MEDICAL HEALTH INSURANCE Coverage for Cancer Survivors or Cardiac and Diabetes Patients in India

Introduction:

The essential health indices in India have widely improved since we became independent in 1947, the common life expectancy has gone up, the newborn mortality rates and maternal mortality rates have improved a whole lot but we still have quite a distance to go before we achieve developed or European standards.

These improvements happened because of improvement in education, sanitation, healthcare facilities and upsurge in disposable income resulting in general improvements in living standards across the board.

Today we are producing more cereals, pulses, fruits, poultry, fish and in addition consuming more therefore the availability of protein in our diet has improved quite definitely leading to taller and healthier Indians.

But along with increase in disposable income and increasing living standards there is increase in usage of alcohol, tobacco, red meat and fatty foods.

The upsurge in affluence and affordability of new technological gizmos has made us more sedentary and dependent even for smallest and easiest of the job; today we tend to use mobile phone from the comforts of our home to get hold of grocer, pharmacist, maid, electrician, mechanic, etc.

And instead of walking to nearest convenience store, we tend to use vehicle and rather than walking or cycling for moving-around in our neighbourhood we take motorised vehicle.

Many of us could have trouble remembering last time we walked a distance to catch a car rickshaw or taxi today we have a tendency to book taxi and it picks us up from our door step.

Which along with unresponsive or indifferent civic management has resulted in unplanned development across a lot of the urban centres where option of potable water, sanitation services are under stress alongside increased and unmanaged vehicular, industrial, ground, noise pollution.

In 2012 GOI with Indian council of medical research released an updated definition of overweight and revised the figures to:

If BMI (Body Mass Index) is between 18-22.9kg/m2 person is of normal weight

If BMI is 23-24.9kg/m2 the individual is overweight.

If BMI is a lot more than 25 kg/m2 the individual is OBESE.

In 21st century obesity has had epidemic proportion in India and more than 5% of population comes under definition of OBESE.

While studying of 22 SNP ( single nucleotide polymorphism) near to MC4-R-gene, scientist have identified a SNP 12970134 to be mostly associated with waist circumference. In this study nearly 2000 folks of Indian origin participated which SNP was found to be most prevalent in this group.

Hence genetically we are predisposed towards abdominal obesity which is probably the biggest morbidity factor behind diabetes type 2 and cardio vascular disease.

Globally 3-5 million deaths are due to obesity, 3.9% years of life lost and 3.9% of years lost to disability adjusted life years.

All the above has increased the number of Indians suffering from non-communicable lifestyle induced diseases like Cancers,Cardiac Vascular diseases, Diabetes, Hypertension, Mental Illness, breathing disorders like Asthma etc.

What is the condition burden for non-communicable prevalent disease like cancer, diabetes and cardiovascular diseases in India? (Reference: Background papers on Burden of disease in India published by National commission on macroeconomics and health)

The figures for Diabetes, CVD (Cardio vascular disease) and cancers are alarming and the largest percentage of new cases are increasingly being reported from Cities and the younger women and men are as vulnerable as middle aged men.

Diabetes:

India is projected to become diabetes capital of the globe, it's estimated that in 2015 approximately 4.6 crore Indians were diabetic.

The prevalence is estimated as:

In 30-39 years age group around 6% of population is estimated to be diabetic.

In 40-49 years age group around 13% of population is estimated to be diabetic.

In 70+ years generation around 20% of population is estimated to be diabetic.

Diabetes has been recognised as one of the major contributing factor towards upsurge in numbers of Cardio Vascular Disease (CVD) patients in India.

Cardiovascular Disease (CVD):

It's estimated that around 6.4 crore Indians had one or the other condition which can be classified as CVD.

Coronary Heart Disease is a mix of conditions offering Acute Myocardial Infraction, Angina Pectoris, Congestive Heart Failure (CHF) and inflammatory cardiovascular disease.

It really is increasing in rural areas it really is estimated to effect 13.5% of rural population in age group 60-69 years.

A growing number of cases of CVD are being diagnosed among young adult in age group 40 and above.

Cancers:

It's estimated that nearly 10 Lakh new cancers wold have been diagnosed in 2016 and 670,000 deaths were expected due to cancer in 2016.

