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Are lifestyle-related diseases covered in a health insurance plan?

Team AckoOct 6, 2021

A sedentary lifestyle, improper diet, lack of physical activities, etc., have led to an alarming increase in lifestyle-related diseases, especially among the young. The high probability of being affected by lifestyle illnesses such as diabetes, hypertension, heart ailments, respiratory problems, etc. and the constant rise in medical care expenses only makes it more compelling to cover your family with a proper health insurance policy.

But are lifestyle-related diseases covered in a health insurance plan? Read ahead to learn about health insurance plans and their coverage of lifestyle-related illnesses.

Are Lifestyle Diseases Covered by Your Health Insurance Plan?

What are lifestyle diseases?

Lifestyle diseases are ailments that are mainly based on the day-to-day habits of people. They are referred to as non-communicable diseases. Diseases such as obesity, hypertension, stroke, diabetes, heart diseases, colon cancer and diseases associated with alcohol, smoking and drug abuse are lifestyle diseases.

In the National Family Health Survey 2019-20, released by the Ministry of Health and Family Welfare, the share of underweight adults has fallen significantly. However, in the case of non-communicable diseases (lifestyle-related diseases), the data reveals worrying signs of an increase in diabetes, obesity, hypertension and other lifestyle-related illnesses.

COVID-19 is an example of how comorbidities can severely impact the outcome of the treatment and mortality. Improving lifestyle and investing in a well-proportioned health insurance policy for lifestyle diseases is the right way forward.

What can you do about it?

Lifestyle disorders are primarily due to the choice of lifestyle you follow daily. Most of these chronic health issues are preventable. You must follow a balanced diet, adhere to physical activities twice or thrice a week, have proper sleep to improve health, avoid chronic ailments, and to protect your family with a good health insurance plan. Health insurance plans play a pivotal role by providing financial coverage in case of medical emergencies.

To help you, the following are some of the vital aspects that must be given due consideration when you are planning to buy a health insurance policy.

Factors to consider before buying a health insurance plan

Here are some of the factors that you need to consider before purchasing a health insurance policy.

  • Family vs. individual plan: You may consider buying the Family-floater plan, where all family members are covered under the same plan. However, if kids are above the age of 25 years, they can be covered under the Individual plan.

  • Sum insured: Sum insured is the maximum amount that the insurer pays to you in case of hospitalisation claims. With rising medical care expenses, you must opt for a higher sum insured amount for comprehensive coverage.

  • Choose higher No Claim Bonus (NCB): If you don’t raise any claims during the policy period, you get the highest discount on the renewal premium or can increase the sum insured amount for a claim-free year. Typically, the maximum NCB you can avail of is 50%, again depending on the type of plan you choose. A policy with up to 50% NCB is ideally an excellent plan.

  • Opt for zero copayment: By opting for the co-payment clause, you promise the insurer to bear a part of the hospital bill when you raise claims. This reduces the related risk for the insurance company and thus you pay less premium. But if you want the insurer to bear the maximum claim amount then opt for a plan with no copay option.

  • Waiting period: Health insurance plans do not cover all ailments from the commencement date of the policy. You have to wait for a certain period before you can avail of the coverage. Lifestyle disorders such as diabetes, hypertension, heart ailments, asthma, etc., are typically covered after 2 to 3 years, depending on the policy you select.

  • Opt for Critical Illness cover: You can also opt for Critical Illness cover to further extend the basic plan’s coverage. These are customised health insurance policies and add-on covers for life-threatening medical conditions such as heart attack, cancer, kidney failure, etc.

  • Choose plans with wellness benefits: Maintaining a fit and healthy lifestyle avoids complicated medical conditions. Plans with wellness benefits reward you for keeping fit and healthy. These rewards points can be accumulated and used in future for renewal premiums, health check-ups, or memberships for spa, gym, and yoga centres as per the terms and conditions of the health plan.

  • Wide network of hospitals: While choosing the right insurer and health insurance plan, make sure you select the plan that offers access to a wide range of hospitals. These network hospitals offer cashless hospitalisation, helping you avoid out-of-pocket expenses. By not opting for cashless treatment, you pay from your pocket and then get reimbursement of the costs. This process is tedious and cumbersome; hence, buy a health insurance policy with a maximum number of network hospitals close to your place of residence.

  • Additional features: Apart from the higher sum insured amount, and other factors listed above you need wide-ranging benefits. Opt for plans that offer additional features such as coverage for out-patient department (OPD) expenses and consumables (PPE kits, gloves, masks, etc.).

In a nutshell

Lifestyle-related diseases are fast becoming common among the younger generation. Make an extra effort to stay healthy and fit to avoid unwanted financial burdens. Avail of the right health insurance plan after considering the above factors to protect yourself against financial stress, and rising medical treatment costs due to lifestyle illnesses.

Frequently asked questions

Here are some common queries about health insurance.

I have an existing family health insurance plan. How can I include coverage against lifestyle diseases?

For broad coverage that includes cover for lifestyle diseases, you may have to purchase a new plan. You may consider continuing the existing plan or you can invest in two plans, with one plan covering lifestyle disorders.

What will happen if I don’t inform my insurer about my pre-existing disease when buying the health insurance plan?

The insurer can reject your health insurance claim if you don’t disclose your pre-existing illness such as diabetes, asthma, hypertension, or other lifestyle diseases.

How do insurers check for pre-existing conditions?

Some insurers consider the medical history of the policy’s beneficiaries and some insurers may only consider the beneficiary’s medical history for a set period. However, insurers may ask for medical screening of the beneficiaries before offering a health insurance plan.

Can I raise a claim against my health insurance immediately?

It depends upon the type of policy. A Group Medical Cover allows claims from day one; however, private Family-floater or Individual plans may have a waiting period before you can avail of the benefits of the health insurance policy. It may range from 30 to 90 days before you can raise a claim for medical emergencies and planned hospitalisation. As for pre-existing diseases such as lifestyle-related disorders, most insurance plans have a minimum waiting period of up to 4 years unless you have opted for a plan that covers lifestyle diseases from day one at a higher premium.

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