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Health Insurance for heart disease

September 24, 2006

Health Insurance may soon become synonymous with Heart Insurance. Dr J.S. Hiremath, a leading cardiologist from Pune, said at an international conference recently that ‘there is a CAD tsunami in India.’ Statistics bear him out. Studies have shown that not only are Indians genetically predisposed CAD or Coronary Artery Disease, but that India is registering a 12 per cent increase in it’s incidence. Health Insurance, particularly for treatment from heart problems, has never been as important as it is today.
The good and the bad
Fortunately, all Health Insurance policies cover risks from heart disease. Ofcourse, the polices do have first year and/or second year exclusions (diseases developed in the first year or second year of the policy) but heart disease is not included. In other words, this means that if you develop heart disease in the first or second year after you take the policy, it will be covered by the insurance company. That’s the good news. The bad news is that the cost of serious heart problems requiring organ transplants for instance may not be covered under broad-spectrum health policies. This may necessitate buying specialized, expensive policies. Also, if insurance companies are approached too late, when you already suffer from a heart problem, you will be turned away, even if you believe yourself cured. No insurance company covers pre-existing diseases, not right away.
A wide variety of insurance products
The buyer has a wide variety of insurance products to choose from ofcourse, and luckily, the differences between them are not nearly as wide as perceived. Ultimately, the buyer’s decision depends upon how much faith he has in a particular company.
Government products
Insurance polices from government insurance companies have been popular in the past. Their MediClaim policy, for individuals up to the age of 75 years, allows the insured to insure themselves for as low as Rs 15,000/-, and up to a limit of Rs 5 lacs. Premium varies according to the age of the insured. The policy provides reimbursement of medical treatment expenses like hospitalization, doctors’ fees, medicines, diagnostic tests and drugs. Treatment that does not need hospitalization like Coronary Angiography or Cardiac Catheterization can also be covered. Government companies also offer Family Floater Plans which cover the family under a single sum, the insured amount being transferable amongst the family members. However these policies have restrictions. There can be limits on pay-outs. For instance, a maximum of 50% of the total expenses incurred for any one illness. Also, the same illness is not covered again if it reoccurs after 45 days.
Private Products
ICICI Lombard has a Family Floater Plan where the minimum insured sum for 2 adults and 2 kids is Rs 2 lacs, with the premium varying according to age. For example, if the oldest member is between the ages of 56-60, the premium can go up to Rs 14,148 per annum. Lombard’s 10 K Plan, for a minimum of 2 members is for those up to the age of 60, but the policy can be renewed up to the age of 70 years. There is a fixed premium of Rs 10,000/-, but the sum insured varies depending on the age of the insured. For example if the members are below the age of 45, Lombard will offer Rs 5 lacs as the insured sum. If the members are between the ages of 56-60, the insured sum decreases to Rs 2.50 lacs.

heart-ins-graph.jpg


Royal Sundaram’s Health Shield offers some extra features like online access to your family’s medical history, reimbursement of ambulance charges and free medical check-ups. It also offers a cumulative bonus on renewal of the policy. However while most other insurance companies cover pre-existing diseases after four years, Royal Sundaram does so after 5 years .
Critical Illness Plans
Critical Illness Plans which cover serious diseases like CAD can be useful for those with a family history of CAD as donor expenses in a transplant surgery are covered, unlike under other health insurance policies. However, these policies can be expensive and pre-existing heart conditions are not covered. National Insurance Corporation’s Critical Illness Policy, meant for individuals between 20-65 years is for a minimum insured sum of Rs. 5 Lacs to a maximum of Rs 25 lacs. The amount can be made available in a lump sum if required.However, compensation is limited to 20% of the limit if a claim is made with respect to Coronary Artery Surgery. Also, the insurance company compensates the insured only once for treatment of a particular critical Illness. It will not compensate even if it is another ‘consequent disease or dependent disease.’ Additionally, if the critical illness appears during the first 90 days of the inception of the policy, the company will not entertain any claim. Bajaj Allianz also has a critical illness plan which covers amongst other things, Coronary Artery bypass surgery, the first heart attack, as well as a major organ transplant. The sum insured can be as low as Rs 1 lac, going up to Rs. 50 lacs. The sum is paid as a lump sum so that treatment can be planned accordingly.
More specialised products
Another specialised policy is New India Assurance’s Overseas MediClaim Policy, meant for travelers up to the age of 70. The premium depends on the age, the length of the trip, and country of visit and claims can be settled abroad in foreign currency. Coverage is initially for a period of up to 180 days but extensions are allowed for an additional 180 days if the insured is still healthy. Medical reports like an ECG and blood sugar from a cardiologist or a physician need to be submitted along with the proposal form in case applicants are over 60 or if they are over 40 and traveling to the US or Canada. And like other insurance policies, no pre-existing diseases are covered.
Life-cum-Health Insurance
There are also Life Insurance Plans with health benefits tagged on. These have inherent disadvantages. After a medical claim, the whole structure of the base policy changes and this could result in reduction in future pay-outs and termination of benefits. Future premiums could also be hiked. Some of these terms and conditions might seem unwarranted to the insured, but ultimately, insurance companies have to remain in business and make profits if they have to continue to honor the claims made.

