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Things to remember while buying health insurance with diabetes

Diabetes has become a household name in the modern age. India is soon becoming the Diabetes Capital of the World. According to reports by the International Diabetes Federation, 8.9% of the Indian population, i.e. roughly 77 million individuals are affected with diabetes. The diabetic population of India is expected to rise by 266% by 2030. This data is not only alarming but of severe concern too as diabetes is considered to be a genetic and lifestyle ailment. There is a high risk, but it can be controlled by a change in lifestyle.

Cost of diabetes management in India

The prevalence of the ailment with the younger popular has risen by more than 10%. There are 2 types of diabetic people in the world, namely confirmed diabetic and pre-diabetic. So, if you are in the zone of pre-diabetic or have a relatively sedentary lifestyle with one or more diabetic family members, it is time to change your lifestyle as well as opt for higher health insurance coverage.

The average cost of medicines for a diabetic ranges from Rs 5000 to Rs 10,000 per month. However, with comorbidity, the cost of monthly treatment could be higher. Thus, Diabetes management is an expensive affair that could be a strain on your monthly household budget.

The bigger worry is the risk of having other complications such as Cardiovascular disease, hearing impairment, skin conditions, kidney and nerve damage, etc, which rises with diabetes. The rising cost of healthcare expenses has pushed inflation to about 15% in India.

According to the NSS data, the average cost for hospitalization costs Rs 38,222 in urban areas and Rs 27,347 in rural India. In private hospitals, the average cost of hospitalization can be summarised as:

IllnessCost of Treatment
Heart AttackAverage treatment for CVD costs INR 1-6 lakhs based on cities
Kidney Related IllnessThe average cost of dialysis is INR 12K to 20K, based on the condition of the kidney
CataractThe cost of surgery can range from INR 10K to INR 1L
Gall Bladder SurgeryLaparoscopic Cholecystectomy cost ranges from INR 21.8K to INR 2.1L based on city and type of hospital
CancerThe average cost of treatment is Rs 3 to 4.5 lakhs 
Covid-19The average cost of 10-day treatment is Rs 80,000 and for ventilator support, the cost is in lakhs5 

In fact, Indians pay about 78% of the entire medical expenses from their own pocket. Hence the expected hospitalization and treatment cost could deplete your savings even before you are aware of the same!

Insurance options for the confirmed diabetic in India

Having the highest possible coverage especially if you are a confirmed diabetic is your second best option. The first being overtly active with a change in lifestyle to keep the illness under control, of course. However, if you still do not have any health insurance, here are some of the options that you can consider. To understand the various possibilities, we have taken the example of Varun, aged 46, who was also diabetic suffering from Type 2 diabetes. He was looking for a health insurance policy for himself, his wife, and two children.

Health Insurance options:

Diabetes is a common ailment that is covered under most health plans. However, it is considered to be a pre-existing condition if it is diagnosed before the inception of the plan. 

Choice 1: Group health plans

If Varun enjoys a group health insurance scheme offered by his employer, bank, club or any other group that he is a member of, he can get covered for diabetes. 

Group health plans usually allow coverage against diabetes as well as other pre-existing conditions. He can enjoy coverage even from the first day without any waiting period. So, if Varun can avail a group health plan, he can rest assured that diabetes and its related complications would be covered.

However, there is a downside to group health plans too. The coverage of the policy is not in the hands of the insured member. Insurance companies can increase the premium and/or reduce the sum insured based on their claim experience. This would limit the coverage available. Also, the plan would be available to him only as long as he is a part of the group, which he might not be able to continue lifelong.

Solution: If a group cover is available, he can opt for the same. But he must take an additional individual insurance plan too! 

Choice 2: Indemnity oriented health plans

Almost all health insurance plans allow coverage for diabetes after a waiting period of 1 to 4 years. Some plans even allow coverage for diabetes without any waiting period by paying an additional premium while others allow to buy back the waiting period and reduce it. So, if Varun wishes to buy a new policy, he can get coverage against diabetes. 

However, remember the premium under the policy is likely to rise more than usual given the adverse medical condition. Also, if Varun has a severe case of diabetes, there might be coverage restrictions right from the policy inception. You might also be required to undergo a health check-up and based on your medical reports, the insurance company would take the necessary action when allowing coverage.

Solution: This plan can be taken by Varun and his entire family if immediate coverage is not a priority. 

Choice 3: Diabetes specific health insurance plans

If you want, you can also explore diabetic specific health insurance plans. These plans are made specifically for those who suffer from Type1 or Type 2 diabetes. You can get this plan on an individual basis, i.e. covering one life under one sum insured.

Diabetes specific plans are indemnity oriented plans which cover medical complications arising out of diabetes or other illnesses or injuries. They allow lifelong renewals allowing you to enjoy coverage lifelong. The premiums are slightly on the higher side and the sum insured is restricted up to a certain limit.

Some of the popular plans are:

  1. Star Health Insurance Diabetes Safe covers the cost of hospitalization for all diabetic-related complications from both Type 1 as well as Type 2 Diabetes. This plan has a 0-12 months waiting period along with other benefits such as OPD coverage, sum assured restoration, etc.
  2. HDFC ERGO Health Insurance Energy Plan, an exclusive diabetic health insurance plan especially designed for people with diabetes and hypertension. This plan has no waiting period and wellness check-up and incentives for the diabetic as well.

So, if you are also looking for a health insurance plan against diabetes person like Varun, consider the above-mentioned options. The earlier you opt for it, the easier it is to underwrite the plan, and even if there are waiting periods, it would not affect too much. You can also opt for diabetes-specific plans for specialized coverage but remember such plans would not allow the floater benefit. So, assess your coverage needs and then make an informed choice.


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