Individuals suffering from diabetes can now get health insurance coverage from the first day after paying a rider premium. These special plans do not have the usual three-year waiting period for both type 1 and type 2 diabetes and cover those with high HbA1c levels up to 10 or those even on insulin therapy, depending upon the underwriting.
These specialised health insurance plans for people with diabetes provide comprehensive coverage tailored to their specific needs, including regular doctor visits, medications, and preventive care, without the exclusions found in standard policies. While other illnesses or diseases not-related to diabetes are also covered under these plans, there may be a waiting period up to a year.
Siddharth Singhal, head, Health Insurance, Policybazaar.com, says conditions associated with diabetes such as renal failure, cardiovascular diseases, and diabetic retinopathy are covered from day 1 under the specialised coverage plans. “OPD benefits include diagnostic tests, doctor visits, and medicines for diabetes-related conditions,” he says.
Day 1 riders for diabetes are different from the pre-existing disease reduction riders, which reduce the standard waiting period for pre-existing conditions like diabetes from 3-4 years to around one year. Other health insurance riders are not linked to pre-existing conditions (PED) and focus on additional benefits like OPD, critical illness protection, or consumables cover.
Before the introduction of Day 1 riders, policyholders with diabetes had an option to choose PED reduction riders which offered partial relief by reducing the waiting period from 3-4 years to one year. Diabetes-related claims couldn’t be made during the first year of the policy. This gap often left individuals with high diabetes exposed to significant medical expenses. The introduction of Day 1 riders has resolved this issue by providing immediate coverage, ensuring policyholders are financially protected from the start.
Disclose details
People with diabetes should disclose this when choosing a health plan. They must select a plan offering cashless hospitalisation. A policy with lower sum insured may not fully cover expensive treatments like dialysis or surgeries. “Good coverage can reduce treatment costs and safeguard against unforeseen medical emergencies,” says Bhaskar Nerurkar, head, Health Administration Team, Bajaj Allianz General Insurance.
Underwriting for diabetic patients varies case-to-case and includes HbA1c level, age of onset, dependence on insulin, general health, and the presence of complications. The extent and nature of underwriting can vary depending on the severity of the diabetes such as type 1 or type 2, the individual’s overall health, and how well the condition is managed.
The premium for an insurance policy for a person with diabetes is determined by her medical condition and several other factors, such as complications and lifestyle choices. While insurers usually don’t apply risk-based loading in the specialised plans, in case they do, it varies between 10% and 30% depending on the insurer, policy features and severity of the illness.
Policyholders must note that the standard waiting period will be applicable if day 1 rider benefit is not opted for and costs for diabetes-related complications will not be covered during the waiting period.
Diabetes management programmes
Insurers are also offering diabetes management programmes in these special plans to prevent and manage diabetes. These help in tracking health metrics and blood sugar, HbA1c levels, and weight. These programmes not only help manage the disease but also support reversal in early-stage type 2 diabetes through sustained lifestyle changes and medical supervision.