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Health Insurance for Diabetes Patients in India

Team AckoJan 23, 2024

Diabetes is primarily a self-managed disease and is one of the most dominant forms of illness in India. As per a report by the International Diabetes Foundation (IDF), one in six people with diabetes in the world is from India. An estimated 77 million Indians in the country are affected by this lifestyle disease, and India is home to the second-largest diabetic patients in the world.

Health Insurance for Diabetes Patients in India

Sufficient and affordable health insurance is vital for diabetic patients to help them access quality healthcare to manage their high blood sugar levels and prevent or treat them. Health insurance for diabetes patients covers hospitalisation expenses for treating the disease.

Contents

What is diabetes health insurance?
How does diabetes insurance work in India?
Benefits of diabetes health insurance
What’s covered in diabetes insurance plans
What’s not covered in diabetes insurance plans?
Eligibility for diabetes health insurance plan
How does diabetes health insurance help patients?
Is Type 1 and Type 2 diabetes covered?
Frequently Asked Questions (FAQs)

What is diabetes health insurance?

Diabetes health insurance is a specialised medical insurance plan that covers treatment and hospitalisation expenses due to ailment. High blood sugar levels caused due to improper or insufficient insulin secretion in the human body can cause other critical illnesses such as renal failure, loss of vision and heart stroke.

Diabetes insurance coverage protects you against the expenses arising from diabetes-related ailments. The customised health insurance plan covers hospitalisation expenses and out-patient expenses incurred during pre and post-hospitalisation. You also have the option to opt for cashless or reimbursement claims.

As per the report by IDF, India is expected to have 93 million diabetes cases by 2030 and 125 million cases by 2045. Health insurance for diabetes is a customised plan that provides financial assistance for comprehensive and immediate coverage for any complication or disease related to ailment. It is therefore vital that you invest in it.

How does diabetes insurance work in India?

Diabetes insurance in India covers regular hospitalisation due to diabetic and non-diabetic complications. Regular health insurance plans are not designed to cover the pre-existing disease and may have a waiting period before the plan covers the disease. However, there are diabetes insurance plans that are customised plans exclusive to treating high blood sugar levels and related illnesses.

Most insurers provide coverage for Type 1 and Type 2 diabetes, but it is prudent to read the inclusions and exclusions before finalising the plan. You can also opt for Individual or Family Floater plans based on your requirements.

Apart from hospitalisation, health insurance for diabetes plans may also include outpatient expenses, including medical consultation and diagnostic tests. You might also get Personal Accident cover that provides compensation for the accidental death of the insured person.

Benefits of diabetes health insurance

Here are the benefits of health insurance for diabetes patients in India.

Covers hospitalisation costs due to complications arising from diabetes
Out-patient expenses (diagnostic tests, medical consultations)
Covers hospitalisation expenses for health complications other than diabetes
Compensation for the accidental death of the named insured person
Tax benefits under Section 80D of the Income Tax Act

What’s covered in diabetes insurance plans

Here are the details of diabetes insurance coverage.

In-patient hospitalisation
No waiting period
Day Care treatment
Pre-and post-hospitalisation cover
Portability benefit
Restore benefits
No Claim Bonus (NCB)
Organ donor expenses
Tax benefits under Section 80D
AYUSH (Ayurveda, Unani, Sidha, Homeopathy) treatment
Ambulance cover
Diagnostic test coverage
Domiciliary hospitalisation
Annual health check-up
Personal Accident cover
Companion benefit
Dialysis cover
Consumable cover

Note: The benefits of diabetes health insurance varies between insurers and the type of insurance policy. Please check with the insurer about the inclusions and exclusions of the health insurance plan before you decide to purchase a plan.

What’s not covered in diabetes insurance plans?

Here are the exclusions of diabetes insurance plans.

Other pre-existing diseases
Self-inflicted injuries
War-related treatments/hospitalisations
Cosmetic surgery
Treatment of obesity
Venereal or sexually transmitted diseases
Hospitalisation without doctor’s recommendation
Prenatal and postnatal expenses
Some plans may not cover Type 1 and Type 2 diabetes.

Note: Please read the policy wordings for the inclusions and exclusions before you finalise the plan.

Eligibility for diabetes health insurance plan

The eligibility for diabetes health insurance coverage depends on the insurer and the plan that you choose. Here are some of the eligibility criteria to opt for health insurance that covers diabetic patients.

Age: Typically, you need to be between 18 to 65 years of age (children under 18 years and above 91 days can be insured under the family health insurance policy).
Medical test: Some insurers may insist on a medical examination to assess your current health condition.
Pre-existing illnesses: You have to reveal any pre-existing diseases that you may have.
Waiting period: The waiting period differs between insurers and health insurance plans. You may have to wait for two to four years before the insurance plan covers ailments related to diabetes if you are suffering from high blood sugar levels. If you are not suffering from the disease, the waiting period can be lower by up to 3 months.
Pre-existing diabetes: Some plans might cover only Type 1 or Type 2.

Note: Please read the policy document for the eligibility details since it varies, and the terms and conditions differ between plans and insurers.

How does diabetes health insurance help patients?

Diabetes health insurance helps ease the battle against high blood sugar levels. Patients can be secured knowing health insurance will help avail of the best treatment.

Comprehensive financial coverage for the treatment of diabetic-related health issues.
Coverage for diagnostic tests charges.
In some plans, the cost of medicines is covered.
The cost of a doctor’s consultation is covered so that you can consult some of the best doctors.
You can focus on recovery knowing you are financially protected with diabetes health insurance and not worry about hospital bills.

Is Type 1 and Type 2 diabetes covered?

Insurers have introduced health insurance plans that specifically cater to Type 1 and/or Type 2 diabetes people. While some insurers offer a combined plan, some have restrictions on Type 1 and Type 2 diabetes coverage. It is necessary to read the inclusions and exclusions before you purchase the plan.

Frequently Asked Questions (FAQs)

Here are answers to some of the common questions about diabetes health insurance.

What are the documents required to purchase diabetes health insurance?

You may be asked to submit the following documents.

Age proof
Address proof
Passport size photographs
Identity proof
Medical reports

Some insurers may ask for more documents based on their requirements.

What is the waiting period in diabetes insurance?

While there is a waiting period ranging from 24 to 48 months for the coverage of diabetes-related illnesses in regular health insurance plans, diabetic-specific health insurance plans may not have any waiting period.

What is the amount of coverage provided under health insurance for diabetes?

The coverage provided under diabetes health insurance can vary from Rs. 5 lakhs to Rs. 10 lakhs. Other enhanced plans offer coverage of up to Rs. 1 crore.

Is it compulsory to inform the insurance company that I’m a diabetic patient when buying health insurance?

Yes, informing the insurer about your health condition is mandatory before buying their health insurance policy. This is because the cost and coverage will differ if you are a diabetic patient. Your claims might be rejected for non-disclosure of diabetes. Also, there would be medical tests done by the insurer to ascertain any pre-existing diseases. If the insurer learns that you have the condition, then the insurer may reject offering the policy to you.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.