Best Health Insurance for Diabetic Patients in India

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Medically Reviewed by Dr. Aman Priya Khanna
Written by Rajath R Prabhu, last updated on 9 March 2023
Best Health Insurance for Diabetic Patients in India

Diabetes is a chronic condition that requires ongoing medical care, monitoring, and treatment. For people with diabetes, having health insurance is essential to access the necessary healthcare services and medications to manage the condition effectively. However, obtaining health insurance for diabetics can be challenging, as insurers often consider diabetes a pre-existing condition, and may either deny coverage or charge high premiums.

Fortunately, there are various options available for diabetics to obtain health insurance coverage, from government-sponsored programs to private insurance plans. This comprehensive guide will assist you in everything there is to know about health insurance for diabetic patients.

Need for Health Insurance for Diabetics

Health insurance coverage is crucial in helping diabetic patients manage their condition and access necessary treatment and care without facing financial barriers.

  1. Access to diabetes medications: Health insurance coverage provides diabetic patients with access to necessary medications essential for managing their condition. Insured patients can get prescriptions for insulin, oral medications and other necessary treatments without paying out of pocket.
  2. Regular check-ups and preventive care: Insurance coverage can help diabetic patients get regular preventive care to manage their condition and avoid complications. Patients can schedule regular appointments with their healthcare providers, including blood glucose monitoring, lipid profiles and other tests that help identify any changes in their condition.
  3. Financial relief: Diabetes treatment can be costly and uninsured patients may have to pay costly bills for medications, tests and other treatments. Health insurance coverage can help diabetic patients get the necessary treatment without burdening their finances.
  4. Access to specialists: Diabetes patients often require specialised care from other specialistsas well for other underlying conditions. Health insurance coverage can help them get the necessary care from these specialists without making cash payments.
  5. Continuous monitoring and management: Diabetes patients require continuous monitoring and management of their condition to avoid complications. Health insurance coverage can help diabetic patients access necessary equipment and supplies, such as glucose metres, test strips and insulin pumps, which can be expensive without insurance.
  6. Improved quality of life: With proper access to diabetes treatment and management, diabetic patients can lead healthier and more active lifestyles. Insurance coverage can help diabetic patients manage their condition and avoid complications, improving their quality of life.
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Benefits of Health Insurance for Diabetics

Health insurance can provide peace of mind for individuals living with diabetes, a condition that requires ongoing management and medical care. While it can be challenging for diabetics to find affordable insurance coverage, many insurance plans offer specific benefits that cater to the unique needs of diabetics. In this section, we will explore the benefits of health insurance for diabetics.

  1. Affordable Healthcare: Health insurance with diabetes cover can help individuals with diabetes to manage their medical expenses better. The insurance provider covers the cost of medical treatments and procedures, which can be quite expensive without insurance.
  2. Comprehensive Care: Health insurance with diabetes cover provides comprehensive care for individuals with diabetes, including regular check-ups, medication and testing supplies. It also covers emergency hospitalisation and medical evacuation if needed.
  3. Better Management of Diabetes: The insurance plan encourages individuals to care for their health by providing access to regular check-ups and medication. This helps in better management of diabetes, which can lead to fewer complications in the long run.
  4. Peace of Mind: It offers peace of mind to individuals and their families, knowing that they are covered in case of a medical emergency. It reduces the financial burden of medical expenses and ensures that individuals receive timely and adequate medical care.
  5. Customised Coverage: Health insurance with diabetes cover is tailored to the specific needs of individuals with diabetes, considering their age, medical history and current health condition. This ensures they get the right coverage and care to manage their diabetes effectively.

Financing Options

Financing healthcare can be a significant concern for patients with chronic conditions like diabetes. The following options can help in availing the best medical treatment:

  1. Option 1: Health insurance coverage can offset the cost of medical treatments and hospitalisations.
  2. Option 2: Medical loans available from banks and other financial institutions can help patients cover the cost of treatment upfront and repay over time.

