Do you have diabetes, blood pressure, asthma and high cholesterol and worry that these ailments will impede your ability to get health insurance? There is no need to be concerned as multiple health insurers provide coverage for these pre-existing diseases (PED) from Day 1.
Here is a list of some of the top health insurance plans that provide coverage for PEDs, their key features and benefits. Please do note that Day 1 coverage in insurance parlance means that the cover will kick in 30 days after the purchase of the policy. So, you will get coverage for these ailments from the 31st day.
HDFC Ergo Energy Diabetes Insurance
This plan is specially designed for people with diabetes and hypertension. It gives you coverage from Day 1 for all hospitalisation arising out of diabetes and hypertension.
What is covered
Hospitalisation expenses: The insurance covers you for hospitalisation due to illnesses and injuries.
Pre and post-hospitalisation: All pre-hospitalisation expenses of up to 30 days before admission and post-discharge expenses till 60 days are included.
Day-care procedures: Covers day care treatments taken in a hospital /day care centre for less than 24 hours.
Emergency road ambulance: Covered up to ₹2000 per hospitalisation.
Organ donor expenses: The plan covers medical and surgical expenses of the organ donor when harvesting a major organ for transplant.
What is not covered
Other pre-existing diseases: Any pre-existing condition (other than diabetes or hypertension) will be covered after a waiting period of two years.
Treatment of obesity or cosmetic surgery: Treatment of obesity or cosmetic surgery is not eligible for coverage under this insurance policy.
Self-inflicted injuries: The policy does not cover self-inflicted injuries resulting from use and abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol.
Care Supreme Instant Cover
This plan waives off the waiting period for diabetes/ hypertension/ hyperlipidaemia/ asthma. But it has to be bought separately as a rider on payment of extra premium. The benefits will be available only to the extent of applicable coverage related to hospitalisation under the base policy.
Standard inclusions and exclusions that are covered in the main insurance policy will apply for this plan. Pre and post hospitalisation waiting periods, coverage for organ donor expenses, day-care procedures, ambulance assistance and other benefits will be in accordance with the base insurance policy.
The following Disease Management programme (DMP) can be opted in any combination: Diabetes, Asthma and Hypertension.
| Consultations |
Up to 4 consultations in a year; maximum up to ₹750 per consultation |
|---|---|
| Pharmacy | Up to ₹6000 in a year |
Star Health Diabetes Safe Insurance
This policy covers not just complications of diabetes (both Type I and Type II) but also regular hospitalisation, personal accident and outpatient expenses as well.
Plan A: Covers hospitalisation expenses due to complications of diabetes without any waiting period
Plan B: Covers hospitalisation expenses due to complications of diabetes after a waiting period of 12 months
What is covered
Covers hospitalisation expenses due to complications of diabetes.
Emergency ambulance charges: Up to a sum of ₹2000 per policy period for transportation of insured to the hospital
Expenses for dialysis: Dialysis expenses covered with ₹1000 per sitting payable up to 24 months, commencing from the month in which the need for dialysis is recommended.
Claims directly or indirectly relating to any cardiovascular system, renal system, diseases of the eye (excluding cataract), foot ulcer, diabetic peripheral vascular diseases and other complications are eligible to be payable only for hospitalisation due to complications of diabetes.
Pre and post-hospitalisation: Up to 30 days prior to the date of hospitalisation. Post hospitalisation up to 60 days after discharge from the hospital not exceeding 7% of the hospitalisation expenses or ₹5000 per hospitalisation whichever is less.
Day care procedures: All day care procedures are covered. OPD expenses are also covered subject to the policy’s terms and conditions.
Expenses related to the surgical treatment of obesityis covered subject to certain conditions
AYUSH treatment: Payable up to sum insured. Claims under ‘Yoga and Naturopathy’ system of treatment will be payable subject to prior approval from the company.
What is not covered
- Treatment for alcoholism, drug or substance abuse or any addictive condition and their consequences.
- Expenses related to sterility and infertility.
- Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.
- Treatments received in health hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons
Niva Bupa ReAssure Smart Health Plus Disease Management
This plan offers instant coverage for diabetes and hypertension. This is a rider that can be purchased along with the main insurance policy on payment of extra premium. Since it is a rider, the regular inclusions and exclusions under the main insurance policy will apply. Pre and post hospitalisation waiting periods, coverage for organ donor expenses, daycare procedures, ambulance assistance and other benefits will be in accordance with the main insurance policy.
What is covered
You can avail unlimited tele-consultation with general practitioner, specialists, and super specialists through the insurer’s partner throughout the policy term.
Investigations up to sum insured are covered when it is prescribed by the general practitioner, specialist or super specialist consulted through the insurer’s partner. The insurer will help organise it and pay for it. You can also do it at centres of your choice and get it reimbursed by the insurer.
Medicines up to sum insured are covered if it is prescribed by the general practitioner, specialist or super specialist who is consulted through the insurer’s partner. The insurer will help deliver medicines at your home and pay for it. You can buy it from the pharmacy of your choice and get it reimbursed.
The plan also covers health check-up tests for BMI (Body Mass Index), lipid profile and HbA1C. The insurer will pay for the tests, on reimbursement basis, which is capped at ₹3000 for all the tests in a policy year.
What is not covered?
- Chronic conditions
- Consultations not availed through insurer’s partner
Universal Sompo A Plus Health Insurance
Coverage for diabetes and hypertension from Day 1 is available as an add-on under the ‘Diamond Plan’.
What is covered
Hospitalisation expenses: The insurance covers you for hospitalisation due to illnesses and injuries.
Pre-hospitalisation: Expenses for pre-hospitalisation consultations, investigations and medicine incurred up to 60/90 ( as per plan) days before the date of admission to the hospital.
Post-hospitalisation: Expenses for post-hospitalisation Consultations, investigations and medicines incurred up to 120/180 ( as per plan) days after discharge from the hospital.
Day care procedures: Listed day care treatments to be covered
AYUSH treatment: Medical expenses incurred by the insured person in any AYUSH Hospital up to the sub-limit mentioned in the policy schedule
Ambulance cover: Subject to the limit specified in policy schedule
Organ donor: Medical and surgical expenses of the organ donor for harvesting the organ where an insured person is allowed if the recipient is any person whose organ has been made available in accordance and in compliance with ‘The Transplantation of Human Organs (Amendment) Bill, 2011’ and the organ donated is for the use of the insured person
What is not covered
- Treatment for alcoholism, drug or substance abuse or any addictive condition and its consequences
- Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.
- Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.
- Expenses related to sterility and infertility treatment.
Allirajan M is a journalist with over two decades of experience. He has worked with several leading media organisations in the country and has been writing on mutual funds for nearly 16 years.