World Health Day was on 7 April, and this year’s theme was diabetes. With 50 million type-2 cases, India is the diabetic capital of the world. And the numbers are going up—by 2030, more than 100 million people will be afflicted. Worse, the majority of patients are aged between 20 and 60.This means the disease has the power to disrupt a family’s finances due to the loss of a source of income.
Then there is the burden of treatment. According to insurers, the average claim size of a diabetic policyholder is close to Rs 50,000 and is rising by 18% every year. "Amputation, retinopathy, coronary angiography and bypass are the common costly procedures many diabetics often have to go through," says Mick Miller, SVP & Head, Claims, SBI General Insurance. How prepared are you? Unless you have enough savings, insurance is your best bet to meet the financial challenges posed by diabetes. Before choosing an insurer, decide how much insurance you need. The cover size should be larger if you fall in the high-threat category, according to your age, gender and city you live in. Data shows 64-67% of the total claims come from the top 10 cities. That may be because hypertension and lifestyle choices often lead to diabetes.
Treatment costs in cities are higher than in small towns. Also, men are more prone to diabetes than women. Not only are the number of claims made by men higher, the average claim amounts are also bigger than the average claims made by women. According to data from SBI General insurance, of the claims made in the past three financial years, 64% were by men. The average claim size among men was close to Rs 35,000 while for women it was Rs 25,000. Most claims were made by people in the 36-60 age group.
Buy a cover early
If there is a family history or you are a patient of hypertension, make sure you buy insurance now. Unless detected, insurers will agree to offer a regular health indemnity plan (standard hospital cover) that covers you against the disease. This cover will be much cheaper than a specialised diabetes health plan. A Rs 5 lakh cover would cost a healthy individual Rs 6,000 a year, while a diabetic would haveto pay Rs 17,000. For a Rs 10 lakh cover the premiums will be Rs 8,000 and Rs 22,000, respectively. A pre-existing ailment like hypertension will invite a waiting period of two to four years. But if you buy a health cover in the early stages of detection, chances are that it will cover the waiting period before the need for any major hospitalisation arises.
If you are already suffering
"A person with impaired health needs immediate protection. This is where specialised covers come in," says Dr Prakash, ED, Star Health and Allied Insurance. Though one pays a higher premium, many diabetes specific complications get covered under these plans, which might be in the exclusions list of a regular plan. Most of these plans cover type-2 diabetes, related complications such as heart and kidney ailments, kidney donor-related expenses,artificial limb and amputation costs and recurring dialysis costs.
Ways to cut down premium The easiest way to cut cost is distribute the required cover size between an indemnity plan and a top-up plan. Most top-up plans from standalone health insurers cover diabetes-related complications and will cost you half the price of your base plan. Do not try to cut corners in the base policy. Get a regular hospital/indemnity policy only if you have not been diagnosed with the disease yet. If you are diabetic, get a specialised plan that covers you from day one. The only way you can save on premiums for the base policy is if you get a floater cover. The pitfall here, however, is exhausting the cover. Opt for a floater top-up to avoid such a situation.
Ideally you should not depend on an indemnity cover for more than Rs 10 lakh. Choose a cheaper critical illness (CI) plan to meet larger treatment costs, like going abroad to receive health care. The advantage of buying a CI cover is that you receive the whole sum assured as soon as you are diagnosed with the disease and can spend it as you like, withoutworrying about sub-limits or inclusions and exclusions.