3. If I have a chronic ailment (diabetes, BP, thyroid, heart cond ition, etc.) can I still get coverage? Should I inform the insurer?

Ans:

Health insurance is a safety net for the financial well-being of an individual or a family. With medical inflation close to 15 per cent year on year, it has become imperative to opt for a comprehensive health insurance plan for the entire family so that the hospitalisation expenses are taken care of.

A comprehensive health insurance plan is an indemnity plan and hence pays for all expenses incurred during hospitalisation. It typically covers all hospitalisation expenses related to an illness, injury or an accident.

So, from the time of hospitalisation, the cost of an ambulance, room rent, medicines, diagnostic tests, surgery/ implant or any other treatment procedures, etc. would be covered under in-patient hospitalisation. Additionally, pre- and post-hospitalisation expenses for diagnosis and follow up treatments, AYUSH treatment, domiciliary, organ donation, etc. treatments and procedures are usually included.

There are other value-added benefits of comprehensive health insurance plans as well; such as free annual medical check-ups, sum insured restoration benefits, maternity and other covers. You can further enhance the base coverage by purchasing optional add-ons like personal accident and critical illness coverage.

Ans:

Certain conditions are not covered by health insurance policies. These conditions will land in an ‘Exclusion' in your health insurance policy.

The exclusion list includes unless specifically mentioned in your policy document:

1. Pre-existing health conditions which are not declared from the time of policy inception

2. Lifestyle-related conditions

3. Maternity related complications, including treatments and childbirth, etc,

4. Cosmetic Treatments unless necessary for survival

5. Suicide Attempt Injuries

6. Congenital Diseases

7. War Injuries

8. Dental and eye expenses, unless specifically covered under OPD

9. Diagnostic tests without any proper line of treatment which needs hospitalisation

10. Therapies such as naturopathy, magnetic or acupressure, etc.

11. Waiting Period Illnesses

The insurance provider will not accept any claims in these instances. However, you can purchase add-on coverage to include any exclusion to your base coverage.

Ans: Yes, some health insurance companies in India offer mediclaim coverage for diabetics and cancer patients, but with certain conditions and limitations. Here's a breakdown:

For diabetics:

• Specific diabetes-focused plans: Several insurers offer dedicated health insurance plans for diabetics, covering medical expenses related to managing the condition, including:
• Daycare treatments: Dialysis, insulin pump therapy, etc.
• Pre and post-hospitalisation expenses: Doctor consultations, lab tests, medications.
• AYUSH treatments: Ayurveda, Yoga, Unani, Siddha, and Homeopathy.
• Critical illness cover: Coverage for specific complications like kidney failure.
• Regular health insurance plans: Many regular health insurance plans also cover pre-existing conditions like diabetes after an initial waiting period (2-4 years typically). However, coverage for specific diabetes-related expenses might be limited or excluded.

For cancer patients:

• Dedicated cancer-focused plans: Similar to diabetes, some insurers offer specific cancer insurance plans covering:
• Cancer treatments: Chemotherapy, radiation therapy, surgery, etc.
• Hospitalisation expenses: Room rent, nursing charges, etc.
• Loss of income: Financial support during treatment.
• Regular health insurance plans: Most regular health insurance plans cover cancer treatment after a waiting period. However, specific aspects like pre-existing stages, claim limits, and exclusions might apply.

Important things to remember:

• Pre-existing condition loading: Both diabetics and cancer patients might face higher premiums due to their pre-existing conditions.
• Waiting period: You might have to wait for a specific period (typically 2-4 years) before claiming benefits related to your pre-existing condition.
• Exclusions: Policies might exclude certain treatments, stages of cancer, or complications arising from pre-existing conditions.

Recommendations:

• Compare plans: Carefully compare various plans offered by different insurers, focusing on coverage details, exclusions, waiting periods, and premium costs.
• Consult an advisor: Seek guidance from a qualified insurance advisor who can understand your specific needs and recommend suitable plans.
• Disclose your condition: Always disclose your pre-existing condition (diabetes or cancer) accurately when applying for insurance.

Remember, this information should not be considered financial advice. Please consult with a qualified professional for personalised guidance on choosing the right health insurance plan.

Ans: Yes, you can still get health insurance coverage even with a pre-existing chronic ailment like diabetes, high blood pressure, or a heart condition. Here's a breakdown of what to consider:

Disclosing Pre-existing Conditions:

• It is crucial to disclose any pre-existing conditions to the insurer. This is because they assess the risk involved in covering you. Hiding this information can lead to claim rejection later.

Coverage for Pre-existing Conditions:

• Most health insurance plans cover pre-existing conditions, but with a waiting period. This waiting period can range from 2 to 4 years depending on the plan and the severity of the condition.
• There are plans that offer coverage for pre-existing conditions from day one, but they typically come with higher premiums.

Finding the Right Plan:

• Do your research and compare different health insurance plans to find one that offers coverage for your specific chronic ailment and has a reasonable waiting period.

Here are some additional tips:

• Be honest and upfront about your medical history in your application.
• Get a copy of the policy documents and carefully review the exclusions clause to understand what is not covered.
• Consider critical illness plans that provide a lump sum payment for specific critical illnesses, including some chronic conditions.
• Remember, transparency is the key. Disclosing pre-existing conditions ensures you get the right coverage and avoid claim rejections later.