However, it is essential to carefully review the terms and conditions of any financing option to ensure that it is affordable and manageable for the patient and their family in the long term.

Factors Affecting the Diabetes Insurance Coverage

Diabetes insurance coverage can vary based on several factors. It is important to understand these factors to ensure adequate coverage for your medical needs. Some of them include:

  1. Type of Insurance Plan: Some insurance plans have limited coverage for certain treatments, medications or supplies.
  2. Policy Benefits and Limits: Some policies may limit the number of visits to specialists or the amount of money they will pay for diabetes treatments.
  3. Pre-existing Conditions: Patients with pre-existing conditions may face higher premiums, co-payments or deductibles.
  4. Provider Network: Patients may have limited options in selecting their healthcare providers and may have to pay more for out-of-network care.
  5. Geographic Location: Patients in rural areas may have limited access to healthcare providers, affecting coverage.
  6. Age and Health Status: Patients with chronic conditions such as diabetes may face higher premiums or may not be eligible for certain insurance plans.

Eligibility Criteria for Diabetes Insurance

The eligibility criteria for health insurance coverage for diabetes varies according to the insurer, however, a few common requirements are listed below:

  1. The age of the applicant should be between 18 to 65 years. 
  2. Some of the insurers may focus on getting a medical examination to see the current health condition. 
  3. The average waiting period is up to 2 to 4 years 
  4. The person applying for insurance coverage has to reveal any previous illness or existing disease. 

It is advised to read and review the terms and conditions before opting for a health insurance policy for diabetes. 

Exclusions and Inclusion Criteria

Diabetes insurance coverage policies have inclusion and exclusion criteria that must be carefully considered before purchasing. These criteria outline what is covered and what is not and can vary greatly among insurance providers. Understanding these criteria is essential for individuals with diabetes to ensure adequate coverage for their medical needs. The criteria are as follows.

Inclusion Criteria

  1. No waiting period 
  2. No claim bonus 
  3. Organ donor expenses 
  4. Tax benefits under the 80D section 
  5. Diagnostic test coverage 
  6. Companion benefit 
  7. Dialysis cover 
  8. Portability benefit 
  9. Personal accident cover 
  10. Day care treatment 
  11. In-patient hospitalisation

Exclusion Criteria

  1. Self-inflicted injuries 
  2. Cosmetic surgery 
  3. Treatment of obesity 
  4. Some plans may exclude Type 1 and Type 2 diabetes 
  5. Any pre-existing diseases 
  6. Sexually-transmitted diseases 

It is important to note that specific coverage may vary depending on the insurance plan, and patients should carefully review the plan details and speak with their insurance provider to understand the specifics of their coverage. 

List of Insurance Companies That Offer Diabetes Insurance Coverage

Several insurance companies offer health insurance for diabetics. Some of the well-known insurance companies include: 

  1. Star Health and Allied Insurance Company Limited
  2. HDFC ERGO Insurance
  3. ICICI Lombard General Insurance Company Limited
  4. Aditya Birla Capital Insurance
  5. Apollo Munich Insurance

List of Empanelled Network Hospitals in Delhi NCR 

Many government and private hospitals are empanelled with health insurance providers. This means that patients can avail of cashless hospitalisation at these hospitals. Some of the empanelled network hospitals for diabetes insurance include: 

  1. Apollo Hospitals (Private)
  2. Fortis Hospitals (Private)
  3. Max Healthcare (Private)
  4. Dr. Ram Manohar Lohia Hospital, New Delhi (Government)
  5. Safdarjung Hospital, New Delhi (Government)

Ayushman Insurance Coverage for Diabetes

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a government-funded health insurance scheme that provides coverage for medical expenses related to diabetes and other health conditions, for families living below the poverty line in India.

Under the scheme, diabetic patients can receive coverage for hospitalisation, consultations with specialists, diagnostic tests and medications. The scheme has a defined list of covered medical procedures and treatments, and the coverage is available for both pre-existing and new cases of diabetes.