Standard procedures across all Insurance Companies:
Bonus for claim free years.
Premium determined by the age of the insuring person.
Claim only up to the sum insured.
Pre-existing illnesses not covered for a minimum of 4-5 years after buying the policy, whether known or unknown.
No claims for the first 30 days, unless expenses are related to an accident.
Certain diseases, even if developed well into the policy are not covered for 1-3 years, but this does not include heart disease.Some diseases are not covered at all, but again this does not include heart disease.
Family plans do not include old parents.
Health check ups mandatory after the age of 46 years before buying the policy.
Age limits for fresh entrants to the policy, ranging from 60 to 70 years. However if the insured crosses this age, he will be allowed to continuethe policy for a few more years.Premium paid exempt under the Income Tax Act.

(Published in The Times of India in 2006)
A judgement by the consumer court this month (Oct 2006):
It said that if a pre-existing disease is not known to the buyer of the policy, then it is a legitimate claim. However, consumer courts do not have the teeth in this country and it remains to be seen whether insurance companies will follow through on this.

Read more about health insurance and whether it is the answer to your health expenses.

15 Comments leave one →
  1. November 2, 2006 12:34 pm

    In India Health Insurance is still a relatively new concept and only time will tell which companies are more reliable. MediClaim, which is a government based policy, has already run into some trouble as not all claims are not being honoured. It is believed that a lot of false claims are also being filed due to the collusion between doctors and hospitals. This causes the insurance companies to go into a loss. Only once this is cleaned up will health insurance companies show a healthy bottom line and only then will they be able to make sufficient profits to honour all the claims.

  2. Devashish permalink
    November 2, 2006 12:19 pm

    Hi!

    i was online searching for mediclaim policies in india. It was very fresh and nice information. I still want more info. Actually i feel the company will talk sweet before taking policy afterwards the sweetness will not be there so you need to know all details beforehand

    but i still not able to make which policy or which company will be nice for me

    anyway………
    with regards

  3. Sundarraj R permalink
    December 1, 2006 11:47 pm

    Hi Nita,
    Your article titled ‘What do Indian Insurance companies offer those with heart disease?’ is very useful.
    Thanks a lot for such a valuable information.
    Regards,
    sundar

  4. Pawan Prabhat permalink
    December 7, 2006 1:18 pm

    Hi Nita,
    I came across your blog while I was surfing the web to know whether it is perfectly legal to refuse claims within the first 30 days of the mediclaim policy. Can you please help me with this.
    Regards,
    Pawan

  5. December 7, 2006 1:47 pm

    Pawan, yes it is perfectly legal. Insurance companies mention this in the terms and conditions itself. Once you sign the form you are bound by the rules. However it is also a fact that each insurance company has different rules and they differ depending on the type of claim. If you are talking about a specific policy, then look at the fine print.

  6. Ankit Tyagi permalink
    May 9, 2007 9:57 am

    Hi Nita,
    Thanks a lot for such a detailed and well researched article.
    I would like to ask you about the how the critical illness products are better over mediclaim (other than having the lumpsum payment on diagnosis).
    I mean the disadvantages are very obvious, higher premiums, less no. of illnesses covered etc.
    Also, could you please share with us how successful has the Critical Illness product been?

    Regards,
    Ankit

  7. May 9, 2007 11:19 am

    Since I wrote the article, numerous new critical illness products have come into the market, introduced by the same companies.
    Now where Mediclaim is concerned, remember that Mediclaim is government so the comparision is basically between government and private.
    The critical illness products have been around for too short a time for any research on their success.
    Basically do not just look at a product solely as a product, but at the company which is selling it.

  8. Paresh Wadke permalink
    June 28, 2007 3:21 pm

    Hi…Nita…
    I was just surfing for some information on the medical insurance service and came accross ur site. the information on cardiac side is really useful. since i am looking for some figures for my presentation on cardiac illness / insurance, could you able to tell me what is the total market size (rs premium collected by all cos in a year) and what percentile claims are registered for all kinds of illness ??? could you also able to tell me what is the share of Cardiac claims among these total claims of the year…???
    thx…

  9. June 28, 2007 5:58 pm

    Paresh, thanks for coming to my site and I am glad you find the information useful. However I do not have the market size figures with me. However perhaps this information is available on the internet. If it is not, then senior people in the insurance business are sure to have it. I wish I could have helped you in this matter. In fact I too will search for this information as it would make a very interesting addition to my post.

