Health Insurance for Heart Patients

Can Heart Patients Get Health Insurance Coverage? Yes, you can get health insurance for heart patients. As per IRDAI, insurers must offer coverage to individuals with pre-existing conditions, including heart ailments, though terms may vary. Coverage may involve waiting periods, higher premiums, or specific exclusions depending on the severity of the condition. Specialized plans and riders are also available to reduce waiting periods.

Heart disease is one of the leading health concerns worldwide. If you or a loved one has been diagnosed with a heart condition, securing the right health insurance for heart patients can feel overwhelming.

Many wonder, “Does health insurance cover heart diseases?” The answer depends largely on your specific situation and this guide, we break down those scenarios so you can make informed decisions about your coverage.

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Does Health Insurance Cover Heart Diseases?

Health insurance does cover heart diseases, but the extent of coverage can vary. For anyone exploring health insurance for heart patients, the scenario depends on whether you purchased your policy before or after being diagnosed with a heart condition. Understanding these nuances will help you choose the best plan and avoid surprises when you need critical care.

Scenario 1: Health Insurance for Heart Patients Already Diagnosed 

If you have already been diagnosed with a heart condition and are now seeking a health insurance plan, the process is more complex than buying when healthy. Insurers treat applicants with pre-existing cardiac ailments as higher risk, which impacts underwriting, terms, and availability of plans.

Underwriting Considerations

When you apply for health insurance for heart patients post-diagnosis, insurers undertake a thorough underwriting process to assess your risk profile. Key factors include:

• Loading Charges: Insurers may apply additional premium loading depending on the severity and stability of your cardiac condition. The percentage range of premium loading for heart patients generally ranges from about 10% to 40% or even higher depending on factors such as the severity of the heart condition, number of conditions, and insurer’s risk assessment.
• Waiting Periods: Heart-related ailments are usually subject to waiting periods (often up to 3 years) before coverage kicks in. Insurers may allow reduction of waiting periods via add-on, upon payment of extra premiums.
• Permanent Exclusions: Depending on your heart condition’s nature and prognosis, insurers may permanently exclude coverage for certain treatments, surgeries, or complications linked to that condition. This is why choosing the right health insurance for heart patients becomes essential.
• Possibility of Application Rejection: In some cases, insurers might reject your health insurance application if they determine the risk is too high. This is more likely if the cardiac condition is severe, recent, or unstable. In such cases, exploring specialized health insurance for heart patients may increase the chances of approval.

Common Heart Conditions Covered

Common conditions covered under health insurance for heart patients include:

• Hypertension (high blood pressure)
• Coronary artery disease (CAD)
• Heart stroke / cardiac arrest
• Rheumatic heart disease
• Hypertensive heart disease

Plans With Cardiac Coverage and Waiting Period Waiver Riders: Ditto’s Cut

Several health insurance plans are popular for their cardiac care focus and coverage of chronic heart conditions. When buying health insurance for heart patients, it is highly advisable to include add-ons or riders that reduce or waive the waiting periods for pre-existing diseases (PEDs). These riders are worth the investment, as heart patients won’t have to fulfill the typical long waiting periods before their cardiac treatments are covered. Instead, they usually just face the initial standard 30-day waiting period.

Before we discuss the list, here’s how we decide what plans to feature. At Ditto, every health plan goes through our six-point evaluation framework. It doesn’t mean these are the only good plans, but that they stand out after being scored across all six pillars. You can learn more about how we evaluate health insurance plans here.

Here are some key plans along with their riders designed to waive or reduce PED waiting periods:

• Care Supreme with Instant Cover Plus Rider: Recommended for Hypertension, Diabetes, Cholesterol, Asthma, Obesity, Chronic Obstructive Pulmonary Disease (COPD), or Coronary Artery Disease (PTCA done more than 1 year ago). This rider reduces the waiting period for these declared pre-existing diseases from 3 years down to just 30 days. Makes it a strong option in health insurance for heart patients who want faster access to coverage.
• Aditya Birla Activ One Max with Chronic Care Add-on: Same as the above (Care Supreme). This add-on offers an even stronger benefit by reducing the pre-existing disease waiting period from 3 years to 0 days, enabling immediate coverage from policy inception.
• ICICI Lombard Elevate with Jump Start Rider: This rider is targeted at insured individuals with diseases like Asthma, Diabetes, Hypertension, Hyperlipidaemia, Obesity (BMI > 35), or who have undergone PTCA previously. It reduces the PED waiting period from 3 years to just 30 days, with no additional premium loadings except the cost of the rider itself.

Last Resort Options When Comprehensive Plans Are Rejected

If you face rejections from mainstream comprehensive plan applications because of your heart condition, you may consider specialized health insurance for heart patients.

• Care Heart Plan
• Star Health Comprehensive Plan
• Star Cardiac Care Platinum

These plans are designed specifically for individuals with diagnosed heart conditions or other serious pre-existing diseases. However they may come with higher premiums and stricter terms (with respect to waiting period, pre-existing disease coverage, copayment etc.).

Note: The above-mentioned plans are only a few examples based on our research and are not an exhaustive list of options available for health insurance for heart patients. They may also be part of our current recommendations to prospective clients, depending on individual needs and suitability.