To be eligible for coverage under AB PM-JAY, individuals must belong to a registered family and fall under the identified vulnerable or disadvantaged groups. The scheme covers up to INR 5 lakhs per family per year for secondary and tertiary care hospitalisation. The treatment can be availed at any of the empanelled government or private hospitals.

Claim Process

The claim process is a crucial aspect of any insurance policy, and the same holds true for diabetes insurance coverage. Understanding the claim process is essential to ensure a smooth and hassle-free experience during the claims settlement. The claim process for health insurance can be either cashless or in the form of reimbursement. 

  1. Cashless Claim Process: Under the cashless claim process, the insured individual can avail of treatment for diabetes without having to pay any upfront cash. They can visit any network hospital or healthcare provider listed by the insurer. Then, they can get the necessary treatment without worrying about the expenses. The insurance company directly settles the bill with the hospital on behalf of the policyholder. 
  2. Reimbursement Claim Process: Under the reimbursement claim process, the insured individual has to pay for the diabetes treatment expenses upfront. The policyholder can then claim reimbursement for the expenses incurred by the insurance company. The policyholder needs to maintain all the bills and receipts related to the treatment and submit them to the insurance company along with the claim form. The insurance company will then verify the bills and reimburse the policyholder for the eligible expenses.

Takeaway

Don't wait until it's too late to get health insurance coverage. Protect yourself and your family from the financial burden of medical expenses related to diabetes. Take the necessary steps to secure the right health insurance coverage and give yourself peace of mind.

Looking for more information on health insurance coverage for diabetes in India? Visit HexaHealth now to learn everything you need to know! The HexaHealth Care Buddy carefully manages everything for you in the hospital, including tests, paperwork, and insurance claims.

Frequently Asked Questions

Why do I need health insurance for diabetics?

If you are a diabetic patient, health insurance can provide you with access to quality medical care without increasing the financial burden. Diabetes requires ongoing medical care, and the cost of treatment can be high. Health insurance can help alleviate these costs and provide peace of mind.

What are the benefits of health insurance for diabetic patients?

There are numerous benefits associated with health insurance for diabetic patients. Some of these benefits include coverage for hospitalisation, consultations with specialists, diagnostic tests & medications, affordable healthcare, customised coverage, better management, etc.

Should you go for diabetes insurance?

If you are a diabetic patient, it is recommended to consider health insurance coverage to ensure access to affordable healthcare. With rising medical costs, health insurance can help alleviate the financial burden for you and your family. 

What are the features of ‘Health Insurance with Diabetes Cover’?

The features of ‘Health Insurance with Diabetes Cover’ can include coverage for hospitalisation, consultations with specialists, diagnostic tests and medications related to diabetes. However, the specific features of the policy may vary depending on the insurance provider.

Which is the best diabetes insurance plan?

There is no one-size-fits-all answer to this question, as the best health insurance for diabetics in India will depend on individual needs and circumstances. It's recommended to research various health insurance plans, including those specifically for diabetes and compare factors such as premiums, deductibles and coverage limits to determine which plan is the best one.

Which company provides the best health insurance diabetes plan?

The best company will be determined by the needs and conditions of each client. To find out which company offers the finest plan, it is advised to investigate several insurance providers and evaluate aspects like premiums, deductibles and coverage limits.

Can diabetics get life insurance?

Yes, diabetics can typically get life insurance coverage. However, the coverage and premiums may be affected by the severity of diabetes, age and other health factors.

Can diabetics get term life insurance?

Yes, people with diabetes can typically get term life insurance coverage. The extent of coverage will also depend on a number of things and on the company that is providing the insurance.

Can I get health insurance if I have diabetes?

Yes, you can get health insurance if you have diabetes. Many health insurance providers offer policies specifically for diabetic patients, while others may include coverage for diabetes treatment in their general health insurance policies. 

How to get life insurance for diabetes?

To get life insurance coverage as a diabetic patient, you should speak with an insurance agent or broker. They can guide you in a better and more efficient manner through the entire process. 

Do we need separate health insurance for diabetes patients?

