Health Insurance for Chronic Diseases


Most people get so involved in their 9-6 job that they often forget to volunteer for a health insurance policy. As time passes by, they realise the need and importance of a health insurance coverage for themselves and their family. Health coverage is vital nowadays because not only does it help people get timely medical assistance but also provides financial stability in emergency scenarios that may result in terrible financial distress.

To apply for a health insurance, a person has to declare details of his/her medical history. There are several medical condition categories in the application form itself which may confuse applicants. One such confusion being, whether health insurance covers chronic diseases. Don’t worry, we have provided a comprehensive guide which will help clear up some of your concerns, and give you an understanding of insurance policy for chronic diseases, enabling you to select the best one for yourself.

Health Insurance for Chronic Diseases

What is Health Insurance?

Health insurance or Private Medical Insurance is a term used for an insurance coverage that covers medical and surgical expenses of a person and saves them from any financial risk. It mainly focuses on paying off for the treatment that comes under “acute” medical conditions and includes curable diseases and illnesses. It is also important to note that normally a health insurance does not cover all aspects of a chronic condition and persons who seek insurance for treatment of chronic diseases are recommended to approach the National Health Service (NHS).

Why do People Choose Health Insurance?

The National Health Service or NHS of India covers many forms of treatments for free. However, most people choose health insurance or private medical insurance. Here is why:

1. More Options: The Choice is Yours

There are more options available for health insurance policyholders. These options range from choice of hospital to the choice of a preferred doctor. In simple words, a person with health insurance has more control over his comfort and healthcare environment, something, the NHS does not offer.

2. Skip the Queues:

In health insurance, the long wait in queues can be easily avoided. This is the reason people mostly go for this coverage due to its early treatment facility. Many private hospitals have shorter waiting lists compared to NHS hospitals. This means that fast and effective treatment is guaranteed under this form of health coverage.

3. Quality of Care Provided:

Most people go for health insurance policies because they prefer a peaceful ambience and dedicated care leading them to opt for lucrative health insurance schemes instead of the NHS.

What is a Chronic Condition?

A chronic condition is a disease or illness which has the following symptoms:

  1. It requires a long-term or ongoing treatment to manage its symptoms.
  2. It requires rehabilitation.
  3. When the symptoms continue indefinitely
  4. When the disease has no known cure with available medical technology.
  5. It requires a lifelong monitoring through regular checkups, consultations or timely examinations.
  6. When there’s a risk of reoccurrence of the disease.

A lot of curable, acute conditions are covered by most of the health insurance policies. On the other hand, if a person is suffering from a chronic condition, they may find it difficult to get assured under health insurance coverage.

Related Read: Top 5 Chronic Diseases in India

What is Chronic Illness Insurance?

A chronic illness or chronic condition is one that lasts for a lifetime. This makes chronic illness insurance more important for a large population. The ratio of people at a risk of developing a chronic disease is more due to a lifestyle nowadays, the biggest culprits being poor diet, and insufficient exercise, leading to obesity.

Chronic Illness Insurance is a kind of rider, or call it a mortgage protection policy, that pays bills for our medical and non-medical expenses not covered under a normal health insurance.

For example, certain common chronic conditions like heart stroke, heart disease, and cancer cannot go away on their own. However, with the right form of treatment, one can survive these illnesses, but the risk of recurrence or continuity of the condition is always there. A person never knows when such a condition will fall on them. So, during such times, chronic illness insurance acts as a saviour from financial distress.

Criteria to Avail Chronic Condition Benefits:

Chronic medical conditions require ongoing treatments and one going through it also needs help in their day-to-day activities. Such activities are known as Activities of Daily Living, or ADLs that people with chronic conditions often find difficult to perform. The chronic condition insurance policy pays off if a person is diagnosed with a chronic disease and is unable to perform at least 2 of these below-mentioned ADLs:

  1. Bathing: Includes many grooming activities like brushing, shaving, etc.
  2. Dressing: Includes pulling clothes on, closing zippers or fastening buttons
  3. Eating: Eating independently
  4. Transferring: Moving from the bed to a wheelchair and vice versa.
  5. Toileting: Getting on and off the toilet seat independently or without help
  6. Continence: Control of bowel and bladder functions

How Chronic Condition Insurance Works?

Most chronic condition insurance come under life insurance policies and not as a separate policy, meaning, a person needs to choose whether they want to add this coverage in their standard life insurance policy or not. The insurer will list the chronic diseases which will be covered under the policy along with number of ADLs required to approve payment (usually two).

When a person goes for a standard life insurance policy by paying a certain amount of money, on the death of that person, the amount is paid to the nominee, named by the insurance holder before his/her death. In the case of chronic illness, a portion of the insurance money is paid in advance to the family while the insurance holder is still alive. Therefore, when we purchase a life insurance policy, we get the option of deciding how much we want to invest under the name of chronic condition insurance.

