Diabetes Cover Health Insurance Plan
Diabetes stands out as a significant lifestyle disorder that the world is currently grappling with. Numerous factors can lead to diabetes which include genetic predisposition, unhealthy diet, sedentary lifestyle, insulin resistance, stress etc. Diabetes treatment can result in a substantial monetary expenditure. Medication required for diabetes treatment is usually costly. Diabetes treatment may require supplies such as glucose meters, lancets, insulin pumps etc which can be really expensive. Diabetes patients may require emergency hospitalization and it can cost a lot of money as well. Therefore, in today’s date, having a diabetes insurance cover is a prudent choice. Having a health insurance plan with diabetes coverage helps patients to achieve all-round financial security.
What is Diabetes?
Diabetes is a chronic lifestyle disorder. It is characterized by an insulin imbalance and an increase in blood sugar levels in the body. It is called diabetes mellitus. It affects the glucose-processing ability of the body. After a meal, the carbohydrates are broken down into glucose. The entry of glucose in the cells is facilitated by a hormone called insulin which is produced in the pancreas. In diabetes, either the pancreas does not produce enough insulin or the cells become resistant to the insulin produced. The main symptoms are polyuria, thirst, blurred vision etc. Untreated diabetes may lead to severe health complications including cardiovascular disease, kidney failure, neuropathy and other critical medical conditions. Therefore, it is vital for diabetes patients to effectively treat the disease to avoid fatal circumstances.
Types of Diabetes:
Diabetes can present itself in several forms.
The most common types of diabetes are as follows:
• Type 1 Diabetes:
IDDM (Insulin Dependent Diabetes Mellitus) is often regarded as juvenile diabetes. This is an autoimmune condition. The pancreatic beta cells are responsible for the production of insulin in the body. In Type 1 Diabetes, the beta cells of the pancreas are attacked by the immune system of the body. Children and young adults generally acquire this condition and hence it is also called juvenile diabetes. Individuals who develop this condition have to take insulin injections.
• Type 2 Diabetes:
This type can present itself in individuals of any age group. It is the most prevalent form of diabetes. Here cells do not respond efficiently to insulin and absorb less amounts of sugar. Insufficient production of insulin from the pancreas is also a significant factor in this condition. This is associated with obesity, a sedentary lifestyle and unhealthy diet. Lifestyle changes, especially diet and exercise can be effective to reduce the risk but in later stages, insulin therapy is a mandate. It is usually seen more in adults but the number of cases in young individuals is also increasing day by day.
• Gestational Diabetes:
This type of diabetes occurs during pregnancy. In certain cases, increased insulin resistance gives rise to this condition. It generally resolves after pregnancy but the risk of developing type 1 or 2 remains.
• Monogenic Diabetes:
It occurs due to genetic mutation and is an uncommon type. It is often misdiagnosed as Type 1 or Type 2 diabetes. Genetic testing is essential to avoid misdiagnosis. Unlike Type 1 (which is auto-immune), monogenic diabetes is not caused by immunity attacking the beta cells of the pancreas. Early diagnosis is crucial for this type.
• Pre-diabetic: This condition is similar to a warning bell. Here, blood sugar level is on the rise but diabetes has not properly set in yet. Taking proper precautions is really important if you want to avoid a long-term ailment.
Now that we understand the various types of diabetes, it is important to know how to manage diabetes.
How to Manage Diabetes Through Lifestyle Changes?
Diabetes is a chronic lifestyle disorder which requires continuous management to avoid fatal circumstances. There are several factors which have to be taken care of.
• Diet:
Maintaining a healthy diet is crucial for diabetes management. Both the quality and quantity of food can be impactful. Especially, sugar intake has to be critically looked after. Having a balanced diet is important. Hence, one should blend proteins, carbohydrates, fats and vitamins in the correct amounts. Consulting your doctor or nutritionist for a proper diet that suits your health is a wise choice. Avoiding sugar-sweetened beverages is also a vital step in diabetes management.
• Exercise:
A sedentary lifestyle can be detrimental to diabetes patients. It is vital to exercise regularly. A proper exercise regime should be taken from an instructor and it should be followed to maximize the benefits. Walks can also be beneficial. Keeping the body physically active helps to prevent or fight diabetes.
• Stress:
Blood sugar levels can also increase because of stress. Minimizing stress is always a healthy practice and it helps in diabetes management as well.
• Medication:
Medications come into play when you fail to resist diabetes naturally. However a few aspects should be kept in mind while taking medication. Insulin, if prescribed, should be stored correctly. Factors such as temperature, humidity etc can affect efficiency. Medicines prescribed for other medical conditions may affect diabetes. Doctors should be well informed about an existing condition of diabetes so that medicines for other conditions can be prescribed accordingly.
