Health Insurance Guide for Diabetics

According to the ICMR-INDIAB study (2019-2021), an estimated 101 million people in India were living with diabetes in 2021, corresponding to a national prevalence of 11.4%. Additionally, 136 million people (15.3% of the population) were identified as having pre-diabetes, a condition that indicates a high risk of developing diabetes in the near future.

Given the significant number of people who are diabetic or pre-diabetic, securing health insurance becomes essential, as not everyone may qualify for coverage under government schemes. Understanding how to obtain health insurance as a diabetic or pre-diabetic is crucial to ensure comprehensive coverage without the risk of claim denial due to non-disclosure.

Precautions When Buying Health Insurance as Diabetic

If you have diabetes or are pre-diabetic, you must take all necessary precautions to ensure your health insurance policy provides comprehensive coverage and that your future claims are not denied due to non-disclosure. While obtaining health insurance as a pre-diabetic is not very difficult, utmost care should be taken during the buying process.

1. Filling Out the Proposal Form Accurately

The proposal form is the most critical document when buying health insurance. It is filled in “utmost good faith,” meaning you are legally obligated to declare all known medical conditions. Never hide your medical condition (diabetes or any other ailment) from the insurance company. If medical documents later reveal that your diabetes was pre-existing before purchasing the policy, you risk claim rejection and even policy cancellation.

2. Choosing a Policy with Pre-Acceptance Medical Screening

Prefer policies that mandate a medical screening before acceptance. Since the insurer screens you before issuing the policy, they cannot deny coverage for diabetes if it is diagnosed later.

Even if medical screening is not mandatory, undergo a basic medical check-up at your own cost, share the results with the insurer, and keep a record. This precaution helps prevent disputes and keeps you legally safe in case of claim denials based on diabetes being cited as a pre-existing condition before policy purchase.

3. Handling Undiagnosed Diabetes

There could be situations where you are unaware of your diabetic condition before purchasing a policy and get diagnosed afterward.Many insurance claims have been denied under such circumstances, with insurers placing the burden on policyholders to prove the condition was not pre-existing.

To address such issues, the IRDAI issued a Master Circular in 2020 (IRDAI/HLT/REG/CIR/193/07/2020), stating that the waiting period for lifestyle conditions like hypertension, diabetes, and cardiac issues cannot exceed 90 days unless these conditions were pre-existing and disclosed during underwriting.

This means if a person was not diabetic before purchasing the policy, they will be covered for diabetes from the 91st day after policy issuance (irrespective of medical screening before policy purchase). However, if the person is diabetic or borderline diabetic, they must declare it to the insurer, and the pre-existing disease waiting period—up to a maximum of 36 months—will apply. Some policies have shorter waiting periods, and others even offer an option to waive off this waiting period.

IRDAI Guidelines and Their Implementation

Although the IRDAI issued this guideline in 2020, many insurance companies have yet to incorporate this condition into their health insurance products.

Public sector general insurance companies and select private insurers like ICICI Lombard have implemented this provision.

Regardless of the policy wording, if an insurance company denies your claim by circumventing this IRDAI guideline, you stand a strong chance of fighting and winning your case.

Challenges in Getting Insurance for Diabetics

Obtaining health insurance for individuals with diabetes can be challenging, as insurance companies often reject applications based on medical underwriting criteria.

The best approach is to first apply to reputed insurance companies with a strong track record in claim settlement. If you secure a policy from such a company, that is ideal.

If a preferred insurer rejects your application, consider Public Sector General Insurance Companies (PSGICs), as they tend to be more lenient in their underwriting process and rarely reject claims due to minor non-disclosures.

If obtaining regular health insurance remains difficult, look for specialized health insurance plans designed specifically for diabetes coverage

Best Health Insurance Policies for a Diabetic

Go for Comprehensive Health Insurance Policy

If you are pre-diabetic, choose a comprehensive health insurance policy and declare your condition in the proposal form.

Such policies will cover diabetes and its complications, usually with a premium loading and after completion of the pre-existing waiting period. (Which can be maximum 36 months)

Prefer policies with the shortest waiting period or those that allow a reduction in waiting time, either generally or specifically for diabetes.

For example in New India Yuva Bharat Policy, If a person has HbA1c >6.4, a 2.5% medical loading applies to the premium. This means the policyholder will pay a slightly higher premium, and diabetes-related complications will be covered after a 24-month waiting period.

This policy is a safe choice for those with borderline diabetes who can manage their condition and remain otherwise healthy. The two-year waiting period is reasonable, after which diabetes gets covered without dispute.

Several other health insurance policies offered by general insurance companies provide diabetes coverage as an add-on feature. Some policies, like ICICI Lombard Elevate Health Insurance, even allow the waiting period to be reduced to just 31 days upon payment of an extra premium.

Health Insurance Policies with Diabetes-Specific Riders

• ICICI Lombard Elevate Health Insurance (with Diabetes Coverage)
• Tata AIG Medicare Premier (with Diabetes Rider)
• National Senior Citizen Mediclaim Policy (Add-on cover for diabetes)

Diabetes-Specific Health Insurance Plans

If securing general health insurance proves challenging, consider diabetes-specific policies:

• Star Health Diabetes Safe Insurance Policy
• HDFC ERGO Energy Diabetes Health Insurance
• Care Freedom (Diabetes and Hypertension Plan)

Note: These policies are listed as a last resort because they are specifically designed for diabetes care, often come with higher premiums, and have restrictive features. While they offer diabetes management coverage, their overall coverage may be limited. For example, Star Health Diabetes Safe Insurance Policy restricts post-hospitalization expenses to a maximum of ₹5,000 per hospitalization. Additionally, features like sum insured restoration, organ donation coverage, and other benefits are not as comprehensive as in regular health insurance plans.

Final Thoughts

If you are finding it difficult to get a health insurance policy due to your diabetes condition, you will definitely find coverage under one of the above-mentioned policies. By taking the necessary precautions, accurately disclosing your medical condition, and selecting a policy that aligns with your needs, you can ensure financial security and hassle-free claim settlements in the future.