Health Insurance for Chronic Diseases in India

A slight fever for 5 days, a cough and cold, a stomach ache for a couple of days, a headache that splits your thoughts - and you feel like your mind and body are drained beyond their functioning capability. Just imagine the condition of those for whom certain health complications persist for months, or even years! Such long-term ailments are called chronic diseases.

With a work-from-home setup and sedentary lifestyle, acquiring chronic ailments is not really a surprising situation. However, such ailments have a long-lasting impact on an individual's long-term physical and financial well-being. And seeking assistance to get through the same is a justified move.

This is where seeking and availing of health insurance for chronic diseases comes into the scenario. Having access to a significant fund that is there to act as a financial security net and help you meet the expenses for your medical treatments, takes half the stress out of the situation. Following up with similar ideas, the top health insurance providers across the country have been offering the best-possible policies to critical illness individuals.

Of course, there are certain restrictions, hold-backs, and exclusions in such policies. However, are these health insurance policy variants still worth availing of? That’s what we are here to find out!

What are Chronic Diseases?

Chronic diseases are those health conditions that continue for a prolonged period of more than a year and require continued medical attention. Such medical situations prove to be guaranteed hindrances in the professional and personal lifestyles of individuals. Such chronic ailments comprise -

1. Diabetes (Type 1, Type 2, Gestational, and Pre-Diabetic, Diabetic Retinopathy, Diabetic Tripathy)
2. High blood pressure
3. Renal conditions
4. Cardiac conditions (Eg: Myocardial Infarction, Arrhythmias, Cardiovascular diseases etc.,)
5. Arthritis
6. Osteoarthritis
7. Rheumatoid Arthritis
8. Cancer (Any type of cancer, undergoing treatments or considered as PED)
9. Autoimmune diseases

Individuals are often torn between carrying on a normal life and frequent hospital visits. This isn’t just a psychological burden, but a financial one too.

And if one starts dipping their toes into their savings to meet with such issues, it won’t be long before the savings melt away. However, there’s the perfect solution to this - availing of health insurance for chronic diseases. Compared to the original hospital invoices over frequent hospitalisations, the premiums to be paid for the best health insurance plans are minimal.

Also, if you end up choosing a suitable provider and a tailored health insurance plan for diabetes and the rest of the chronic ailments, you may end up having more benefits than you aimed for. Such advantages include -

• Tax benefits under Section 80D
• Pre and post-hospitalisation coverage
• Domiciliary and daycare treatment coverage
• No-Claim Bonuses, and more.

Here’s a look at some of the best health insurance plans for such chronic ailments -

Best Health Insurance Policies for Chronic Diseases

(Please remember that while these health insurance plans do offer coverage for the treatment of the aforementioned chronic ailments, the last say lies with the underwriting team of your health insurance provider.)

Things to remember while choosing health insurance plans for chronic diseases

In general, when one avail of health insurance plans, it is a significant financial decision. However, when it comes to choosing a health insurance plan covering pre-existing conditions or chronic ailments, the decision becomes much more crucial. That’s because,

• in the standard cases, where a healthy individual seeks a plan, the medical conditions do not exist yet, it is a financial move with anticipatory reasons.
• On the other hand, when it comes to choosing plans for chronic ailments, the costs are already a reality, and hence, the plans have to be chosen with utmost care keeping in mind that this same policy would come in handy in case of any auxiliary health complications too.

Taking into account, the importance of a health insurance plan for chronic ailments and how it is instrumental in ensuring quality healthcare services sans facing any financial distress, here are a few points to remember when you choose your plan -

1. Disclosure of any pre-existing conditions is a must

Chronic diseases, if acquired before availing of the health insurance policy, need to be disclosed to the Third Party Administrator (TPA) or directly to your health insurer. Else, in case of future treatments, while in the continuance of the insurance policy, your insurer might reject your claim or cancel the policy overall.

So, it’s best to disclose any chronic ailments that you are or had been treated for. This will also help your health insurance provider suggest the most suitable health insurance plan, one that caters to your existing medical conditions.

2.  Higher cost of health insurance policies

Since there is a pre-existing chronic disease, any health insurance provider would consider the policyholder to be a high-risk individual with increased (read: guaranteed) chances of multiple hospitalisations across the year. Hence, they include loading charges into the premium for a health insurance policy.

This means you are looking at a spiked premium for your health insurance plan. However, this spike is minimal compared to the total bills generated from hospital treatments. All that you need to do is compare various health insurance plans over our free comparison tool and then decide upon a financially convenient one.

3.  Permanent exclusions under such plans

Now, it is true that health insurance providers do offer plans to chronically ill patients. However, they also include certain exclusions in their plans. So, when purchasing a health insurance plan for cancer, diabetes, or any other such ailments, make sure to read into the finer prints of the plans to get familiar with the exclusions in your plans. This will help you make an informed decision when availing of a plan.

4.  Extensive waiting period involved

Health insurer providers do offer coverage for a queue of chronic ailments. However, there is also an associated waiting period that a policyholder needs to hold on to before their treatments regarding a chronic ailment are covered. Since there is a chronic ailment involved, the waiting period is essential for the insurance provider to safeguard their financial stability.

On the other hand, the less the waiting period, the better it is for the policyholders because during the waiting period, an individual needs to pay for their treatment out of their own pocket.

5.  Possible requirement of medical health checkup

When you inform your health insurance provider/expert insurance advisor that you have a chronic ailment, there is a high chance that they request a complete medical checkup (this is a probability, but not a compulsion). This will help the insurance provider be completely aware of any and all pre-existing health conditions.

Look for Health Insurance plans with:

• No copayment: With a chronic illness, the frequent hospital bills, pharmacy charges, and diagnostic tests can all add up to a large amount. In such a case, if you opt for a plan that requires you to pay a mandatory copayment, you will end up paying significantly, despite having health insurance coverage in place.

PLEASE NOTE: The absence of a copayment in your health insurance policy is an ideal situation. In some cases, however, when you have some chronic ailments that make availing of a health insurance policy cumbersome, you can always opt for a cover that requires minimum copayment. At least you will still have the policy to cover the lion’s share of the charges.

• No disease-wise sub-limits: The sole cause of availing of health insurance for chronic diseases is to make sure that you are financially covered for the treatment of that specific ailment.

However, if there is a disease-wise sub-limit in place, this purpose becomes partially null and void. And you end up paying both a part of the treatment charges and the premium towards your existing health insurance plan.

• No room rent restrictions: When it comes to high chances of frequent hospitalisations, room rent across hospitals becomes a crucial aspect that needs to be carefully considered.

If you have restrictions on the room type and rent, you will be paying substantially over pro-rata-based charges. And it won’t just be the room rent, it would also include the hospital bills, in total. Thus, you must choose a plan with no room rent and type restrictions.

• Appreciable restoration features: Choosing a plan for chronic ailments means that you need a high coverage amount to meet your high-end medical expenses for an entire year. However, the problem is the higher the cover amount you choose, the higher the premium that you will be paying.

But, there’s a solution to this; you can choose a plan that comes with the beneficial feature of Unlimited restoration in your health insurance plan. This would give you access to a broader coverage bandwidth when you exhaust your base amount and that too for pretty low charges on your premium.