Want immediate coverage? Go for diabetes-focused plan

A recent study published in The Lancet says that diabetes currently afflicts 101 million individuals in India. Another 136 million could be suffering from pre-diabetes. These figures considerably surpass the previous estimates of the World Health Organization, which had put the number of diabetics and pre-diabetics and pre-diabetics at 77 million and 25 million, respectively. Those sufferings from this ailment should consider purchasing diabetes- focused plans offered by insurers.

Getting coverage becomes difficult

Insurers regard diabetics as high-risk, “if unchecked, it can affect various organs such as the eyes, heart, nerves and kidneys. Such persons need to see a doctor frequently for complications arising from diabetes. The chances of hospitalisation increase. Hence, they tend to make more claims with their insurers.

Insurers are reluctant to cover diabetics under their standard health insurance plans, especially if they are above 50. Patients with high levels of HbA1C or those on insulin are likely to be denied coverage.

If a diabetic does manage to get covered by a standard policy, diabetes and its resulting complications get classified as pre-existing conditions, leading to a waiting period of two to four years. The premium also gets loaded.

Waiting period waived

Diabetes-focused plans offer inclusivity: they cover people already sufferings from his disease and its associated complications, “ they cover people who are on insulin, or have an HbA1C level above eight. Most plans cover both type I and II diabetes,”

Another pivotal feature is the elimination of waiting period for diabetes and associated conditions. “Coverage is available from day one,”

 Madhumathi Ramakrishan, senior vice president, Star Health & Allied Insurance, says these also offer focused coverage for diabetes-related complications. These include dialysis, kidney transplant, and eye complications, among others. These plans also offer outpatient department (OPD) coverage, encompassing consolations, diagnostics, and pharmacy expenses. “Diabetes, who is susceptible to frequent issues like hypoglycaemia, infections, injuries, etc., finds this feature valuable,

Furthermore, these plans offer routine health checkups. “Those who effectively manage their diabetes get discounts on their renewal premiums. These plans also function as standard health insurance plans, offering coverage for other ailments. Individuals with uncontrolled diabetes or associated complications such as renal failure or cardiomyopathy may not be eligible for coverage even under these plans.

 All the above-mentioned features could be offered as part of the main plan, or as a rider. The premium of these plans can vary significantly.” These plans could cost between 20 and 100 percent more than a standard health insurance plan,”

Run these checks 

The most critical point prospective customer should check is the waiting period for diabetes and related complications. Customers should also scrutinise the plan for sub-limits on room rent, doctor’s fees, and specific procedures. Buying a high sum insured (Rs 10 lakh and above) is crucial as diabetes patients require multiple treatments and hospitalisations. The plan should also offer sufficient OPD benefit.

“Unchecked diabetes can impact organs like kidney, so the plan must offer robust coverage for organ transplant. It must also cover cataract,”

A part from diabetes, check the waiting period for other pre-existing diseases too.

Make full disclosure

Compare the wide variety of plans available in the market before selecting one that suits your needs. “At the time of purchase, make a complete disclosure of your current health status and medical history, “says Ramakrishna. Any omission might lead to claim denial.

REDUCE WAITING PERIOD BY PAYING MORE

Insurer	Plan	Diabetes Type 1 (Insulin)	Diabetes Type-2 (Tablet)	Waiting period reduction option
CARE	Care Supreme Direct	Not covered	12,682	15,114 (After 30 days)
NIVA BUPA	Reassure 2.0 Bronze + (Direct)	Not covered	11,809	15,528 (Day 1, gold)
	Reassure 2.0 Platinum + (Direct)	Not covered	12,868	16,630 (Day 1, gold)
ABHI	Enhanced (Diabetes)	21,536	21,536	21,536 (OPD day 1 IPD 30 days)
	Essential (Diabetes)	18,939	18,939	18, 939 (OPD day 1 IPD 30 days)

For More Details: Pooja Manoj Gupta, visit www.giia26.com
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