Does health insurance cover chronic conditions?

Health is a commodity that is more precious than gold. It has to be nurtured and protected to live a fulfilling life. But chronic conditions can put a huge damper on your quality of life. Once diagnosed with such illnesses, there are many modifications, both big and small, that need to be made on a long-term basis to manage these conditions. Some can even be life-threatening in nature and require extensive and expensive treatments. As such, can one depend on health insurance coverage when it comes to chronic conditions? Here are the answers you are looking for.

Health is a commodity that is more precious than gold. It has to be nurtured and protected to live a fulfilling life. But chronic conditions can put a huge damper on your quality of life. Once...

Health is a commodity that is more precious than gold. It has to...

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What are chronic conditions?

A chronic condition is an illness that lasts for more than three months to a year and requires long-term medical care. It can hamper your everyday life if left untreated. They are tricky, as some may not even make their presence known till the later stages of the illness. Diseases such as hypertension, arthritis, heart disease, diabetes, cancer, stroke, lung diseases, etc., are considered to be chronic conditions. Some chronic conditions can even be classified as critical illnesses, which are considered to be more severe and life-threatening in nature.

Can health insurance cover chronic conditions?

Yes, health insurance does cover chronic conditions. They can be covered under a normal health insurance plan and a critical illness plan as well. In the case of a standard health insurance plan, after the initial waiting period of 30 days, coverage can be claimed. If you have opted for a critical illness plan, you may have a survival period, which can be anywhere between 14 and 90 days, depending on the insurer. Survival period is the timeframe given to a patient diagnosed with a critical illness to survive the disease. If the patient survives this period, a lump sum is released to take care of their medical needs.

Things change when the chronic condition falls in the pre-existing conditions category. Pre-existing conditions have to be declared at the time of policy purchase. They will get coverage after a waiting period. This waiting period is specific to pre-existing conditions and can range from one to three years, depending on the insurer.

Is it important to disclose a chronic condition when buying health insurance?

Yes, if you have been diagnosed with a chronic condition before purchasing a health insurance plan, you will have to disclose it to your insurer at the time of purchase. Hiding the condition serves no purpose and can actually be very harmful. Insurers are very vigilant when it comes to such issues and have a tough verification process in place, which catches such lapses instantly. This can ultimately lead to your claim being rejected and may also bring more intense scrutiny to your claims in the future. It can also pose a problem when you want to renew your policy. Depending on the severity of the falsification of medical facts, the insurer can also cancel your policy completely and blacklist you to ensure that you never get access to health insurance in the country.

Checklist to keep in mind when opting for health insurance if you have chronic conditions

Before buying insurance, check the exclusions to see if any chronic illnesses and critical illnesses are excluded
Ensure that you declare pre-existing chronic conditions when filling out the insurance application form
Learn about the wait period and survival period for the policies you are considering. Choose one that has the lowest waiting and survival period. Have some money set aside to see you through the waiting period, as you will have to spend out of pocket during this time
Check the claims settlement ratio of the insurer and choose the one who has a higher claims settlement ratio
If you can afford it, always choose a plan with a higher sum insured, as treatment for chronic conditions can add up over time
Choose a plan that comes with lifetime renewability, as chronic illnesses become more rampant as one ages and may require more care with age

Managing chronic conditions in this day and age without the help of health insurance can lead to financial distress. So, ensure that you and your dependents get the right plan to help you overcome any challenges that chronic illnesses can pose.

Frequently asked questions

What is considered to be a chronic condition?

Any health condition that has lingered for more than three months to a year can be considered a chronic condition. They are usually caused by lifestyle choices, stress, and genetics. They can’t be cured completely, but can be managed with medical interventions and changing lifestyle habits.

Will insurance providers cover chronic conditions?

Yes, chronic conditions are covered by health insurance companies. You can purchase a health insurance plan or a critical illness plan, depending on the illness, to get coverage for these conditions

Does it make sense for me to purchase a critical illness plan if I already have a health insurance plan?

Yes, it does. Purchasing a critical illness plan can give you additional financial protection when it comes to critical illnesses, as they can be expensive to treat.

Written by Roocha Kanade

2.5K Linkedin Followers

Reviewed by Dr. Harshita Dahiya

Health Insurance content enthusiast who turns complex topics into easy, binge-worthy reads—fueled by SEO, creativity, and way too much chai! Loves juggling multiple projects, cracking impossible deadlines, and sprinkling humor into the mix. When not geeking out over digital trends, you'll find her lurking on Quora and Reddit, planning the next getaway, or passionately decoding all things health and insurance!