic insurance targeted for older age groupput a policy renewal cap at 90 years.
  • Premium Amount – Varies from 800 rupees to 18550 rupees based on the age and diseasecoverage.
  • Base Sum Assured – Ranges from rupees 50,000 to 10 lacs depending on the policy.
  • Disease and symptom coverage – there is a wide variation in coverage of diabeticcomplications based on policy. These are (but not limited to):
    • Diabetic Retinopathy for Eyes
    • Diabetic Nephropathy for Kidney
    • Diabetic foot ulcer for Feet
    • Coronary Artery Bypass Graft
    • Cancer
    • End Stage Renal Failure
    • Major Organ Transplant (as recipient)
Apart from these, other things that are covered in different policies are: Hospitalization dueto Diabetes and Hypertension, Pre and post hospitalization costs as per policy. In case ofcontrolled and improved diabetic condition, some insurers reduce the premiums. Certain policiescan be availed as individual or floater policies. Inclusion of certain routine diabetic bloodcheck ups and Income Tax benefits are brownie points of some Diabetic Insurance Plans.
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