Kunal, a young IT professional in his mid-30s was recently diagnosed with ‘Type II Diabetes Mellitus’. He did his homework about the long term and short-term implications of his latest condition. He was advised to walk regularly, exercise and curb the sugar intake in his diet. These are some of the measures his physician say are necessary to protect his heart, eyes and legs which prime casualties in diabetes patients in the long-term.
According to the International Diabetes Federation (IDF) website, diabetes is growing at alarming levels in India; more than 65 million people suffer from it presently and this figure is estimated to cross the 100 million mark by 2030. The usual suspects which lead to this condition are decreased physical activity, increased consumption of fat, sugar and calories, and higher stress levels affecting insulin sensitivity and obesity.
A friend of Kunal’s advised him to get a health insurance to cover the costs of any medical emergencies or procedures required in the future. Kunal was smart enough to heed the advice and called myinsuranceclub.com helpline, shortly after. So, let’s see what kind of health insurance plans are available for people with his condition.
Diabetes health insurance market in India
If you want to buy a health insurance plan and are suffering from diabetes, it will qualify as a ‘pre-existing condition’ and will be subject to a specified waiting period (usually a few years) as per the policy terms and conditions. In the worst case, insurer can deny the policy to you.
ICICI Prudential Life was the first insurer to launch a diabetes-specific health insurance plan called ICICI Pru Diabetes Care (discontinued). Star Health Insurance followed with ‘Star Diabetes Safe’ and a couple of years back, Apollo rolled out a dedicated diabetes product called ‘Energy’. Apart from this, National’s regular family floater health insurance plan ‘Parivar’ also offers a preferential treatment to diabetes and hypertension patients.
Comparison of diabetes health insurance products in India
After a review of the brochure and policy wordings of the respective products, below is a comparison table whereby the plans are compared on a few key parameters:
Following are some of the main conclusions we can draw from the above analysis:
- All three products can cover diabetes from day 1. In case of National, a small additional premium is payable for this. For illnesses other than diabetes, Apollo has a lesser waiting period of 3 years which is a plus.
- Apollo has the least sub-limits and capping and stands out completely from the other two in terms of clarity in the policy wordings on what is covered and not covered.
- Apollo offers highest sum assured of Rs. 10 lac and & also explicitly mentions the sum assured enhancement condition in its policy wordings.
- Only Star is offering a restoration feature in a diabetes policy. Though this is a plus, it cannot be the sole determinant.
- National does not cover organ donor expenses.
- Age at entry in case of Apollo is very low at 18 years which is a positive for younger generation and pre-diabetes cases.
- On the point of renewability, Star and National policies cap renewal age as per their brochure. This is against the 2013 IRDA Health Insurance Regulations & policyholder can dispute this condition.
Hence, if we see from an overall perspective, Apollo Munich Energy emerges out the best option that can be considered. Opting for silver plan with 20% co-pay can bring down the premium to manageable levels, if budget is a constraint.
What are the other options?
As we can see, the options in terms of dedicated diabetes health insurance plans are quite limited. If you select these plans, then though you get day 1 cover, you stand to miss out on other features like higher sum assured, features like restore and multiplier, coverage for treatments of select illnesses outside India etc. Also, apart from National, both the other plans are individual plans & hence you cannot cover all family members in one policy & get the benefit of lower premium.
Hence, if you are young (i.e. below 35) and have been recently diagnosed with the illnesses, a day 1 diabetes cover may not be a must-have. Instead, you can consider a regular health insurance plans with a lesser waiting period. For e.g. Religare Care Freedom has a waiting period of only two years.
Similarly, in case of senior citizens, while they check for diabetes specific plans, it also makes sense to compare senior citizen plans which either cover diabetes & hypertension from day 1 (e.g. National Varistha Mediclaim) or other plain vanilla ones which are low on premium and high on features like Apollo Munich Optima Senior.
From a financial planning perspective, even though you’ve got a health policy, you should still maintain a dedicated medical fund to tide over things like claim delay, rejections & cost of non-medical expenses.
Conclusion
Diabetes health insurance in India is poised for growth & will see much more innovation in times to come, resulting in better features and hence, a win for the end consumer. As for our friend Kunal, finally he is clear on the options available for him and a confidence that irrespective of his health condition, he can buy his peace of mind & well being of his family through the right health insurance.
