Chronic Diseases covered under Health Insurance Plans in India
Are you considering getting health insurance? In recent years, health issues have become a major cause of concern due to changes in individual lifestyles. Increased daily stress, pollution, and workload, combined with a sedentary lifestyle, has made us vulnerable to chronic illnesses. Due to rising inflation in the healthcare industry, the cost of treating these serious conditions could bear a hole in your pocket. Hence, to protect yourself from copious amounts of medical bills and to secure the quality of care in private hospitals, health insurers offer comprehensive health insurance policies that cover chronic diseases at affordable prices.
Chronic illness affects not only an individual physically but financially as well. This disrupts patients as well as their family’s daily life. If not treated promptly and with great care, these may even lead to mortality of the individual.
What are Chronic Diseases?
Chronic diseases are illnesses that last for at least three months and require regular medical intervention. They are usually progressive and adversely affect your daily activities. The most prevalent chronic diseases in India are diabetes, high blood pressure, cancer, stroke, arthritis, etc.
The majority of chronic illnesses are related to our modern sedentary lifestyle, active or passive smoking, chewing tobacco, and increased consumption of alcohol and junk foods. Most of them are incurable and require long-term management or may be prevented with vaccination, both of which result in high medical bills for people to bear.
Some chronic diseases are also considered critical illnesses as these may often prove fatal in the absence of the right treatment at the right time. A few critical illnesses are cancer, stroke, hepatitis, cardiovascular-related diseases, etc. But some are not critical, such as arthritis, asthma, and gout.
How Do Health Insurance Plans Cover Chronic Diseases in India?
Most health insurance policies in India cover chronic diseases and critical illnesses. They offer a variety of health insurance plans which cover most critical illnesses depending on the plan.
Some healthcare insurance providers also cover pre-existing medical conditions for their customers. Although, they must be disclosed at the time of subscribing to the healthcare plan and are only covered under health insurance after a certain waiting period depending on your health insurance policy provider.
Hence, check the required waiting period before coverage when choosing your health insurance provider. So, choose the plan carefully and with the least waiting period.
Some chronic illnesses are genetically transferred, i.e., from one generation to the next. So, if you have a medical history of chronic illnesses in the family, it is advisable to opt for the health insurance plan as early as possible.
Health insurance covers not only medical expenses but also bed charges, ambulance, and lab investigation. It offers coverage of up to 1 crore or more for the treatment of critical illnesses. You’re paid a lump sum amount for critical illnesses diagnosed under the policy period. But most health insurance policies for critical illnesses have a waiting period of 90 days and a survival period of 1 month. If you do not fulfill the waiting or survival period, the insurance company is not liable to pay the amount.
Diseases Covered Under Health Insurance for Chronic Diseases
- Accident-related expenses
- Cancer
- Covid-19
- Critical illnesses
- Diabetes
- HIV/AIDS
- High BP
- High BMI
- Heart ailments
- Arthritis, osteoporosis, gout, spinal disorder, joint replacement, ligament repair, cataract, hernia, etc.
Is it Advisable to Disclose Pre-existing Chronic Diseases While Purchasing Health Insurance?
Yes. While purchasing health insurance from your insurer, it is strictly advisable to disclose all pre-existing chronic and critical ailments. Otherwise, you may have to forfeit your insurance claim.
If you don’t disclose a pre-existing chronic illness to your health insurance provider and file an insurance claim for the disease, it could lead to rejection. The insurance company, while you are undergoing treatment, checks the medical investigation report thoroughly. If it finds the treatment is due to an illness that existed before buying a policy, it could decide to reject your health insurance claim on the grounds of non-disclosure. Not disclosing shows your tendency to cheat the insurer in some ways.
So, never hide your medical history from your health insurance provider while signing up, even if the price of your plan or the waiting period increases. This will help prevent inaccuracies in the disclosure of your medical history and prevent your application from being rejected.
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What are the General Features of Health Insurance for Chronic Diseases?
• Sum assured ranges from INR 2 lakh to INR 1.5 crore enough to cover expenses. However, the sum insured can vary from plan to plan. The sum insured, which you can avail of during treatment, helps avoid payments from your savings.
• There is an option for babies as young as 90 days. The upper age limit for enrollment under the policy can be 65 years. However, the same can vary across policies.
• The procedure is very simple and requires very little documentation. A health insurance company directly deals with the hospital to provide hassle-free settlements.
• Most insurances usually have a waiting period of 48 months for pre-existing illnesses.
• You may avail of a tax benefit under Section 80D of the Income Tax Act, 1961, for up to INR 25,000 if you pay on time and up to INR 50,000 if you also pay for the senior citizens.
| What to do While Buying Health Insurance | What not to do While Buying Health Insurance |
• Research different policies •Understand your requirements • Compare different policies • Read policy document • Pick the right insured sum • Check available hospitals • Read reviews | • Don’t Choose low premium without checking • Don’t hide your medical conditions • Don’t delay in renewing your policy • Don’t buy unless you understand |
What Should You Know Before Buying Health Insurance for Chronic diseases?
You should keep a few things in mind while signing up for the health insurance policy for chronic diseases.
• Research and consider plans for a lower waiting period. So, you can use it ASAP.
• The policy you choose should at least have coverage of INR 10 lakhs to support your expenses.
• Choose a plan with no age limit for expandability so that you can benefit from it for the maximum age.
• Cautiously go through the policy exclusions to avoid discomfort during claim settlement.
• Choose an low-cost plan for you without compromising on your needs.
• Also, most importantly, check the claim and settlement ratio of your health insurance provider to know the likelihood of your claim being settled.
• Disclose any pre-existing medical condition.
Conclusion
In this era, everyone needs to be financially prepared should they develop any chronic illnesses at any age. Being unprepared for such expenses may result in a financial burden and losing all your savings.
There is no perfect plan that fits all. So, research and choose a plan that’s best suited for you. Also, always pre-disclose any chronic and critical ailments you have when purchasing health insurance. Failing to do this might result in the forfeiture of your claim.
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Chronic and critical illness policies cover life-threatening diseases such as cancer, heart, liver and kidney failure, stroke, etc. You can avail of a lump sum amount to prevent out-of-pocket payments, tax benefits, and more.
You should clarify this with your health insurance provider. Your health insurance policy may or may not provide coverage for pre-existing diseases. Check the list of diseases covered under the policy to have an idea about the same. Mostly when an insurer provides compensation for pre-existing conditions, there is a specific waiting period before coverage.
There is no limit to the number of times you can avail of a claim from your health insurance provider. But the total amount cannot exceed the upper limit for which you’re insured.
Generally, children as young as 90 days to 18 years of age and adults from 18 to 65 years of age are eligible to buy health insurance. However, these may differ from policy to policy.
You may avail of tax benefits under section 80D under the Income Tax Act,1961, for up to INR 25,000 on your premium payments and up to INR 50,000 if you also pay for senior citizens.