Health Insurance Coverage for Cancer Survivors or Heart and Diabetic Patients in India

Introduction:

Basic health indices in India have improved a lot since we became independent in 1947, average life expectancy has increased, infant and maternal mortality rates have improved a lot, but we still have a long way to go before we achieve a development or European standards.

These improvements came about due to improvements in education, sanitation, healthcare facilities, and increased disposable income, resulting in overall improvements in living standards across the board.

Today we are producing more cereals, legumes, fruits, poultry, fish and we are also consuming more, as a result, the availability of protein in our diet has improved a lot, resulting in taller and healthier Indians.

But along with rising disposable income and rising living standards, consumption of alcohol, tobacco, red meat, and fatty foods is on the rise.

The increasing wealth and affordability of new tech gadgets has made us more sedentary and dependent on even the smallest and easiest jobs; Nowadays we tend to use the mobile phone from the comfort of our home to contact a shopkeeper, pharmacist, maid, electrician, mechanic, etc.

And instead of walking to the nearest convenience store, we tend to use a vehicle and instead of walking or biking to get around our neighborhood, we use a motorized vehicle.

Many of us will have trouble remembering the last time we walked a distance to take an automatic rickshaw or taxi, today we usually book a taxi and it picks us up at our doorstep.

Which, together with indifferent or unresponsive civic management, has resulted in unplanned development in most urban centers where the availability of drinking water and sanitation services are under pressure along with vehicular, industrial, and land pollution. and increased and uncontrolled acoustics.

In 2012, the GOI with the Indian Council of Medical Research published an updated definition of overweight and revised the figures to:

If the BMI (body mass index) is between 18-22.9 kg / m2, the person is of normal weight

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

If the BMI is greater than 25 kg / m2, the person is OBESE.

In the 21st century, obesity has assumed epidemic proportions in India and more than 5% of the population falls within the definition of OBESE.

While studying 22 SNPs (single nucleotide polymorphism) near the MC4-R gene, the scientists identified a SNP 12970134 that is primarily associated with waist circumference. Almost 2000 people of Indian origin participated in this study and this SNP was found to be the most prevalent in this group.

Therefore, we are genetically predisposed to abdominal obesity and this is one of the major morbidity factors behind type 2 diabetes and cardiovascular disease.

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

All of the above has increased the number of Indians suffering from non-communicable lifestyle-induced diseases such as cancer, heart vascular diseases, diabetes, hypertension, mental illnesses, respiratory disorders such as asthma, etc.

What is the disease burden of prevalent non-communicable diseases such as cancer, diabetes and cardiovascular disease in India? (Reference: Background Papers on Burden of Disease in India Released by the National Macroeconomics and Health Commission)

The numbers for diabetes, CVD (cardiovascular disease) and cancers are staggering with the highest percentage of new cases being reported in urban areas and younger men and women are just as vulnerable as middle-aged men.

Diabetes:

India is predicted to become the diabetes capital of the world, it is estimated that in 2015 approximately 4.6 million million Indians were diabetic.

The prevalence is estimated as:

In the age group 30 to 39 years, it is estimated that around 6% of the population is diabetic.

In the age group 40-49 years, it is estimated that around 13% of the population is diabetic.

In the age group over 70, it is estimated that around 20% of the population is diabetic.

Diabetes has been recognized as one of the main factors contributing to the increase in the number of cardiovascular disease (CVD) patients in India.

Cardiovascular disease (CVD):

It is estimated that around 6.4 crore of Indians had one or another condition that can be classified as CVD.

Coronary heart disease is a combination of conditions including acute myocardial infarction, angina pectoris, congestive heart failure (CHF), and inflammatory heart disease.

It is increasing in rural areas and is estimated to affect 13.5% of the rural population in the 60-69 age group.

More and more cases of CVD are being diagnosed among young adults aged 40 and over.

Cancers:

An estimated 10 lakh of new cancers were diagnosed in 2016 and 670,000 deaths from cancer were expected in 2016.

Worldwide, cancers account for 5.1% of the burden of disease and 9% of all deaths, in India cancers account for 3.3% of the burden of disease and 9% of all deaths.

Response of health insurance companies to the increasing burden of disease:

Looking at the large number of people diagnosed and affected by a higher burden of disease, it is a fact that all of these diseases or conditions are rejected as pre-existing conditions and no insurance company accepts the risks.

The best answer has been the benefit policy of life insurance companies that offer fixed-term plans for cancer or heart disease, but to pay for the benefit, the diagnosis must be made during the policy period.

Survivor benefit plans, popularly known as critical illness benefit policies, pay only when illness becomes critical, particularly in cancer. once the disease reached the third or fourth stage of manifestation.

Currently, the schemes for people diagnosed or surviving these diseases are minimal. Some insurance companies have tried launching products that serve people with pre-existing conditions or survivors, but the effort seems half-hearted.

New India Assurance has launched cancer care policies with the Indian Cancer Society and CPAA, but both policies exclude existing cancer patients or cancer survivors and only enroll people who have no signs of cancer.

Health insurance policies for patients with cardiovascular diseases:

The insurance company Start Health and Allied has launched the Star Cardiac Care Policy for individuals who have undergone PTCA, CABG within a period of 7 years prior to the commencement of coverage under this policy.

Some features of the Cardiac Care insurance policy:

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

But the section 2 that covers the coverage of known cardiac cases there is no other limitation than the SI.

There is a 91-day waiting period before a person can claim for any complications due to a pre-existing heart condition under this policy.

Health insurance plans for people with diabetes:

In the Diabetes area there are two Diabetes safe products from the insurance company Star Health and Allied and the Energy Health insurance plan from the insurance company Apollo Munich Health:

A comparison between the two products is as follows:

Insurance company: Star health insurance

Product: Insurance plan for diabetes

Who is covered?

Patients suffering from type 1 and type 2 diabetes

Plan number:

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

Waiting period: In plan A without waiting period, in plan B 15 months of waiting period for coverage of disease related to the CV system, disease of the renal eye system and diabetic peripheral vascular disease, foot ulcers

Family float option: available, both plans have 2 decks of a section

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

Sum assured 300,000 rupees to 10,00,000 rupees

IIncome tax benefit: Less than 80 (D)

Limitation:

For Cataracts, limitations are defined as :

For SI 3-500,000 liabilities at Rs 20,000 per eye and Rs 30,000 per policy period

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

For diseases of the cardiovascular system, limitation is defined as:

For SI 300,000 limited liability to Rs 200,000

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

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

For SI 10,000.00 liability limited to Rs. 400,000

The cost of artificial limbs is limited to 10% of the IS if the amputation is related to diabetes.

Insurance company: Apollo Munich health insurance co. Limited

Product : Energy health insurance plan

Who is covered?

Patients with type 2 diabetes, impaired fasting glucose, impaired glucose tolerance, or hypertension are covered.

Plan number: Single plan

Waiting period : No waiting period, hospitalization from day one for diabetes and hypertension

Family float option: No, policy available individually

Sum assured : 200,000 rupees to 10,000,000 rupees

Income tax benefit : Less than 80 (D)

Limitation: Unlimited

VAS (value added services): Health advisor, phone consultation, health line, discounts, access to HRA wellness portal, stores medical record

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

Rewards: Discounts on premiums and additional benefits in good health management.