Does Health Insurance Plans Cover Chronic Diseases in India?

Buying health insurance is the need of the hour with the rise of chronic diseases in India. A sedentary lifestyle and stress have made people vulnerable to chronic diseases. This raises the question that does health insurance plans in India cover the treatment cost of chronic diseases.

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    What are Chronic Diseases?

    Chronic diseases are those diseases that last for more than one year and require regular medical attention. Such diseases limit your day-to-day activities unless treated. The most common chronic diseases in India are cancer, heart diseases, diabetes, high blood pressure, arthritis, stroke, etc. They are also one of the leading causes of death and disability amongst people.

    Some of the major contributors to chronic diseases are the use of tobacco actively or passively, lack of physical activities, excessive intake of alcohol and poor diet. Most chronic diseases cannot be cured, prevented through vaccination or fade with time. Nonetheless, their treatment can go on for years.

    Moreover, chronic diseases can be fatal if you do not get the right treatment at the right time. As a result, chronic diseases are also considered critical illnesses. Cancer, cardiovascular diseases, stroke, etc. are some of the most common critical illnesses in India that are also chronic in nature. But not all chronic diseases are critical ailments. For example, asthma is a chronic disease but not a critical disease.

    No matter what kind of chronic disease you suffer from, its treatment can cost you a bomb. The treatment of chronic diseases is very expensive. For instance, the cost of a knee replacement surgery in India ranges from Rs 1.5 lakh to Rs 2.5 lakh. Moreover, it can deplete your savings as it goes on for a long time. It can also lead to a major financial burden on you and your family.

    The high treatment cost of chronic diseases and critical illnesses raises the question if it is covered under health insurance plans in India.

    Let’s find out.

    Does Health Insurance Cover Chronic Diseases?

    Yes. Health insurance plans in India provide coverage for chronic diseases. Most regular health insurance plans cover several chronic diseases after a waiting period of not more than two years. For instance, arthritis can be covered under health insurance after a waiting period of 2 years under most plans.

    In case you have been diagnosed with a chronic disease before buying the policy, your health insurance provider will consider it as a pre-existing disease. All insurance companies provide coverage for pre-existing diseases under most plans. However, pre-existing diseases come with a waiting period ranging from 2 to 4 years depending on the plan. Although, some plans may cover pre-existing diseases from day 1.

    Health insurance providers in India also offer impressive critical illness plans with coverage for up to Rs 1 crore to cover the treatment cost for critical illnesses. A critical illness policy will provide a lump sum benefit to you if you have been diagnosed with a critical illness for the first time during the policy tenure. Moreover, you can also find critical illness cover as an add-on under regular health insurance plans.

    However, critical illness plans also come with a waiting period of 90 days and a survival period of 30 days. This means you cannot raise a claim under your critical illness policy unless your waiting period gets over and your claim won’t be accepted unless you survive the survival period.

    Why is It Essential to Disclose Chronic Diseases While Buying Health Insurance?

    It is absolutely necessary to disclose any pre-existing chronic disease that you may be suffering from to your health insurer at the time of buying the policy. Failure to do so can lead to the rejection of your claim.

    When you raise a health insurance claim for chronic disease, the insurer may verify the medical reports and seek your medical history. If you have hidden your pre-existing chronic disease from the insurer, they will find about it and learn about your non-disclosure. This will lead to the rejection of your claim for being untruthful.

    Therefore, whether your health insurance premium shoots up or your waiting period increases, never hide your pre-existing chronic diseases from your health insurer. In fact, you should go through your previous medical files and cross-check  the details of your medical history before buying the policy. This will prevent any inaccuracy in your medical history disclosure and prevent your claims from getting rejected.

    Things to Consider While Buying Health Insurance for Chronic Diseases

    You must keep the following things in mind while buying a health insurance plan for chronic diseases:

    • Go for critical illness plans with a coverage of at least Rs 10 lakh
    • Prefer plans that come with lower waiting periods
    • Go through the exclusions under the various plans
    • Opt for a plan that comes with lifetime renewability
    • Check the claim settlement ratio of the insurance company to know how likely your claim is to get settled
    • Choose a plan whose premium you can afford to pay

    Summing It Up

    The risk of developing a chronic disease has increased among people of all ages. It is important for everyone to stay financially prepared to tackle the treatment cost of such diseases without losing their savings. The best way to do that is to buy health insurance plans for chronic diseases or critical illness plans. Always remember to disclose your medical history to your health insurer truthfully to prevent your claim from getting declined.  

    Written By: PolicyBazaar - Updated: 24 August 2021
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