World Diabetes Day | Health insurers say yes to diabetics, but higher premiums are a not-so-sweet reality

Not a disqualifier

Buying a health insurance policy when you have been diagnosed with a pre-existing illness is not easy. Yet, non-life insurance companies are now increasingly open to covering diabetes under their health insurance policies.

“Companies have started adopting an inclusive approach towards those who have diabetes or hypertension or both. They can even buy health covers with minimal or no waiting period,” said S Prakash, managing director of Star Health and Allied Insurance.

Medical check-ups, though, are the norm.

“Diabetics can either buy policies with two to four years’ waiting period based on their health condition, or choose (dedicated) policies with a waiting period of 2-3 months. They can pay additional premium but have the cover with bare minimum waiting period,” he says.

Most insurers do not deny coverage outright to those with diabetes, though the terms and conditions could be more stringent and some products might not be offered to them. This apart, insurance companies such as Niva Bupa, Star Health, Care Health Insurance and Aditya Birla Health Insurance offer full-fledged policies or rider benefits designed specifically for diabetics.

Many of these products, especially the premium variants, facilitate regular check-ups and offer incentives such as discounts on renewal premiums to keep health conditions in check.

So, as a diabetic, whether type 1 or 2, do not assume that health policies are beyond reach – scout for the ones that best suit your requirements and budget.

“People with diabetes are more vulnerable to damage to organs – sudden heart attacks, cerebral strokes, and kidney disease leading to renal transplant and so on. Therefore, it is advisable to have health insurance cover,” says Prakash.

Diabetics are also prone to contracting infections and falling sick often. If your diabetes has already led to organ damage, however, your chances of obtaining a policy go down drastically.

Also read: How much health insurance do you need?

Higher premiums

Loading on premium refers to the additional premium that a policyholder has to pay over the rate applicable to a ‘standard,’ healthy policyholder. In the case of diabetics, it can vary as per the insurer’s underwriting policy and can go even as high as 200 percent, depending on the HbA1c levels (average blood glucose levels over three months).

“By and large, diabetics can obtain many products. For instance, our products are available to diabetics, but not all, and at an additional premium. We accept customers even with HbA1c value of eight (denoting moderate control) in case of some products, provided there are no other complications such as diabetic neuropathy, kidney disease and so on,” says Mishra of Niva Bupa.

Also read: Declare all pre-existing diseases or your health insurer will reject claims

Failure to disclose

You will have to undergo pre-policy issuance medical check-ups if you are over 45 while buying most regular health insurance products. If you are not upfront about your diabetes or other pre-existing conditions, they are likely to be discovered during the check-ups.

Even if you are younger and do not have to undergo medical tests, it's best to be completely transparent about your health history. “Claim denial can happen only if you have suppressed your ailment (at the time of filling up the proposal form),” said Prakash.

Failure to disclose your illnesses is treated as a breach of contract. This means that claims can be rejected even if they are completely unrelated to your pre-existing condition. Not surprisingly, this is the most common ground for disputes, as per the Mumbai Insurance Ombudsman’s annual report 2021-22.