Lifestyle Diseases Coverage Under Health Insurance Plans in India

Lifestyle diseases are now one of the major public health concerns worldwide. Essentially lifestyle diseases are ailments arising out of the daily lifestyle or everyday habits of people. While till a few decades ago, lifestyle diseases were considered a Western phenomenon, today lifestyle diseases are extremely common in urban India. What is equally alarming is that they are associated with the development of chronic diseases such as diabetes, stroke, obesity, COPD as well as cancer. However, for those who are suffering from lifestyle diseases, it may offer some small comfort that lifestyle diseases also find coverage in several health insurance packages.

Let’s Check Some Stats About Lifestyle Diseases

Just in case you feel a sense of complacency because your present lifestyle and health seems far removed from the prospect of a lifestyle disease, WHO estimates that the chronic diseases will contribute to 56 per cent of the global burden of disease by 2030 and 70 per cent of the total global deaths. What is also alarming, is the fact that children are also now the victims of lifestyle diseases.

Reasons for Lifestyle Diseases in India

The high increase in the incidence of lifestyle disease in urban India may be attributed to several reasons. There is a marked increase in purchasing power as compared to earlier generations. Advancements in technology have made a sedentary lifestyle so much more possible than before. With a click of a mouse or a tap of a finger, groceries are delivered to your doorstep, a deep clean of your house can be ordered and cooking has become a victim of numerous food delivery apps. There has also been a significant shift in work culture, resulting in long hours at work and long hours of commute, making it difficult for a “successful” professional to make time for physical exercise or sports.

Health Insurance for Lifestyle Diseases

Let us look at some of the more common lifestyle diseases and if, and how, they are covered by health insurance plans:

1. Obesity: This is a condition where one’s BMI exceeds 25. As such most insurance plans do not cover surgery to rectify obesity unless specifically diagnosed by a doctor as life-threatening. Irrespective of whether or not obesity surgery is covered, obesity is likely to increase your health insurance premium.

2. Type II Diabetes: This is the more common type of diabetes that generally affects adults over 45. It is estimated that about 60-90% of people diagnosed with this are overweight. If diabetes is classified as a pre-existing disease, hospitalisation due to any illness as a result of diabetes will only be covered after the stipulated waiting period.

3. Heart Disease: Heart-related diseases are very often related to obesity, high blood pressure and smoking. Like Type II diabetes, if it is considered a pre-existing disease, coverage for any issues related to it will only be done after a waiting period, if at all.

4. High Blood Pressure: This is another common lifestyle disease in people over 40 years of age. Though there is no clear agreement on what causes hypertension, there are several risk factors associated with – being overweight, a sedentary lifestyle, smoking, alcohol, a high salt diet, junk food. Hypertension is also often the result of underlying health conditions such as kidney disease, sleep apnoea, diabetes and thyroid disorders. If left untreated, this disease can lead to paralytic strokes and fatal heart attacks. Most basic health insurance plans will only cover hospitalisation expenses coverage after a stipulated wait period or not at all.

5. Cirrhosis: As a lifestyle disease, cirrhosis is associated with regular and heavy alcohol consumption. It may also be the result of hereditary reasons or viral infections such as hepatitis. Many basic health insurance plans do not cover treatment related to this disease. However, coverage may be obtained through purchase of a critical illness cover.

6. Nephritis: A disease associated with the abnormal functioning of the kidneys, it is sometimes triggered by bacterial infections arising out of consumption of food prepared in unhygienic conditions. So, if you frequently eat outside and have no control over the hygiene of the kitchen, you are more likely to suffer from nephritis. Nephritis, like most critical illnesses, rarely find cover in basic health insurance plans. Coverage may then be purchased separately through an add-on critical illness policy cover.

Very often, by the time you consider taking on a health insurance policy, you will be in your forties and are likely to be already suffering from some lifestyle disease or the other. Most health insurance plans come with some permanent or temporary exclusions. You will need to closely study these as they vary from plan to plan. Several treatments, such as heart surgery, cancer, hospitalisation due to kidney failure etc., most of which are associated with lifestyle diseases, are not covered by basic health insurance policies. However, coverage for these can be purchased through a critical illness rider.

As always check the fine print of your health insurance plan to find out if you are covered for any of the lifestyle diseases you may be suffering from, or which you perceive yourself to be at risk from. Do not hesitate to port or migrate to a policy that does cover these issues if you think you are at all likely to need the coverage in future. Do also check the need for an add-on cover and the best options available for the coverage you are seeking.