Around the world Cancers take into account 5.1% of disease burden and 9% of all death, in India cancers account for 3.3% of disease burden and 9% of most deaths.

Response of medical health insurance companies towards the increased disease burden:

Looking at the large numbers of people being diagnosed and being affected by increased disease burden, it is a fact that these diseases or conditions are rejected as preexisting conditions and risks are not accepted by any insurance company.

The best response has been benefit policy from Life insurance companies that offer fix term plans for cancer or cardiac disease but for paying the power the diagnosis should be during policy period.

The survivor benefit plans popularly referred to as critical illness benefit policy pays only once the disease becomes critical particularly in cancer today many cancer cases are diagnosed and treated completely through the early stage and do not become critical hence most claims beneath the Critical Illness can only be produced once disease reached 3rd or 4th stage of manifestation.

Presently schemes for people diagnosed by or surviving these diseases are bare minimum some insurance companies have tried to launch products catering to people with some preexisting condition or survivors however the effort seems halfhearted.

New India assurance have launched Cancer care policies with Indian cancer society and CPAA but both these policies exclude existing cancer patients or Cancer Survivors and only enrol people who have no sign of cancer.

Health Insurance Policies for CORONARY DISEASE Patients:

Start Health and Allied insurance company has launched Star Cardiac care policy for those who have undergone PTCA, CABG within 7 year period before the commencement of the coverage under this policy.

Few features of Cardiac Care insurance coverage:

There are 2 sections of the policy section 1 is normal health insurance with PED covered after 48 months, 2% limitation on room, doctor fee and nursing charges subject to max of Rs.5000 per day and liability in case of package rates is limited to 80%of package rates.

But section 2 covering giving coverage to known cardiac cases there is no limitation apart from SI.

There exists a waiting amount of 91 days before a person can claim for just about any complication due to preexisting cardiac condition under this policy

Health Insurance plans for people with diabetes:

In Diabetes space you can find two products Diabetes safe from Star Health and Allied insurance provider and Energy Health insurance plan from Apollo Munich Health insurance company:

A comparison between your two products is really as:

INSURANCE PROVIDER: Star Health Insurance

Product: Diabetes Safe INSURANCE COVERAGE

Who is covered?

Patients experiencing Type 1 and type 2 diabetes

Number of plan:

2 plans in plan A pre-acceptance medical test must, in plan B no pre-acceptance medical tests

Waiting period: In plan A no waiting period, in plan B 15 months waiting period for coverage of disease related to CV system, Renal System disease of eyes and diabetic peripheral vascular disease, foot ulcers

Family floater option: available,both plans have 2 section one section covers

benefits under family floater and section 2 is specific to diabetes care.

Sum Insured Rs. 300,000, to Rs. 10,00,000

TAX Benefit: Under 80(D)

Limitation:

For Cataract the limitations are defined as :

For SI 3-500,000 liability to Rs.20,000 per eye person and Rs. 30,000 per policy period

For SI Rs. 10,00000 liability limited by Rs. 30,000 per eye person and Rs.40,000 for policy period

For diseases of cardio vascular system the limitation are thought as:

For SI 300,000 liability limited by Rs.200,000

For SI 400,000 Liability limited by Rs.250,000

For SI 500,000 liability limited to Rs. 300,000

For SI 10,000,00 liability limited by Rs.400,000

Cost of artificial limbs limited to 10% of SI if amputation is related to diabetes.

INSURANCE PROVIDER: Apollo Munich medical health insurance co. Ltd

Product : Energy Health Insurance Plan

Who is covered?

Patients experiencing Type 2 diabetes, impaired fasting glucose, impaired glucose tolerance and or Hypertension are covered.

Amount of plan: Single plan

Waiting period : No waiting period, day 1 hospitalisation arising out of diabetes and hypertension

Family floater option: No, policy available on individual basis

Sum Insured : Rs. 200,000 to Rs. 10,000,000

TAX Benefit : Under 80(D)

Limitation: No limits

VAS (Value added services): Health coach, telephonic consultation, health line, discounts, usage of wellness portal that conducts HRA, stores medical record

Optional VAS services: diagnostic monitoring program to monitor and manage health).

Rewards: Discounts on premium and addition benefits on a healthy body management

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