So, we can conclude that maintaining a healthy lifestyle can efficiently tackle diabetes. If medications are required then storage and usage are of utmost importance.
Why Opt For a Health Insurance Plan with Diabetes Cover?
Opting for an adequate Health Insurance Plan with Diabetes Cover will help you manage the expenses and focus on the treatment rather than working on the financial aspects of the same.
• Protection from a huge expenditure:
We all know how expensive health care has become in recent years. From doctor appointments to medication, hospitalization and diagnosis, substantial money is required. Diabetes is a condition whose treatment is characterized by continuous and exhaustive cash outlay. Expensive insulin analogues are replacing human and animal insulin.
Regular health checkups, hospitalization and medicines can be overwhelming and put a lot of financial pressure on patients. This is where health insurance with diabetes coverage swoops in. Individuals with health insurance with diabetes coverage can manage the high costs associated with the treatment.
• Medication and supplies availability:
Costly medication supplies such as glucose meters, insulin etc put a lot of pressure on patients. Having health insurance with diabetes coverage takes care of major portions of this cost and helps to lighten this financial burden.
• Coverage of Diabetes-linked complications:
Diabetes can give rise to severe medical complications such as kidney failure, cardiovascular disease and severe issues related to vision. Health insurance with diabetes coverage takes care of these complications as well.
• Emergency hospitalization:
Diabetic patients can find themselves in situations where urgent hospitalization is required. Health insurance with diabetes coverage takes care of emergency hospitalization which is really essential for diabetes patients to have.
So, it is imperative to opt for a health insurance plan with adequate coverage especially if you are already diabetic or pre-diabetic. But can you opt for all types of health insurance plans is still confusing for many. So, let’s understand what your options are if you are already diabetic and wish to opt for a Diabetic-specific Health Insurance Plan in India.
Health Insurance Options for Diabetic Patients in India:
Once you are already diabetic, the choice of insurance plans that you can opt for gets limited. This is because not every single plan offers health insurance coverage for diabetic patients. Hence, you need to opt for Diabetic-specific Health Insurance Plans.
Diabetes is considered as a “Pre-Existing Disease”. Most health plans might not be able to offer coverage or even if it does, there would be an associated waiting period for the same, during which a claim would not be accepted for any diabetic-related ailment. This is because diabetes is considered to be a high-risk chronic lifestyle ailment just like high blood pressure. But there are specific Fixed Benefit as well as Indemnity Health Insurance Plans designed to specifically cater to the needs of diabetic patients.
So, what are your options for a health insurance plan?
1. Standalone Diabetic-Specific Health Insurance Plans:
There are certain health insurance plans which cater to diabetic people only. These policies can be on an individual basis or even family floater plans.
a. Star Health Diabetes Safe Insurance Policy-
This covers people with Type 1 & 2 Diabetes without any Waiting Period under Plan A and with a short waiting period of 12 months under Plan B. This plan can be taken for a coverage amount of Rs 3 to 10 lakhs.
b. Care Health Care Freedom Plan-
This is a Health Insurance Plan for the Diabetic without any upper age limit. There is a waiting period of 2 years for providing coverage of all hospitalisation expenses resulting from Type 1, 2 as well as Gestational Diabetes.
c. HDFC ERGO Energy Plan-
This health insurance provides coverage for Diabetes and Hypertension without any waiting period. For other pre-existing ailments, other than Diabetes, there is a waiting period of 2 years. This plan provides incentives to stay well and fit with various programs and also provides a Sum Insured Restore benefit.
2. Employer-sponsored health insurance:
This plan can be really helpful as it covers wide areas of diabetes treatment. As stated earlier, treating diabetes can get financially overwhelming. This plan reduces the financial burden by covering medicinal expenses, hospitalization expenses, supplies and doctor visits. It is a wise plan to choose as it gives overall financial protection.
Features of Standalone Health Insurance Plans with Diabetes Coverage:
Health insurance with diabetes coverage has helpful features which help patients to effectively protect themselves financially from costly treatments. A few are listed below:
1. Doctor visit coverage:
Diabetes treatment requires frequent check-ups which can lead to significant money outlay. Insurance covers the doctor visits and helps to save a lot of money.
2. Hospitalization coverage: In a lot of cases, emergency hospitalization is required. Hypo-glycemia and hyper-glycemia are both critical medical conditions which happen to diabetes patients. In these conditions, often the patient has to be immediately hospitalized. Diabetes coverage plays a vital role in these situations by minimizing expenses.