Government and Group Insurance Schemes

When looking for health insurance for heart patients, don’t overlook wider safety nets such as:

• Government Health Schemes like PMJAY (Pradhan Mantri Jan Arogya Yojana), which provide coverage from day one for pre-existing diseases including heart ailments. In addition, government hospitals often offer free or subsidized cardiac treatment, ensuring access to essential care even when private insurance isn’t available or affordable.

For more details, here’s a list of the best government hospitals in India offering advanced care and treatment at affordable rates.

• Group Insurance Policies through Employer offer a convenient form of health insurance for heart patients which often include pre-existing disease benefits without waiting periods.

Scenario 2: Purchased Health Policy Before Being Diagnosed With a Heart Condition 

If you bought your health insurance policy before any heart-related diagnosis, you are generally covered for heart disease treatment, as most leading plans include hospitalization, surgery, and medication expenses required for managing such conditions. However, coverage is subject to terms and conditions.

Types of Treatment Under Comprehensive Plans

If you hold a comprehensive health insurance plan like HDFC Ergo Optima Secure, Care Supreme, or Aditya Birla Activ One Max, you are covered for heart ailments diagnosed after you purchase the policy, subject to the policy’s terms and conditions.

These plans typically cover:

• Inpatient hospitalization expenses including room rent, doctor fees, and surgery costs related to heart diseases.
• Daycare procedures such as angioplasty, certain cardiac tests, or minor procedures that do not require overnight stay.
• Pre-hospitalization and post-hospitalization expenses for a specified number of days (e.g., 30 days before and 60 days after hospitalization).
• Consumables and non-medical expenses like gloves, syringes, and PPE kits are covered in some plans or available via add-ons to reduce out-of-pocket costs.
• Health screenings and diagnostic tests related to cardiac health during policy renewal or based on doctor recommendations.

Pro Tip: Once diagnosed with a heart ailment, immediately inform your insurer in writing and ensure you receive an acknowledgment. This proactive step helps maintain a smooth claims process in the future and avoids disputes regarding your condition or coverage. 

Important Things to Be Aware Of When Diagnosed Post-Policy Purchase

• Immediate Coverage Subject to Policy Terms: Most comprehensive health plans cover post-purchase diagnosis of heart conditions immediately, though standard exclusions will apply. Always read your policy document carefully to understand how your health insurance for heart patients applies in such cases.
• Premiums Cannot Be Loaded Due to Diagnosis: Insurers cannot charge you extra premiums simply because you were diagnosed with a heart condition after buying the policy. Premium rates are determined based on the insurer’s overall risk pooling and medical inflation, not individual claims history. This makes health insurance for heart patients a stable financial safeguard even after diagnosis.
• Guaranteed Renewability and Lifelong Coverage: Standard personal retail health insurance plans offer lifelong renewals and cannot be discontinued or refused renewal by the insurer due to your heart condition.

This guaranteed protection highlights why early purchase of health insurance is so critical. If an insurer needs to withdraw a product (due to pricing issues, outdated features, or low adoption), it is obligated to provide its existing customers with continuity through migration to a similar product. Importantly, all accrued benefits such as waiting period credits must be carried forward to the new plan.

• Limited Flexibility for Policy Modifications: In health insurance for heart patients, flexibility is limited. While your plan stays renewable, options like porting, migrating, increasing cover, or adding riders may be restricted as insurers see you as higher risk.

Pro Tip: For extra protection, consider purchasing an add-on called a Critical Illness Rider. This pays out a lump sum upon diagnosis of listed critical illnesses, including heart attacks, angioplasty, and other cardiac events. These riders are available with both health and term insurance policies, but they are generally more affordable when attached to term insurance.

Why is this helpful? While health insurance covers your treatment costs, the lump sum from a critical illness rider can help cover lost income and household expenses during your recovery period. This layered protection is particularly valuable for heart patients facing long-term recovery.

Health Insurance for Heart Patients: Ditto’s Tips

Here’s our advice for you:

1. Buy early: If you don’t have a heart condition yet, get insured now. Waiting till after diagnosis narrows options and increases premiums due to loading charges.
2. Add PED waiting period reduction riders: These speed up coverage for conditions like hypertension or diabetes and ensure faster access to cardiac care.
3. Do your homework: Understand what your chosen health insurance for heart patients covers, specifically for heart-related conditions.
4. Medical Check-Ups Matter: Stay proactive about cardiac health assessments. Early detection can save money and lives. Use insurer offered free annual health check-up and health assessment programs to the fullest extent
5. Be Honest With Insurers: Always disclose existing conditions or early symptoms to avoid disputes and ensure smooth claims.
6. Rely on Guaranteed Renewability: Once insured, your policy remains valid for life. 

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Conclusion

Health insurance for heart patients is available, but the options and terms vary depending on your health status and timing of purchase. Buying early, selecting comprehensive plans with critical illness riders, and understanding policy terms are key to securing the financial protection you need.

Whether you are looking for plans before diagnosis or after being diagnosed with a heart condition, the smart approach is to evaluate coverage, inclusions, waiting periods, and financial benefits carefully.

At Ditto, we aim to guide you every step of the way to find the right health insurance for heart patients to safeguard both your heart and your peace of mind. Book a free call with our advisors today and get unbiased, personalized guidance to choose the best plan for your needs.

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