Understanding the Basics of Diabetes Health Insurance

The change in lifestyle of people has affected their choices drastically, quite often for the worse. The choice of junk food over healthy natural food has led to a rise in various health hazards. It affects the life of an individual directly, and as one always says; Health is Wealth. 

Health insurance was introduced to the world with the purpose of providing financial support to an individual by paying for various medical and surgical expenses incurred by the insured for treatment against various diseases. The health insurance cover helps in covering one’s monetary expenses of illness and hospitalization by paying for them. That assumes importance as medical treatment costs have been hitting the roof and it can be assumed that soon, it may go beyond affordability. 

 Diabetes

As it is known, that many diseases are floating in the outer-world, diabetes is considered to be one of the common types nowadays. General health insurance protects diabetes as a medical condition up to a certain limit by laying down certain specific sub-limits. The clause of sub-limit was introduced into health insurance with the purpose of providing balanced coverage per disease as health insurance is considered as an instrument that provides comprehensive or balanced coverage.

The sub-limit of an insurance policy on diabetes restricts the insured from receiving quality treatment for the necessary condition. To receive the benefit of insurance coverage for this disease, the policyholder needs to serve a waiting period. Diabetes is treated as a pre-existing disease, and thus the waiting period varies from 1 year to 4 years. The medical toll caused to your health by diabetes is serious and long-lasting. Therefore, providing limited coverage for the same will not be adequate; which is why diabetes health insurance was introduced.

Before understanding this new instrument, let’s try to understand the condition.

What is diabetes?

Diabetes is a medical condition in which the body will not accept or will not produce a hormone called insulin. The by-product that is insulin helps in effectively regulating blood sugar. In case the body fails to do so, conditions such as hyperglycemia that is serious damage to the body’s system can occur. Diabetes is a serious chronic disease and can lead to conditions such as heart attack, stroke, kidney, and nerve damage too.

According to the WHO (World Health Organization), diabetes is one of the leading causes of death in the world. According to an estimate by the WHO, approximately 422 million people (42.2 crore) suffer from diabetes worldwide. There 2 types of diabetes.

• Type 1 Diabetes

Under Type 1 diabetes, the insulin produced in the pancreas starts affecting the beta cells and the body’s immune system. This further leads to an insulin deficiency as the beta cells are the insulin-producing cells. The situation arises due to an autoimmune reaction. This type of disease is most common in people of younger age or children.

According to a 2017 clinical perspective, it is believed that people with specific genetic markers and cells consist of at least one autoantibody that attacks the pancreas. People suffering from Type 1 diabetes are more likely to have their life expectancy reduced by up to 20 years.

• Type 2 Diabetes

This is the most common form of diabetes. People suffering from type 2 diabetes is due to the insulin resistance caused and individuals above the age of 45 years suffer from this type. It means that the pancreas is capable of producing insulin but the body does not respond to the same. At the beginning of this condition, the pancreas produces sufficient insulin but with time, it decreases thereby leading to the building up of glucose in the bloodstream.

 One may not realize or see the symptoms while suffering from type 2 and thus until one realizes complications have already arisen in the body. An observation was made recently under which the occurrence of this type is also noticed in children, largely due to sedentary lifestyles and unhealthy food habits. Type 2 diabetes is more likely to reduce life expectancy of an individual by up to 10 years.

 Diabetes Health insurance

We know that the main objective of introducing insurance, in general, is to provide financial support to those in need, thereby providing the best quality service too. Even though health insurance provides coverage to diabetes, the clause of sub-limit is applicable thereby, restricting the individual from receiving good treatment.

Having disease-specific health insurance always works for the benefit of an individual as the coverage offered for the disease is fairly comprehensive. There has been an observation made under which India is considered as the “Diabetes capital of the world.” The gravity of this issue is huge, although insurance providers in India are not interested in issuing diabetes health insurance as they believe that the disease is dreadful, and in most cases, the insured will file a claim for the same. Comprehensive health insurance is offered by insurance companies.

Basics of diabetes health insurance:

• Waiting period

To get diabetes covered under general health insurance, the insurer would treat the condition as a pre-existing disease and thereby ask the policy purchaser to serve a waiting period of 1 to 4 years. Although under diabetes health insurance, the insured does not need to serve any such waiting period. The clause of the initial waiting period is applicable that varies between 30 to 90 days, not beyond that.

• In-patient hospitalization

As the insured is undergoing a fairly debilitating disease and thus has purchased this plan, if the person faces an emergency then they gets admitted to a hospital. The costs related to the treatment, hospitalization expenses, and so on are to be borne by the insurance company. One can get admitted to a network hospital to enjoy the benefit of a cashless claim. If it is not possible due to the serious condition, a non-network hospital is also fine although the mode of payment will shift to reimbursement method and the cashless mode will not work in non-network hospitals.

• Pre-and post-hospitalization

The policyholder is facing a compromising disease related to his health, and in emergencies, while treating the patient, a doctor needs to know if the patient has some infections, sickness to while treating the patient, he shall take care to avoid further complications. Thus, the tests taking place before actual treatment are to be treated as pre-existing costs. Under post-hospitalization, the various costs related to doctor’s appointments, medicines given by the doctors, and more are considered as post-hospitalization expenses.

• Ambulance expenses

In emergencies, the insurance company grants ambulance money. Although the insurer applies the clause of sub-limit and thus an upper band is provided. All insurance providers do not provide such services, and thus one will have to read the fine print of the terms and conditions related to the same while purchasing diabetes health insurance.

• Organ donor

 While treating diabetes, the insured can undergo organ failure, and thus to help the situation, an organ transplant may have to take place. The various costs related to the same are covered under diabetes health insurance. the policy will pay for harvesting and the surgery to implant the organ in the insured’s body.

• Pre-existing condition

 As the policy is providing disease-specific coverage, any other medical condition apart from diabetes will be treated as pre-existing disease, and thus the insured will have to serve a waiting period of 2 years

•  Coverage

The coverage offered by a diabetes health insurance provider; the protection is concentrated. Although, such a policy can be purchased by an individual as well as a family floater plan.

• Co-payment

The diabetes health insurance comes with a co-payment clause. The word co-payment means that while filing a claim for reimbursement, the policyholder needs to shell out a certain proportion of the entire bill amount or claim. The ratio of paying the hospital bills is pre-decided among the two parties. The clause of co-payment was introduced with the motive of helping the insured understand the importance of not filing hefty claims and have a sense of responsibility. Co-payment clause also reduces the premium on the health cover.

• Domiciliary hospitalization

 Domiciliary treatment means that the policyholder can avail the same benefits of getting treated at a hospital even when they are being taken care of at home. A diabetes health insurance provider offers such benefits. Such domiciliary hospitalizations require special authorization and are permitted either if hospital beds are not available or if the patient is not in a position to travel.

• Medical check-ups

The diabetes health insurance provider offers the benefit of free check-ups to the insured depending upon the claims filed by the person. Usually, such a check-up is done annually although, the terms and conditions of each company vary thereby, asking the policy purchaser to go through the terms and conditions of the clause.

• Pre-medical check-ups

Before offering coverage to the policyholder, the insurance company can ask for a pre-medical assessment to understand the health condition of the purchaser. It also depends on the type of diabetes one is trying to receive coverage for, and thus the option of denying such a test is not possible.