Let’s clear the concept with an example. Suppose, a man named, Nitin takes a life insurance policy worth Rs. 40 Lacs with a chronic condition rider of Rs.10 Lacs. After a few months, Nitin gets diagnosed with a chronic disease. So, under this policy, Nitin will receive Rs. 10 lacs in a one-time payment which will be tax-free and can be used as per his needs and not just on medical expenses. With that amount, he can either pay his healthcare bills, in-home care bills, medical mortgage and other medical expenses.

The amount which he had received will be considered a part of the insurance money (death benefit) which his loved ones would have received after his death. Now, only 40 lacs will be provided to his family members after Nitin dies. So, this chronic insurance fund is not additional money but the part of the life insurance policy which he got while he is still alive.

What Exactly is Covered under Chronic Condition Policy?

Being diagnosed with a chronic condition is devastating. Most life insurance policies cover chronic condition benefits in the form of a lump sum for these disasters. The truth is, at the end of the day, the family is everything that matters. It is hard for everyone to imagine the arrival of such disasters but when one is diagnosed with a chronic condition one is affected physically, emotionally as well as financially. If one doesn’t have a life insurance policy, such situations can put the family under massive financial pressure. The time that needs to be spent recuperating effectively is spent worrying about medical bills. Even when a person has a really good medical insurance, sometimes the cost of treatment exceeds the benefits. Therefore, it is suggested to purchase a life insurance that offers chronic condition benefit when you are alive.

If a person is diagnosed with a chronic illness, he/she is eligible for the benefits of chronic illness policy. And the good news is, one can avail it while they are alive. In critical illness scenario, a lump sum is paid once or monthly. The diagnosis of the chronic disease is made by an expert in the field and specific tests should be carried out confirming the diagnosis of the chronic medical condition.

Chronic condition policy covers illnesses like:

  • Cancer
  • Heart Attack
  • Organ Transplant
  • Kidney Failure
  • Loss of Eyesight
  • Loss of Speech
  • Alzheimer’s Disease
  • Aortic Surgery
  • Coma
  • Heart Valve Surgery
  • Multiple Sclerosis
  • Parkinson’s disease
  • Paraplegia
  • Coronary artery bypass graft
  • HIV, if it is contracted from an operation or a blood transfusion

However, this is not a comprehensive list. There are several other chronic illnesses covered under the policy.

The money provided by the insurance company on the diagnosis of a chronic disease can be used as per the choice of the recipient. It can be used for:

  1. Medical bills.
  2. Things like buying a wheelchair.
  3. Making a wheelchair access at home.
  4. Paying mortgage or other medical bills.
  5. Also, we can save the money for future medical expense.

Limitations to Chronic Insurance Benefits:

  1. If a person is diagnosed with a chronic disease during the policy waiting time period, they will not be given any benefits.
  2. Any suicide attempt or self-inflicted injury is not covered under the benefits scheme
  3. An injury occurred due to illegal activity is not covered under the scheme.

Note:  The cost varies with different plans under the policy. Age and health are considered at the time of purchase and accordingly given the best rates. The family history of the recipient is also considered. Remember to buy a chronic insurance policy as early as possible as the older you become, the more expensive it will be.

Why is Health Insurance not Enough for Chronic Diseases?

Most of the health insurance plans do not cover maximum expenses of chronic disease. It may include medications or occupational and physical therapy, but it does not pay the entire cost of the treatment for the rest of the life. At least chronic insurance under life insurance policy pay off some amount while we are alive so that we can use it as per our medical needs, but health insurance has a lot of limitations making it hard for the people to go for it.

What Aspects of Chronic Diseases are Covered under Health Insurance?

Though chronic disease treatments are not fully covered by health insurance companies, there are a few aspects of a chronic condition that fall under health coverage plans. If a chronic condition develops in a person after he/she starts a policy, health insurance coverage will be provided to stabilize certain conditions like:

  • Health insurance policy will pay for any treatment required to stabilize the chronic condition of a person.
  • If the condition is declared “chronic” by medical experts, no further coverage a person will be availed for the ongoing management of the chronic condition.
  • In some cases, when there’s a sudden and unexpected deterioration in the health condition of a person, the policy will cover the expenses till the person stabilizes.

Does Health Insurance Pay off for Managing a Chronic Condition?

The answer is likely to be yes. Almost all plans sold in the individual market, in the Marketplace or through small employers cover most of the important health benefits, as per the rule which is part of the “Affordable Care Act”.

For a few chronic conditions like asthma or diabetes, the insurance plans will help pay for:

  1. Important Lab tests
  2. Doctor’s visits
  3. Prescribed medicines
  4. Behavioural health services
  5. Preventive care against the disease
  6. Rehabilitation (that include occupational therapy and physical therapy)
  7. Hospital care

We never know what’s waiting for us out there, thus, we should not waste any time in gettings the insurance coverage, our families deserve. Having a great insurance plan will let you look after your loved ones or yourself in desperate situations, and will also safeguard you and your family facing a financial crisis.

Read Also: Ayushman Bharat: Health Insurance Benefits, Eligibility


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