Diabetes Health Insurance Plans in India: Coverage, Benefits, And Considerations

Type 1 Diabetes:

This complex form of diabetes requires insulin since the body fails to produce sufficient insulin to convert sugar or glucose into energy. Patients with Type 1 diabetes need insulin injections because their immune system attacks the cells responsible for producing insulin.

Type 2 Diabetes:

The most prevalent type of diabetes, Type 2 diabetes, occurs when the body becomes insulin resistant and can't produce enough insulin. As a result, glucose accumulates in the blood and cannot be converted into energy.

Type 3 Diabetes:

Type 3 diabetes is a variation associated with Alzheimer's disease, primarily caused by insulin resistance in the brain.

Gestational Diabetes:

Common among pregnant women, this type of diabetes typically resolves after delivery. However, if left unmanaged, it may develop into Type 2 diabetes.

Prediabetes:

Prediabetes is a condition characterised by higher-than-normal blood sugar levels, but they do not reach the threshold for a Type 2 Diabetes diagnosis.

Lack of adequate health insurance can exacerbate the hardships faced by individuals with diabetes. As medical expenses continue to rise, it becomes crucial for diabetic patients to obtain the most suitable insurance coverage. Fortunately, there are several specialised health insurance plans tailored specifically for diabetics available in the insurance market.

Why should you buy a diabetic health insurance plan?

1. According to the Arogya World Fact Sheet, "The number of citizens aged between 20-79 in urban areas living with diabetes is expected to increase to 101.2 million by 2030."

2. Diabetics require regular check-ups and screenings to monitor their condition and catch any potential complications early. With a health insurance plan that covers diabetes, you are more likely to schedule and attend these preventive care appointments, promoting better disease management and reducing the risk of serious complications.

3. Diabetes complications can sometimes lead to emergencies that require immediate medical attention. Having a health insurance plan that covers diabetes ensures that you can seek timely treatment without hesitation during such critical situations.

4. According to the Arogya World Fact Sheet, on average, Indians develop diabetes a decade earlier than their Western counterparts.

What are diabetes health insurance plans?

A diabetes plan operates much like any standard health insurance plan and offers coverage for hospitalisation, outpatient medical costs, as well as pre and post-hospitalisation expenses. While the plan features and benefits may differ from insurer to insurer, these plans offer some common features and benefits that remain the same across most insurers:

• Health policies designed for diabetes patients usually offer coverage ranging from Rs 2 lakh to 10 lakhs. However, depending on the insurer and policy terms, some plans extend to higher amounts from Rs 50 lakhs to 1 crore or even more.

• These policies often come with a renewability feature, allowing coverage to increase to double the initial amount and providing automatic recharge of the sum insured once the claim amount is exhausted.

• These specialised health insurance plans not only cover medical expenses but also promote active lifestyles through wellness programs, offering services like health coaching with personalised diet and exercise plans.

• Recognising the potential complications of diabetes, some specific policies also provide coverage for organ transplants, addressing medical expenses for both the insured and the organ donor.

What is the coverage of diabetes health insurance plans?

• Type 1 diabetes is typically detected in children and young individuals, and those affected often rely heavily on insulin for treatment. If you are already diagnosed and dependent on insulin for Type 1 diabetes when purchasing a health insurance policy, you may not be eligible for coverage under the policy. Nevertheless, a few plans might provide some coverage options. However, it's essential to be aware that there remains a possibility of facing rejection.

• As previously mentioned, the causes of Type 2 Diabetes can vary from lifestyle choices to genetic factors, resulting in the body's inability to properly utilise insulin. While it is concerning that India has a high number of diabetic patients, there is a positive aspect to it as well. Since Type 2 Diabetes is the most common form of diabetes in the population, the majority of health insurance providers offer coverage for its treatment. While most diabetes insurance offers coverage without any waiting period, some plans may have a waiting period for pre-existing diabetes.

• Generally, most diabetes health insurance policies provide coverage for gestational diabetes. Besides, many standard health insurance policies also provide this coverage. However, after delivery, insurers may ask you to undergo a test to determine if the diabetes was a temporary pregnancy complication or a permanent condition.

• Diabetes health insurance plans provide coverage for prediabetes, and in many instances, insurers do not impose any additional loading charges.

• A standard health insurance plan might not cover diabetes and related illness if you are diagnosed with it and have been treated for more than 10 years, as the risk and healthcare complications are higher in such cases. However, health insurance for diabetics can extend coverage even if you are diagnosed with diabetes and have been treated for more than 10 years.

Can you buy diabetes riders and/or add-ons?

Yes, you can buy diabetes-specific riders and/or add-ons to make your standard health insurance policy more beneficial. However, if there is a family history of diabetes, it is advisable to opt for a diabetes health insurance plan, as regular medical insurance, along with diabetes riders and/or add-ons, can be more expensive. It is beneficial to purchase the policy early, as most health insurance for diabetics offers coverage even during the waiting period specified in the terms and conditions.

Investing in a diabetes health insurance plan, which covers hospitalisation expenses, is a wise choice for individuals with a less severe form of the disease. Typically, these plans cover pre-hospitalisation expenses up to 30 days before admission and post-hospitalisation expenses for up to 60 days after discharge, providing significant advantages.

Are there any tax benefits to buying a diabetes health insurance plan?

Similar to regular health insurance policies, diabetes health insurance plans are also eligible for tax benefits under Section 80D of the Income Tax Act.

What should you keep in mind when buying a diabetes health insurance plan?

The primary benefit of most diabetes health insurance plans in the market is that they offer coverage without a waiting period for pre-existing conditions. However, the premium for these policies could be relatively higher than regular policies. There are various types of diabetes, and it is crucial to choose the right diabetes insurance for your needs based on the type of diabetes you have.

To secure the best health insurance for diabetic patients, it is crucial to act swiftly when applying. Most health insurance policies have a waiting period for pre-existing conditions. If you already have diabetes, the policy may not cover expenses related to diabetes during the 2-4 year waiting period, which can be a significant drawback, leaving you to bear these costs on your own despite having insurance coverage.

Before selecting a specific diabetes health insurance policy, it is essential to compare key features such as waiting periods and co-pays to make an informed decision. Since diabetes entails high-risk implications, it is advisable to adapt positive lifestyle changes to minimise health and financial risks.

To conclude:

Diabetes health insurance plans offer crucial coverage and benefits tailored to the specific needs of individuals living with diabetes. These specialised plans address the financial challenges associated with managing diabetes and provide access to essential treatments, medications, and medical supplies. While some policies may have higher premiums, they often come with the advantage of covering pre-existing conditions without waiting periods. To make the best decision, you should carefully compare different plans, considering factors such as coverage limits, waiting periods, co-pays, and additional services like wellness programs. By choosing the right health insurance plan, individuals can safeguard their health, well-being, and financial stability while effectively managing diabetes.

KETKI JADHAV is a Content Writer at PersonalFN since August 2021. She is an MBA (Finance) and has over seven years of experience in Retail Banking. Ketki specialises in covering articles around banking, insurance, personal finance, and mutual funds and has been doing it for over three years now.

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