It's not always necessary to have separate health insurance for diabetes patients, as some general health insurance policies may include coverage for diabetes treatment. 

What questions should I ask while buying the best health insurance diabetes plan?

When buying a health insurance plan for diabetes, it's important to ask questions such as the premium amount, deductible, coverage limits, whether the plan includes pre-existing conditions, coverage for consultation with specialists, diagnostic tests, medications related to diabetes, and whether the policy includes cashless claims.

What are the documents required to purchase diabetes health insurance?

The documents required to purchase diabetes health insurance may vary depending on the insurance provider. However, you will need to provide proof of identity, address, age and a medical history declaration that includes information about your diabetes diagnosis and current treatment plan.

Who is eligible for ‘Health Insurance with Diabetes Cover’?

Anyone who has been diagnosed with diabetes, regardless of the severity of the condition, is eligible for ‘Health Insurance with Diabetes Cover’. However, the coverage and premiums may be affected by the factors such as the severity of diabetes and the patient’s age.

What are the exclusions under health insurance with diabetes cover?

The exclusions under health insurance with diabetes coverage may vary depending on the insurance provider. Typically, the policy will not cover pre-existing conditions that are not related to diabetes, treatment or medication for non-diabetes-related conditions, and cosmetic or experimental treatments.

Is diabetes a pre-existing condition for travel insurance?

Yes, diabetes is generally considered a pre-existing condition for travel insurance. It is recommended to review the terms and conditions of the travel insurance policy to determine the coverage and premiums for diabetic patients, as these may vary depending on various factors.

Is diabetes covered under health insurance?

Yes, diabetes is often covered under health insurance policies. It can either be included as general coverage or as a separate policy specifically designed for diabetic patients. 

Do I need to declare diabetes on travel insurance?

It is important to declare any pre-existing medical conditions, including diabetes, on travel insurance applications. Failure to declare a pre-existing condition may invalidate the insurance policy.

Can Children get health insurance for diabetes?

Yes, children with diabetes can get health insurance coverage. Some insurance providers may offer policies specifically for children with diabetes, while others may include coverage for diabetes treatment in their general health insurance policies.

Is diabetes a pre-existing condition?

Yes, diabetes is typically considered a pre-existing condition, which means it existed before the insurance policy was purchased. This may affect the coverage and premiums of the policy.

How can insurance companies know about my pre-existing diabetes condition?

In order to know about your pre-existing diabetes conditions every insurance company may take a different approach. However, the most common one is asking for a medical history declaration that includes information about pre-existing medical conditions, including diabetes. 

Why is health insurance necessary for diabetes patients?

Health insurance is necessary for diabetes patients to help cover the cost of regular medical check-ups, consultations with specialists, diagnostic tests, medications and hospitalisation. It can also provide financial support in case of unforeseen complications.

What is the claim process for health insurance with diabetes cover?

The claim process may vary depending on the insurance provider. The policyholder must typically submit a claim form along with the required medical documents and bills. The insurance provider may then process the claim and provide reimbursement or cashless claims, depending on the policy terms and conditions.

Does insurance cover diabetes?

Yes, health insurance does cover diabetes. However, it is advised to review the policy thoroughly as the coverage and extent can vary depending on your chosen policy. 

How to get life insurance for diabetes?

Getting life insurance for diabetes can be challenging, but it's not impossible. The process typically involves providing detailed information about your diabetes diagnosis, including the type and severity of diabetes. Insurance companies may also require you to undergo medical tests to assess your overall health and risk. Additionally, you may need to pay higher premiums or choose a policy with lower coverage limits than a person without diabetes. 

Updated on : 9 March 2023

Reviewer

Dr. Aman Priya Khanna

Dr. Aman Priya Khanna

MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES

12 Years Experience

Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More

Author

Rajath R Prabhu

Rajath R Prabhu

MSc. Clinical Research I PG Diploma in Public Health Services Management

3 Years Experience

His work in medical content writing and proofreading is noteworthy. He has also contributed immensely to public health research and has authored four scientific manuscripts in international journals. He was assoc...View More

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