World Diabetes Day on November 14: Several insurers now offer coverage to diabetics from day one, along with preventive care and wellness discounts. Policyholders, on their part, must make complete disclosures about their condition to avoid claim rejections in the future.
Diabetics can obtain health covers, but be mindful of higher premiums, waiting periods
With over 101 million Indians estimated to be suffering from diabetes and another 136 million at the pre-diabetes stage, as per the Indian Council for Medical Research (ICMR), there is an urgent need to tackle this health challenge that has assumed epidemic proportions.
Along with measures to reduce blood sugar levels and obesity, Indians also need to ensure that they have adequate health insurance cover in place to deal with any health complications that might arise. But how easy is it for such individuals to obtain comprehensive health insurance policies that will pay for diabetes and related ailments?
Health insurers say ‘yes’ to diabetes coverage
While age and pre-existing medical conditions such as diabetes or hypertension add a layer of complexity to the health insurance buying process, insurers are now increasingly open to covering diabetes, say industry watchers. Several companies today offer coverage from day one, particularly by way of rider benefits or covers that can be purchased by paying additional premiums.
Other options include buying regular health covers with waiting periods ranging from two to three years or dedicated policies that come with waiting periods of 2-3 months. Put simply, during this period, your health insurance will not pay for any hospitalisation expenses arising out of such illnesses.
“Insurance companies offer diabetics restrictive or comprehensive coverage, subject to the absence of any micro or macrovascular complications. Compared to earlier, when diabetes would attract a waiting period of 3-4 years in addition to a loaded premium, today, many cover diabetes from day one,” says Rupinderjit Singh, Senior Vice President – Health Insurance, ACKO.
However, insurers take calls on the basis of the severity of diabetes and the complications, if any. For instance, insulin-dependent diabetics will still find it challenging to obtain health coverage, points out Singh. Likewise, if your diabetes has already resulted in ailments such as diabetic neuropathy or kidney issues, insurers will think twice before issuing a policy.
“Many insurance companies now offer plans with day-one coverage, and most new plans are open to covering both type 1 and type 2 diabetes. Specific plans for diabetes patients are available, and some insurers even accept customers on insulin or with HbA1c levels up to 10, depending on underwriting,” says Siddharth Singhal, Head, Health Insurance, Policybazaar.com.
Moreover, rider benefits are also now offered to help diabetics access health insurance. “Insurance plans have become highly modular, allowing customers to choose the specific features they want in a policy. This flexibility enables customers to adjust premiums based on their choices—adding features for a slight increase in cost or removing them for a discount,” he adds.
Besides health insurance covers, policies have rolled out wellness programmes for such policyholders. “Insurers have begun to link premiums to health outcomes – rewarding policyholders who actively manage their health. Some insurers also integrate preventive health programmes with their plans, offering wellness coaching and lifestyle support, which both assist policyholders and mitigate the insurer’s long-term risk,” says Narendra Bharindwal, vice-president, Insurance Brokers Association of India (IBAI).
Be prepared for stricter evaluation, higher premiums
While policies for diabetics are increasingly available in the insurance space, you have to be prepared for stringent underwriting – that is, risk assessment process before insurers take calls on premiums and policy issuance – processes. “Most insurers have an HbA1C limit of 8 for control and no existing micro or macrovascular complications to offer a full-fledged cover. There are some restrictive covers which can be availed if complications exist along with some co-morbidities. Therefore, it is advisable to get a policy as early as possible to ensure maximum coverage,” says Singh of ACKO.
According to Singhal, not all insurers have a strict HbA1c cut-off of 8. “Some plans even accept levels up to 10, though this varies case by case. Based on the extent of the disease, whether it is type 1, type 2, insulin-dependent, whether it started at a very young age or at a later age – insurers assess each case individually. It’s essential to declare your current medical condition accurately and completely to avoid issues during a claim,” he says.
Depending on the severity of your diabetes and other complications as also the product and company that you have chosen, you might have to pay an additional premium, which is termed as loading. And, insurers’ stances on loading and the quantum vary greatly. “Duration of diabetes, HbA1C levels, and overall health status – including age and co-morbidities like hypertension – are primary determinants. For instance, diabetics with well-managed HbA1c levels under 7 percent may see a minimal increase of around 15-20 percent, whereas poorly managed cases with additional health issues could face a loading of up to 50 percent. Notably, some insurers, like New India Assurance, have recently eliminated the additional 10-20 percent loading for diabetic and hypertensive individuals,” says Bharindwal.
Singhal echoes the view that many insurers do not charge additional premiums. “Most health insurance companies do not apply risk-based loading, but if they do, it typically ranges between 10 percent and 30 percent, depending on the plan and the insurer. Generally, you can opt for a plan with minimal or no loading, if available, which might be a preferable choice,” he adds.
Based on the manageability and control on HbA1c, the loading can vary from 10 percent and 50 percent for customers. “The parameters taken into account are Hb1Ac, duration of diabetes, weight, any other comorbidities, etc, to account for the short-term and long-term health risks,” says Singh of ACKO.
Ensure complete, transparent disclosures
Most health insurance companies require you to go through pre-policy issuance medical check-ups if you are over 45. So, health conditions such as impaired lipid profiles, diabetes and hypertension will show up in your health tests in any case. However, even if you are younger and health checks are waived off, it is in your interest to be upfront about any ailments – including diabetes – that you may have been diagnosed with.
Failure to make these disclosures can result in your claims being rejected. Health insurers can do so even if, say, your claim is unrelated to your diabetes. Worse, the company could even cancel the policy on the grounds that concealing health information constitutes a breach of contract.