  10. Joe permalink
    September 10, 2007 2:47 pm

    Hi Nita,
    This website is very informative and useful. I have a specific question. I want to take an health insurance for my brother who is 39 yrs old. Basically I want to get a cover for any unexpected expensive treatments like heart problems. Basically he should be covered for any expensive hospital treatments irrespective of criticality. I am bit confused in choosing a company. Could you suggest some good company who is reliable, very customer friendly etc. I don’t mind for paying a little extra if they provide a good service.

    Also one more question I have is, if the insured has slightly high blood pressure at the time of taking this policy, would the insurance reimburse the treatment expenses for any heart attack, Angioplasty,dialysis or any heart related treatments. Please let me know your idea on this and also suggest me how should I proceed further.

    Thanks
    Joe

  11. vishakha permalink
    December 15, 2008 12:38 pm

    my dad have undergone angioplast he s got the mediclaaim
    but can u suggest us which company wil help him to get claim in future , incase he undergoes any heart disease n future

  12. July 3, 2009 3:21 am

    Health Insurance may soon become synonymous with Heart Insurance

    I do not know if the writer actually realize the huge problem ahead of Indians.

    The problem is not heart diseases, the problem will be the insurance and its enormous always increasing costs. Even now many middle class/lower middle class people just cannot afford having any health insurance policy worth mentioning, but with times, holding a health insurance policy is going to be further difficult.

    Why? Thanks for government interventions and baseless laws.

    Do we discriminate against smokers by saying that if there is a smoker in the room, he should smoke outside the room? Do we say that the smoker should not smoke in public trains? Do we say that you won’t marry an alcoholic, or an alcoholic person should avoid to be a mother?

    Yes we do, Yet, when some private insurance company tries to reduce the insurance costs by simply “discriminating” against the citizens on the basis of their habits, such as, do they smoke, do they drink, do they have any extra-marital affair, do they have any hereditary complexive illness or signs of heart disorbers or various othe disorders like diabetes etc, are they obesse and many such necessary questions.. Government pinpoints, do not discriminate them. Government restricts insurance company to provide better pooling for insurance, and that increases the overall cost.

    The thing is, when you insure yourself for road accidents, while you are used to drive your scooty or scooter or motor bike or say car twice or at most thrice a day from house to office to market to home again, you pool yourself alongwith the truck/bus/taxi driver who spends his major life while driving, obviously he has more chances of accidents, so while after insurance, you may never meet an accident ever, the other person can meet accidents every third month. And as you are paying your premiums, he will get your hard earned collected money for his insurance. In India, Insurance system is ponzi scheme.

    Insurance providers need to have better pooling system, and government should not restrict them on any issue.

    Reference
    http://www.reasonforliberty.com/reason/indian-insurance-system-and-free-market.html

    It said that if a pre-existing disease is not known to the buyer of the policy, then it is a legitimate claim.

    That could have been termed as judgment if and only if the court had allowed insurance companies all the technical powers they can have to find out whether a insurer is likely to have any sort of disease/problem regarding his health in future on general basis.
    Obviously there are such technical advancements which can tell about your health in future quite acurately by designing your genetical map.

    But then, government and the same government ruled courts (which gave that funny decision) give no power to Insurance companies to be Just and honest.

    Now insurance companies can’t be just cos Indian government/court doesn’t allow them to be honest, also they cannot act like dishonest openly, so what they do?

    They are compelled to do dishonesty in very subtle way, and that is, by pooling all in same category without “discriminations”.

    Truly how important it is to discriminate.

  13. Sunit Uppal permalink
    March 23, 2010 3:42 pm

    Hi Neeta,

    Nice article, do you by any chance know of any insurance company in India which covers pre existing condition such as angioplasty after certain waiting period.

    I am trying from quite some time but none of the insurance company I have contacted covers pre existing heart related condition.

  14. narasimha rao permalink
    January 29, 2012 2:12 pm

    Hi Nita,
    This website is very informative and useful. I have a specific question. My Brother underwent Open heart surgery in 1991 and at present without medication he is working normally with family. can U suggest him, is he enter with health Insurance company under Pre- existing disease. Please guide me properly if yes which company should I take.

  15. narasimha rao permalink
    January 30, 2012 1:02 pm

    Hi Nita,
    This website is very informative and useful. I have a specific question. My Brother underwent Open heart surgery in 1991 and at present without medication he is working normally with family. can U suggest him, is he enter with health Insurance company under Pre- existing disease. Please guide me properly if yes which company should he take.

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