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Diabetes now covered under Mediclaim

Medical policies are available that cover the cost of hospitalization due to diabetes, both as a pre-existing disease and otherwise.

Anup Sreenivasan

21 Jan 2009

Many of us have had relatives, far or near, who have fought the diabetes scourge. Some do it successfully, rarely making a difference in their lifestyle except for the good. And then there are the others who have been forced to be martyrs to the disorder, often being forced to give up not just a comfortable lifestyle but also, in extreme cases, mobility and good health.

Diabetes mellitus, often referred to simply as diabetes, is a disorder that results in abnormally high blood sugar levels, as a result of disordered metabolism. It is usually present in patients either due to hereditary or environmental triggers. The disorder results in various diseases, such as cardio vascular disease, chronic renal failure, retinal damage leading to blindness, and so on. The abnormal levels of sugar, both high and low, are due to a defect in creating insulin in the body - either a lack in secretion or a lack of insulin action.

Diabetes has been treatable since insulin became medically available in the early part of the twentieth century; but there is no cure. Patients have to take regular insulin injections (Type 1 diabetes). Then there is the Type 2 diabetes that can be managed by a combination of dietary treatment, exercise, medication, and insulin doses.

Other serious long-term complications of diabetes include nerve damage of several kinds and micro vascular damage, which may cause erectile dysfunction and poor wound healing. Poor wound healing, particularly in the feet, can lead to gangrene, and possibly to amputation. Unfortunately, a lot many of us have had relatives in the early part of their middle age that have had to resort to this extreme step to save their lives because their diabetes had got out of hand. The trauma of realizing that they will have to go through life handicapped is only slightly lesser than the actual cost of such treatment. While the emotional scars can only be healed over time, we can definitely ensure that the financial ones are minimized.

What is the solution here? Please be aware that medical policies are available that cover the cost of hospitalization due to diabetes, both as a pre-existing disease and otherwise.  

Here is how it works

On payment of additional premium, which is compulsory for a person suffering from the pre-existing conditions of diabetes mellitus, these specific pre-existing conditions are covered in the following manner:

  • 1st year: No Claim
  • 2nd year: No Claim
  • 3rd year: 50% of the admissible claim or 50% of the sum insured set for the individual whichever is less
  • 4th year: 75% of the admissible claim or 75% of the sum insured set for the individual whichever is less
  • 5th year onwards: 100% of an admissible claim or sum insured set for the individual whichever is less

The typical health insurance policies available in the market cover diabetes under the pre-existing illnesses section and come with waiting periods ranging from 2-6 years. The insurers include Bajaj Allianz, ICICI Lombard, HDFC Ergo, Reliance General insurance, IFFCO Tokio, National Insurance, and so on.

Only Star Health and Allied Insurance Co. Ltd have a plan purely for diabetics, the Diabetes Safe plan. This plan covers the following:

  • Eyes: Diabetic Retinopathy requiring laser treatment
  • Kidneys: Diabetic Nephropathy leading to chronic renal failure
  • Feet: Diabetic foot ulcer requiring micro-vascular surgical correction

The Star Health plan does not require the pre-existing illness gestation period; a diabetic is covered for the above mentioned conditions from the start itself.

It was not too long ago that being middle-aged and diabetic meant that you had to face the prospect without any sort of insurance assistance. With more and more insurers in the fray, things have changed. All insurers today offer diabetes cover albeit with a gestation period. And as we have mentioned here, insurers are beginning to cover it from the outset itself.

While diabetes can disrupt life's quality it doesn't have to. And the first step towards the latter begins by having adequate health cover that will pay for its treatment. This ensures that all the other plans you have for you and your family does not have to take a back seat.