3. Preventive care services:
A few plans have covered tests for complications which may arise due to diabetes. Tests such as lipid profile, eye tests, kidney function tests etc are covered in the plans.
4. Access to specialists:
A few plans allow access to ophthalmologists, nephrologists, cardiologists and other specialists who tend to complications which arise due to diabetes.
5. Coverage for durable medical equipment:
Durable medical equipment such as insulin pumps, CGMs, diabetes shoes etc are reimbursed by diabetes coverage.
6. OPD expenses: Diabetes treatment may generate high OPD (Outpatient Department) charges. Thus, a diabetes-specific health insurance plan would reimburse these charges so that the patients can concentrate on the medical aspects of the treatment.
7. Tax Benefits:
Getting a health insurance plan which has diabetes coverage can result in tax savings as well. This is because the effective overall premium would be reduced because of the applicable 80D tax benefits.
8. Modern treatment coverage:
Health insurance with diabetes coverage takes a huge financial burden off the patients. In diabetes treatment, numerous factors such as medications, supplies, emergency hospitalizations etc. which can get pretty expensive, are all covered.
9. Automatic restoration:
This is a helpful feature which comes in handy when the maximum coverage amount has been exhausted. It revamps the sum insured into the previous full amount.
10. No pre-policy health check-up:
A good number of plans need you to do medical check-ups to ensure no pre-existing medical conditions are there, especially diabetes. But in this case, no such checkup is required.
11. Lifelong renewability:
This feature ensures policyholders can renew their coverage throughout their life as long as the premiums are duly paid on time.
Benefits of health insurance coverage with diabetes:
There are a lot of advantages of a health insurance plan that has diabetes coverage. Some of them are listed below:
1. Medication coverage: Diabetes treatment can get really expensive. Patients often find themselves in major financial distress due to a lack of funds. Managing the expenses, especially the ones from costly medicines, can get really tricky and this is where diabetes coverage arrives as a saviour. Medication costs are efficiently covered and this takes a huge burden off the patient’s shoulders.
2. Supplies coverage: Diabetes treatment requires glucose meters, insulin pumps, lancets, test strips and other supplies. They can be quite costly. These supplies are provided by the health insurance plan having diabetes coverage.
3. Doctor check-ups: Diabetes is a lifestyle disorder which requires frequent doctor visits. This might get overwhelming for patients as there is a potential for high monetary outlay. These doctor visits are covered by health insurance with diabetes coverage and are an extremely lucrative feature for the insured individual.
4. Emergency hospitalization: Diabetes patients may require emergency hospitalization. Hyperglycemia and hypo-glycemia are quite critical conditions which may require instant hospitalization and in such cases, health insurance with diabetes coverage takes care of emergency hospitalizations. Certain critical surgeries are also covered, making diabetes a resourceful option.
5. Severe medical complications coverage:
Diabetes may give rise to severe medical complications such as kidney failure, cardiovascular issues, ophthalmological damage etc and treatment of these complications which are associated with diabetes are also covered by a health insurance plan with diabetes coverage. It offers all-round financial protection in reality. Even tests for the prevention of these conditions are taken care of. Eye tests, AC1 tests etc are covered in some plans.
6. Flexible payment options:
There are a few plans in the market which provide flexible payment options such as copayment, co-insurance and deductibles which help individuals choose an option that fits their financial condition.
7. Pharmacy discounts:
Lucrative discounts from various pharmacies are also an attractive feature of this cover.
Reviewing the terms and conditions of the plan is of utmost importance. Proper communication with all the parties such as insurance companies, healthcare providers and others involved in the process is crucial for maintaining clarity and avoiding downturns.
Eligibility for health insurance with diabetes coverage:
Eligibility may depend on various factors such as age, financial status and others. A few have been discussed:
1. Age: For health insurance plans, age is an important factor. Individuals become eligible for a plan when they turn 18.
2. Medical history: This is a determining factor. If an individual has a pre-existing medical condition such as diabetes then chances of getting the plan are considerably slim.
3. Employer coverage: This is quite an interesting option as it allows you to take an insurance plan with diabetes coverage even if the individual has diabetes. Employers offer this to employees and their dependents.
4. Income: Individuals with diabetes may qualify for a plan based on their income. In some cases, the income also becomes an eligibility criterion for diabetes coverage.
To avoid conflicts, it is best to communicate with an advisor of the insurance company, who can explain all the parameters. web-researching the plans you are interested in also helps to clear the air.
