Here’s some sweet news for diabetics

Apollo Munich Health Insurance recently launched a health insurance plan, ‘Energy’, for diabetic and hypertensive patients.

There is no waiting period for hospitalisation arising out of diabetes or hypertension and the insured gets cover from Day One. The sum assured starts from ₹2 lakh and goes up to ₹10 lakh. It covers individuals from 18 years to 65 years.

This plan is renewable life-long and has an attractive rewards programme. But the premiums are daunting.

All individuals suffering from type II diabetes or pre-diabetes or hypertension (HPT) are eligible for a cover under this plan.

But those who have already developed complications, for example, got a retina surgery or kidney replacement done because of diabetes, may be turned away.

“While accepting a proposal we evaluate the individual’s health status and determine whether the risk is acceptable under our underwriting guidelines. One factor in decision making is whether any complication has already manifested or not,” says Antony Jacob, CEO of Apollo Munich. So, be ready for an elaborate pre-policy health check-up.

Tests would include routine urine examination, fasting blood sugar, lipid profile, treadmill Test/2D Echo with ECG, eye and foot examination (for diabetics), among other investigations. These would be carried out in one of the insurer’s network laboratories and the cost will be borne entirely by the insurer.

‘Energy’ covers all hospitalisation expenses of the insured — arising out of diabetes or any other condition. Cover for pre- and post-hospitalisation expenses (for 30 and 60 days, respectively) mainly in the form of consultation fee, investigations and medicines, is available.

The plan also covers 144 day-care procedures and organ donor expenses.

However, though cover starts from Day One for hospitalisation due to diabetes and hypertension, there is a waiting period of two years for specific diseases, such as cataract, hernia and joint replacement.

The waiting period for pre-existing diseases (other than diabetes and HPT) is three years. Exclusions under the policy include hospitalisation due to congenital disease, mental disorder, war, pregnancy, dental treatment, etc.

For a sum insured of ₹5 lakh, a male of 35 years would pay around ₹13,853 for a silver plan and ₹18,559 for a gold plan. This is high given that a standard health plan will charge around ₹5,000 for the same sum insured. But the company has an attractive rewards programme. You can save up to 50 per cent on renewal premium if you improve your health.

Every year, based on the readings from tests on BMI, HbA1c, cholesterol, blood pressure and blood glucose, a wellness score is calculated. This can earn discount of up to 25 per cent on premium and a reimbursement of up to 25 per cent on renewal premium towards expenses on medicines, health food and doctor consultation.

Premium can also reduce if one is willing to go in for co-payment. For example, if you bear up to 20 per cent of the claim amount, the premium on the plan discussed above will reduce to ₹11,121 and ₹15,827, respectively, for the silver and gold plans.

For middle-aged people with a family history of diabetes or hypertension and a high risk of diabetes-related complications in future, Energy is a good option. Given an attractive rewards programme, a health-conscious individual can reduce his premium outgo on the policy.

But those younger and having just tested for slightly higher glucose levels can take a standard health policy and wait for the next three-four years to get specific cover for diabetes.

This is assuming that diabetes-related complications are initially few and that you may not spend as much on the treatment as even the premium this policy asks for.

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