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Should you go for diabetes insurance?

Bavadharini KS | Updated on March 13, 2021

Consider your age, lifestyle and family history instead of choosing a plan just based on cost

India has about 77 million people with diabetes, making it the second most affected country in the world, according to a report by International Diabetes Federation. The numbers are expected to increase in the coming years. Sedentary lifestyle, unhealthy diet and tobacco use are some of the major factors for diabetes in the country, according to the WHO. To address specific disease-related medical expenses, a few health insurers have come out with a standalone diabetes cover. While your regular health policy also covers you for diabetes and other pre-existing conditions, it comes with a waiting period, unlike in case of standalone covers. So, should you go for such a cover?

The basics

As a policyholder, you have to wait for 30 days after the commencement of the policy before an insurer starts covering you. This is the initial waiting period that everyone has to go through. In case of pre-existing diseases such as diabetes, the waiting period is anywhere between 2 to 4 years for a regular health plan. With health covers specifically designed for diabetes, this waiting period either gets reduced or removed. In other words, those with diabetes get covered from day one. HDFC Ergo Health, Aditya Birla Health and Star Health Insurance are some insurers that offer specific policies for chronic conditions such as diabetes (pre-existing disease).

A diabetes plan works similar to any other health plan where it provides cover for hospitalisation, outpatient medical expenses, and pre and post hospitalisation expenses. For instance, HDFC Ergo Health’s Energy Plan provides coverage for all hospitalisation expenses arising out of diabetes and hypertension, and HbA1C (blood sugar level check) check-up benefit. However, the plan doesn’t cover outpatient expenses (OPD). But, Diabetes Safe insurance policy from Star Health Insurance covers OPD expenses. While the plan covers hospitalisation expenses, there is no coverage for pre and post hospitalisation expenses.

Some plans offer cumulative bonus benefit and restore benefit as well. For instance, the Diabetes Safe policy offers automatic restoration of base sum insured (SI) upon the exhaustion of basic SI. Similarly, HDFC Ergo’s plan too offers both restoration (upon complete or partial exhaustion of base SI) and cumulative bonus benefit. Care Health Insurance’s Care Freedom plan too recharges the base SI automatically once the existing SI gets exhausted. But this plan covers for diabetes only after a waiting period of two years.

Do keep in mind that, while there is no waiting period for diabetes, other pre-existing diseases waiting period applies. A few plans do have co-pay clause too (where the policyholder bears expenses up to a certain limit). For instance, Energy Plan provides the option for co-pay of 20 per cent on the eligible claim amount. But in the case of Care Freedom, co-pay of 20 per cent applies under all variants.

Your choice

The biggest advantage with most diabetes-only covers in the market is that, you get coverage without pre-existing condition waiting period. However, the premium outgo can be relatively higher. For instance, HDFC Ergo Health’s 30-year my: health suraksha plan (regular health cover) costs ₹11,768 (excluding tax) per year for ₹10 lakh SI, while its Energy plan (diabetes plan) costs ₹,980 (excluding tax).

Your choice should not only be based on premium outgo but also your age, lifestyle and family history. Suppose, if you are in the early 20s, despite the likelihood of contracting the diseases (such as on account of family history), you could still wait for 24 to 36 months for the diabetic cover to kick in. So, you may not need a standalone diabetes-only cover.

A comprehensive health insurance policy covers for pre-existing diseases including diabetes with a waiting period of 2-4 years. For instance, in Optima Restore policy from HDFC Ergo Health, the pre-existing waiting period is 36 months. You can reduce your pre-existing disease waiting period if you feel it is too long. In the case of ICICI Lombard’s Complete Health Insurance policy, you can reduce the pre-existing waiting period if you opt for SI over ₹2 lakh.

Alternatively, if you have contracted diabetes and your waiting period with a regular health policy is not over, then you can consider a standalone cover. However, there are regular health covers in the market that provide coverage for chronic illness including diabetes, asthma and cholestrol without any waiting period. For example, Activ Health from Aditya Birla Health, a regular health plan, provides coverage from day one.


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Published on March 13, 2021

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