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How does health insurance for diabetes work?

Diabetes happens when the body can not produce sufficient insulin or cannot effectively utilize the insulin produced. This results in high blood per World Health Organization, 69.2 million people in India are diabetic as per 2015 data and sugar level leading to various complications and threats to the different organ systems in the body. Diabetes is generally two types, Type 1 (also known as Juvenile Diabetes) and Type 2, Gestational diabetes being a subset 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 is rare (2-5% of all the diabetics patients) not covered by any insurance company as the cause of the disease is an immune system failure. The only treatment is the daily injection of insulin and that is not covered by insurance companies. However, type 2 diabetes which is mostly a lifestyle disease and aggravated by eating pattern and sedentary lifestyle, is covered by health insurance companies in India and it is the most prevailing type of diabetes. Diabetic Health Insurance is basically as follows:

Individual Health Insurance where the traditional policies cover diabetics, often with a premium or there will be 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 the employment is there.

Diabetic Health Insurance Plans

Until recently there were very few companies who were willing to provide diabetic insurance in India. Even today very limited health insurance companies are there to provide comprehensive coverage for the disease and its complications since many diabetics outlive the policy term in spite of health issues and the cost of insurers to provide comprehensive coverage makes it less attractive for them. Though there is some variability, salient features of available diabetic coverage in India are as follows:

Eligibility – A person with Pre-existing Type 2 Diabetes or Pre-diabetic. There is a waiting period of 4 years for pre-existing patients while an increased premium enables the insured to use the policy benefits right away.

Age Limit – 18 to 65 years. There is some variability in the age range for different insurers within this limit. There are some companies who cater the diabetic patients of the age group of 60 – 80. Moreover, the renewal term is different from one company to another. Some have a yearly renewal of policy while others are limited years’ fixed policy. The renewal age cap differs from one insurance to another. Some cannot be renewed after65 years while some can extend to 70. Some diabetic insurance targeted for older age group put a policy renewal cap at 90 years.

Premium Amount – Varies from 800 rupees to 18550 rupees based on age and disease coverage.

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 diabetic complications 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 the recipient)

Apart from these, other things that are covered in different policies are: Hospitalization due to Diabetes and Hypertension, Pre and post hospitalization costs as per policy. In case of controlled and improved diabetic condition, some insurers reduce the premiums. Certain policies can be availed as individual or floater policies. The inclusion of certain routine diabetic blood checkups and Income Tax benefits are brownie points of some Diabetic Insurance Plans.

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