Exclusions under health insurance with diabetes coverage:
There is efficient coverage in health insurance with diabetes coverage but also there are certain exclusions. Various factors may be taken into consideration:
1. Specific medication exclusions:
Though diabetes covers the care of major medications, a few specific medications are excluded. These may include certain specific classes of drugs. To ensure efficient coverage, the formulary of the plan should be checked with the prescription.
2. Complementary therapies:
Certain complementary therapies may not be covered in the plan. These may include acupuncture, herbal remedies etc.
3. Cosmetic surgeries:
They are not covered even if linked with diabetes. Bariatric is also excluded.
4. Limited quantity of supplies:
A lot of plans provide coverage for supplies needed for diabetes treatment. However, there may be a limitation in the quantity of the supplies provided.
5. Coverage limits:
Annual coverage limits are an aspect which might generate huge expenses.
So, we can say that it is really important to review all the terms and conditions beforehand. Proper communication with the insurer is also quite significant.
Claim process for health insurance with diabetes cover:
Once the insured submits the medical bills, they are reimbursed by the insurer. In the case of a cashless health plan, the insurer will directly pay the hospital.
The health insurance policy has to be checked categorically before the claim process. The parameters which are being covered should be critically examined. The details of copayment and exclusions should be minutely checked.
Healthcare provider selection is important. Healthcare providers who are in-network with insurance companies should be chosen so that claim settlement is carried out smoothly. Such providers have pre-negotiated rates with the insurance company which helps to reduce costs quite effectively.
Keeping a record of treatments, diagnosis and all related bills is also crucial. They should be well documented so that the insured does not have to face any hindrance during the claim settlement process.
In case any copayment or coinsurance is there in the scenario then that share has to be paid by the individual.
After treatment, the healthcare provider submits the claim to the insurance company. This may include different aspects of treatment such as diagnosis, tests done, bills from different medical procedures and other hospitalization charges. After submission of the claim, the insurance company should be contacted to ensure smooth-running of the settlement process. If any documentation is missing or if there is any issue that needs resolution then this is the time to resolve it. So, following up with the insurer is important.
EOB (Explanation of Benefits) will be sent from the insurance company after processing of the claim. It contains the financial details of the claim settlement. If there is any discrepancy then the insured can appeal the decision following the norms of appealing in the policy. If there is any outstanding after claim settlement then that amount has to be paid by the insured. This is essential in order to avoid collection actions. If any difficulty is faced at any stage of the claim settlement then it is always wise to contact the customer support team of the insurance company and seek necessary guidance.
Frequently Asked Questions:
Diabetes coverage in health insurance refers to the financial provisions and benefits provided to an insured individual having diabetes. This may include coverage of medication, supplies, hospitalization charges etc which are associated with diabetes treatment.
Diabetes coverage includes coverage of medication, supplies, hospitalization charges, doctor visits etc. which are associated with diabetes treatment. It may also cover complications which develop due to diabetes (cardiovascular complications, renal complications, ophthalmological complications etc.)
Diabetes Type 1, and Diabetes Type 2 are both covered by health insurance with diabetes coverage. Gestational diabetes in pregnant women is also covered by most plans.
You can research health insurance providers and contact their agents to understand the terms and conditions of the plans they offer and find one which suits your financial needs.
Yes, there are plans which cover pre-existing diabetes conditions. To ensure expected financial coverage one should carefully check the terms and conditions of the policy so that there is no discrepancy later on.
Yes, it is possible to switch plans to get better diabetes coverage. Switching is possible in open enrollment periods. Ensuring that the new plan is better than the previous one is important.
The claim process requires all medical records, prescriptions and hospital bills associated with diabetes treatment. Submitting the relevant documentation is an important part of the claim process so these should be well maintained.
There are a few plans to have counseling sessions about diabetes management which make patients aware and also improve mental health. Therapy sessions which are conducted often prove to be quite resourceful for diabetes patients.
Yes, there are certain exclusions in health insurance with diabetes coverage. These may include specific cosmetic procedures, experimental treatments and non-medical expenses.
In that case, you can always try appealing. All plans empower you with the right to appeal. In case of any dispute, you have to appeal and provide all necessary documentation so that the issue can be resolved smoothly.
EOB (Explanation of benefits) is a statement that the insurance company send the insured after processing the claim. It is an illustration which demonstrates how they have covered the various charges. It is sent so that the insured has a clear picture of the claim settlement process.
In a few cases, having a pre-existing medical condition such as diabetes may increase the premium. To avoid confusion, the terms and conditions of the plan should be read accurately.
These are some of the most asked questions about diabetes. People are often confused about finding the right plan, they have questions about the premium and other questions in mind. These answers should help everyone alleviate their problems
Leading Health Insurance Companies
Latest Blogs
