Insurance Query: Health insurance for chronic diseases

I am a semi-retired professional looking for health insurance. I am diabetic and am facing issues in getting proper health cover. Please explain how I can go about it.

Bhargav

Navigating health insurance in India is complex for those with chronic illnesses, such as diabetes, heart disease and arthritis, due to the ongoing and often worsening nature of these conditions. These diseases require continuous medical care, which greatly influences health insurance choices.

This response to your query covers essential aspects to understand health insurance — including waiting periods, cost of premiums, the need to share medical history, exclusions in the policy, and policy features. It also looks at how to financially plan during waiting periods, the trustworthiness of insurers, family coverage policies, flexibility of policies, network hospitals, and customer service quality.

A crucial factor in health insurance for chronic diseases is the waiting period. This is the time from when you buy the policy to when you can start using its benefits. Waiting periods can range from a few months to several years, depending on the policy and insurer. It’s wise to get health insurance early, ideally before developing a chronic condition, to ensure coverage when needed.

People with chronic conditions often face higher insurance premiums due to the increased health risks. These higher costs mean it’s important to use tools such as health insurance calculators to find plans that offer the needed coverage without being too costly.

When applying for health insurance, it’s vital to accurately share your medical history. This includes all information about any pre-existing conditions, past treatments, and ongoing medications. Not being transparent can lead to claims being rejected or the policy being denied.

Understanding what your insurance policy doesn’t cover is also key. Some policies may not cover certain pre-existing chronic conditions, meaning any issues related to these conditions won’t be covered. Therefore, it’s important to thoroughly check the policy terms to ensure it covers what you need.

Specific features

Knowing the specific features of policies designed for chronic diseases is important. These policies usually cover hospital stays, emergency services, and alternative medicine treatments. However, most have a waiting period, which is an important factor in planning your healthcare coverage.

It’s advisable to have a financial back-up plan during the insurance waiting period, as you’ll likely have to pay for treatment costs for certain conditions yourself during this time. A solid financial plan helps manage healthcare expenses until the insurance kicks in.

Evaluating the reliability of the insurance company is crucial. This can be done by looking at their claim settlement ratio, which shows their ability to settle claims. A high ratio indicates a trustworthy insurer, making it an important consideration.

Consider floater policies, which cover family members, as they might be more comprehensive and cost-effective than individual plans, especially for families with several members needing insurance.

Policy flexibility is also important. Chronic conditions can change, so it’s essential to have a policy that can adapt to these changes. This might include options to increase the insured amount, add new benefits, or change coverage as health needs evolve.

Another key aspect is the network of hospitals and healthcare providers linked to the policy. Many policies offer cashless treatment at network hospitals. It’s important to make sure these hospitals are convenient and provide the necessary medical services.

Finally, the quality of customer support and services from the insurance company is important. Good customer service can make filing claims, getting clarifications, and receiving support during medical emergencies much easier.

Getting the right health insurance for chronic conditions in India requires an informed approach, early policy acquisition, and a deep understanding of your health needs. Being proactive in getting and maintaining health coverage ensures easy access to timely medical care and support.

The writer is General Manager of Insurance Samadhan

Send your queries to insurancequeries@thehindu.co.in  

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