MUMBAI: An effective health cover continues to elude diabetics despite the country being dubbed the diabetes capital of the world with a 9% prevalence in urban India. While the disease itself is not excluded, the worst hit are those already under treatment as they risk most major ailments being excluded.
“There are no fixed guidelines on what is covered as each case is unique and we would go by the merits of the case,” said an official with state-owned New India Assurance. He, however, added that if a person is already receiving treatment for diabetes any complications related to that which could be treatment to heart, kidneys or eyes would be excluded. This stance of the insurers puts diabetics in a spot. If they declare their condition at the time of buying a policy the insurer may not accept the proposal or place restrictions. But if they do not their policies may turn worthless as in such cases insurers can reject all claims on the grounds of mis-representation.
According to Sanjay Datta, head, motor and health at ICICI Lombard, diabetes itself cannot be excluded permanently. “In case diabetes is declared as a pre-existing condition by the insured and accepted by the insurer under the policy, then the same is covered after four years of continuous coverage with the insurer.” But insurers are wary about granting full cover to those who are already under treatment particularly young patients. The other issue is that health policies cover largely hospitalization while for diabetics a large chunk of the costs are daycare.
“Normally a standard health policy would cover all the in-patient treatments requiring hospitalization for ailments arising from diabetes. However out-patient treatments like daily expenses on administration of insulin, medication and regular check up are out of the purview of coverage,” said Ajay Bimbhet, CEO, Royal Sundaram Alliance Insurance.
IRDA rules require that insurers do not reject any claim for pre-existing illness four years after the policy is purchased. While this benefits healthy people who subsequently face health issues it does not benefit those who are already diabetic. According to Rama of Bajaj Allianz, insurers might exclude diabetes from the policy if the proposer is already undergoing treatment at the time of purchase of policy. This means that it would not be covered under the policy. Apollo Munich Health Insurance’s ‘Easy Health’ plan covers pre-existing diabetes and related problems after three years of continuous coverage. “But every policy is unique and is guided by an underwriting principle. Exclusions are dependent on pre-policy check up results and waiting period for various diseases would be as per the applicable policy terms,” said Antony Jacob, CEO, Apollo Munich.
New entrant Max Bupa and Iffco Tokio Marine both provide cover treatment related to diabetes related ailments after four years of purchase of the policy if diabetes is present while buying a policy. “In case diabetes is pre-existing, any complication which is resultant of diabetes also stands excluded for first four years,” said. Arun Mehrotra, head, retail at Iffco Tokio. Although there were attempts to introduce a special cover for diabetics it has not been successful so far.
“There are a hardly any disease specific health insurance covers. Also, as a concept such products are not viable for insurance companies,” said Shefali Chhachhi, director, marketing, Max Bupa. However, Apollo Munich is looking at launching a diabetes specific cover in future which will look at disease management wellness besides catering to insurance needs of diabetics.