Heart-related ailments are increasing every year across countries including India. Pollution, smoking, diabetes and lifestyle-related changes are the key reasons for heart-related ailments across age groups. According to the World Heart Federation, cardiovascular-related ailments results in 18.6 million deaths a year.

To address specific disease-related medical expenses, a few insurers including Care Health, Star Health, Future Generali and ICICI Pru Life have come out with standalone cardiac covers. While your regular health policy also covers you for cardiac ailments and other critical illnesses, should you go for such a cover?

Read more: All you need to know about critical illness insurance

Plans for existing cardiac ailments

Insurers offer two kinds of products to cover against cardiac-related ailments.

One type is for those who have already been diagnosed with cardiac ailments or disorders and possibly have undergone surgeries for it. These types of plans are usually offered by health insurers such as Star Health (Star Cardiac Care) and Care Health (Care Heart). So unlike regular health plans, where those with cardiac ailments have to undergo a pre-existing or disease specific waiting period, here they get covered from day one (post the initial waiting period).

Note that cardiac specific plans too come with a waiting period. As a policyholder, you have to wait for 30 days (initial waiting period) after the commencement of the policy before the cover starts. You will also have to undergo pre-existing diseases waiting period, for those ailments other than cardiac related, such as cataract, bronchitis, and varicose veins, of anywhere between 2 to 4 years. Similarly, there is a waiting period for specific diseases such as all types of cancers, kidney and liver failure and retinal disorders, which is usually around two years.

These cardiac plans work as an indemnity policy where the hospitalisation expenses are covered. For instance, Care Heart Plan from Care Health covers hospitalisation expenses and pre and post hospitalisation expenses. The plan also covers domiciliary hospitalisation and offers restoration benefit, no claim bonus benefit, and health check-up.

Benefit policies

The other kind of health policy that specifically covers against cardiac ailments is the benefit policy, where the insurer will make a lumpsum payment only at the time of diagnosis after which the policy terminates. The policyholder can use the money for medical or non-medical expenses without any restriction. These policies are suitable for those who are likely to suffer from such ailments in future. A few of the policies offered include ICICI Pru Heart and Cancer Protect, HDFC Life Cardiac Care and Future Generali’s Heart and Health plan

The list of cardiac conditions covered varies with insurers. For instance, in case of Heart and Health plan from Future Generali (where you opt for the Heart plan option), you are covered against 18 heart-related conditions (both minor and major) including angioplasty, open chest bag, cardiac arrest and heart transplant.

A few insurers make the lumpsum payment upon diagnosis, depending on the severity of conditions. For instance, in case of HDFC Life’s Cardiac plan, 25 per cent of sum insured (SI) is paid in case of minor conditions which include angioplasty, minimally invasive surgery of aorta and insertion of pacemaker. The plan pays 100 per cent in cases like heart transplant, open chest coronary artery bypass graft and the like.

The waiting period usually ranges between 90 days to 180 days. Do keep in mind that the benefit from the policy will be payable only if the insured person survives for a specific period post the diagnosis, known as the survival period, which usually ranges from 7 to 30 days. These products also come with similar benefits such as SI restoration, no claim bonus and portability.

Our take

If you are already suffering from heart-related ailments, you can consider the plans that offer coverage without pre-existing condition waiting period. But do keep in mind that, these plans come with limits on sum insured. For instance, the SI options available with Star Cardiac Plan are up to ₹15 lakh, while the maximum SI offered in Care Heart is ₹10 lakh. They also come with sub-limits and co-pay. For instance, Care Heart has a sub-limit on room rent of 1 per cent per day up to SI and co-pay of 20 per cent .

If you have a family history of heart ailments or any other critical illnesses, you may be at risk of contracting one. So in such cases, it makes sense to go for cardiac benefit policies (which is taken before you get any heart related ailments) or critical illness (CI) policies. These policies also offer higher SI options.

While you can consider standalone cardiac plans (benefit plans), there are products in the market that covers other critical illnesses too. For instance, Bajaj Allianz General’s Criti-Care plan covers a wide range of 43 critical illnesses and the plan offers five options - cancer care, cardiovascular care, kidney care, neuro care and transplants and sensory organ care - for policyholder to choose from (one or all) depending on the need. Note that, it is always recommended to go for CI plans (cardiac or comprehensive) over and above your base health insurance policy.