Insurers Give Diabetics Short-Shrift Treatment

[Apollo Munich CEO]

An effective health cover continues to elude diabetics despite the
country being dubbed the diabetes capital of the world with a 9%
prevalence in urban India. While the disease itself is not excluded,
the worst hit are those already under treatment as they risk most
major ailments being excluded.

"There are no fixed guidelines on what is covered as each case is
unique and we would go by the merits of the case," said an official
with state-owned New India Assurance. He, however, added that if a
person is already receiving treatment for diabetes any complications
related to that which could be treatment to heart, kidneys or eyes
would be excluded. This stance of the insurers puts diabetics in a
spot. If they declare their condition at the time of buying a policy
the insurer may not accept the proposal or place restrictions. But if
they do not their policies may turn worthless as in such cases
insurers can reject all claims on the grounds of mis-representation.

According to Sanjay Datta, head, motor and health at ICICI Lombard,
diabetes itself cannot be excluded permanently. "In case diabetes is
declared as a pre-existing condition by the insured and accepted by
the insurer under the policy, then the same is covered after four
years of continuous coverage with the insurer." But insurers are wary
about granting full cover to those who are already under treatment
particularly young patients. The other issue is that health policies
cover largely hospitalization while for diabetics a large chunk of the
costs are daycare.

"Normally a standard health policy would cover all the in-patient
treatments requiring hospitalization for ailments arising from
diabetes. However out-patient treatments like daily expenses on
administration of insulin, medication and regular check up are out of
the purview of coverage," said Ajay Bimbhet, CEO, Royal Sundaram
Alliance Insurance.

IRDA rules require that insurers do not reject any claim for pre-
existing illness four years after the policy is purchased. While this
benefits healthy people who subsequently face health issues it does
not benefit those who are already diabetic. According to Rama of Bajaj
Allianz, insurers might exclude diabetes from the policy if the
proposer is already undergoing treatment at the time of purchase of
policy. This means that it would not be covered under the policy.
Apollo Munich Health Insurance's 'Easy Health' plan covers pre-
existing diabetes and related problems after three years of continuous
coverage. "But every policy is unique and is guided by an underwriting
principle. Exclusions are dependent on pre-policy check up results and
waiting period for various diseases would be as per the applicable
policy terms," said Antony Jacob, CEO, Apollo Munich.

New entrant Max Bupa and Iffco Tokio Marine both provide cover
treatment related to diabetes related ailments after four years of
purchase of the policy if diabetes is present while buying a policy.
"In case diabetes is pre-existing, any complication which is resultant
of diabetes also stands excluded for first four years," said. Arun
Mehrotra, head, retail at Iffco Tokio. Although there were attempts to
introduce a special cover for diabetics it has not been successful so
far.

"There are a hardly any disease specific health insurance covers.
Also, as a concept such products are not viable for insurance
companies," said Shefali Chhachhi, director, marketing, Max Bupa.
However, Apollo Munich is looking at launching a diabetes specific
cover in future which will look at disease management wellness besides
catering to insurance needs of diabetics.