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Guide to getting health insurance for patients with heart ailments

Heart ailments have become quite common in today’s age. As per the Global Burden of Disease report, India has nearly 24.8% [1]of total deaths due to cardiovascular diseases (CVDs). 

Hypertension, heart blockages, increased cholesterol, etc. are common ailments gripping today’s population. Since the cost of medical treatments is considerable, many individuals look to invest in a suitable health insurance policy. So, do health insurance plans cover heart ailments?

The answer is Yes! There are coverage options for individuals who are suffering from or are at a high risk of heart ailments. There are 2 types of health insurance plans, namely fixed benefit plans and indemnity health plans.

Fixed benefit health plans

There are certain heart-specific fixed benefit health plans which pay on the diagnosis of any of the listed illnesses such as first heart attack, bypass surgery, etc. This plan basically covers the “risk” of heart ailments, especially if there is a family history of the same. So, it can be taken by those who are at a higher risk. However, if the person has an existing heart condition, he would not be able to opt for this plan. 

These plans can be offered by health, general as well as life insurance companies. Some of the popular plans in this segment are:

  • ICICI Pru Heart/Cancer Protect Plan
  • HDFC Ergo Optima Vital Health Insurance

Indemnity Health Plans

These plans cover the cost of hospitalization expenses. In fact, it can provide coverage to a person with existing health conditions as well. However, there are some variants that could be discussed with this example:

Case study:
Mr Verma had an angioplasty done last year. He was earlier covered under his employer’s health plan but after having left employment at 50, he doesn’t have any coverage currently. Mr Verma is looking for a health insurance plan which would cover his heart ailments besides providing coverage against other medical emergencies.

What options of health insurance coverage does he have?

  1. A normal indemnity health insurance plan
    The first option is a health insurance plan which covers the actual medical costs. Heart ailments are considered to be pre-existing diseases and they are excluded from coverage for a specific waiting period, ranging from 1-4 years. Once the waiting period is over, coverage for heart-related complications is allowed under indemnity plans.

In the case of severe heart ailments, however, there might be exceptions. The insurance company can:

  1. Increase the premium for a higher incidence of risk
  2. Impose coverage restrictions on heart-related complications
  3. Reject the policy completely

In the first two instances, he would get coverage, albeit with added terms and conditions. The third instance, usually, happens in extremely severe cases. If the insurer believes that his risk to be too high to be underwritten, it might reject his proposal altogether. 

Note: A pre-entrance health check-up becomes mandatory in case of existing heart ailments and the terms of coverage are, then, decided by the underwriter.

  1. Heart specific indemnity health plans

Many health insurance companies have introduced heart-specific health insurance plans for individuals suffering from heart ailments. These plans are suitable if he is unable to find the desired coverage under normal indemnity plans. The plans are, usually, offered on an individual basis as they are meant for individuals specifically suffering from heart ailments.

Basically, the heart-specific health insurance plans also cover the regular hospitalisation expenses along with annual health check-ups, domiciliary expenses and pre and post-hospitalisation. They are indemnity health insurance plans for people with a pre-existing heart condition.

So, a person like Mr. Verma who has already been diagnosed with a cardiac disorder  in the past and has already undergone a surgical intervention or a procedure, can opt for the plan.Simply speaking, if a person has had a heart attack or a heart surgery like bypass/stent etc. or a specific health condition can opt for these policies.

The two most popular plans in this segment are: 

  1. Star Cardiac Care Plan, with OPD coverage, silver and gold plan options for upgrade
  2. Care Heart Insurance Plan, with annual cardiac check-ups and automatic sum insured restoration benefit

Group health insurance plans

Group health insurance plans are one of the best options for availing health insurance coverage for a heart patient. This is because of the fact that group health plans do not do individual medical underwriting. They underwrite the group as a whole and allow coverage for pre-existing conditions either from Day 1 or after a short waiting period. The premiums are also low or free for the members and the coverage lasts till the member is a part of the group.

So, if Mr. Verma has the option to get covered under a group policy, maybe from a family member, his bank, club etc, it is a good option to go for.

Note: However, do remember that group plans might offer a limited scope of coverage. Given the medical costs associated with treating heart diseases, having an independent policy to supplement the group cover is a wise choice.

To wrap it up

Mr. Verma enjoyed group coverage from his employer but since he left his job, the coverage ceased. Today, he can buy an indemnity-oriented heart-related health plan offered by many health insurance companies. The plan would offer him specialized coverage for his medical needs, both related to his heart as well as otherwise.

You too can opt for health insurance against heart ailments. Just make sure to compare the available policies on the basis of their coverage offered. You should ensure the widest possible scope of coverage given the medical costs. Also, check the coverage restrictions to know the exact scope of the policy. 

A heart ailment, though unfortunate, does not mean that you could not avail of health insurance coverage. There are solutions available in the market. All you have to do is look.

References:

[1] https://www.downtoearth.org.in/blog/health/india-s-burden-of-heart-diseases-study-says-elderly-women-more-at-risk-74993#:~:text=Published%3A%20Monday%2011%20January%202021&text=According%20to%20the%20Global%20Burden,of%20deaths%20due%20to%20CVD.


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