As heart disease increasingly impacts young Indians, understanding the complexities of health insurance, including higher premiums, waiting periods, and the benefits of specialised cardiac policies, becomes vital for financial protection.
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Key Points
- Heart disease is increasingly prevalent among Indians in their 20s and 30s, with treatment costs often exceeding ₹1.7 lakh and severe cases reaching over ₹5 lakh.
- Early onset of heart disease complicates insurability, leading to higher underwriting scrutiny, longer waiting periods (2-3 years), and potential premium increases of 30-80 per cent.
- Insurers may impose permanent exclusions, sub-limits on procedures like angioplasty, or co-pay clauses ranging from 10 to 30 per cent for cardiac-related claims.
- Specialised indemnity or fixed-benefit heart policies are recommended for individuals diagnosed with coronary disease, those who have undergone procedures, or those denied standard coverage.
- When choosing a policy, it is crucial to select a sufficient sum insured, avoid restrictive sub-limits on room rent or ICU charges, and review co-payment clauses and hospital networks.
Heart disease is no longer only a late-life health and financial shock. It is affecting Indians in their 20s and 30s.
Around one in three cardiac claims exceeds ₹1.7 lakh, and in severe cases costs cross ₹5 lakh, especially when intensive care unit (ICU) care or surgery is involved, according to Plum, an employee insurance and health benefits company.
"According to estimates from the Indian Council of Medical Research and World Health Organization, nearly 60-70 million Indians are currently living with some form of heart disease," says Narendra Bharindwal, president, Insurance Brokers Association of India. He adds that India sees roughly 2 to 2.5 million new cases annually.
Repercussions of Early Onset Heart Disease
Contracting heart disease early affects insurability. "It leads to higher underwriting scrutiny, including detailed medical tests such as treadmill test (TMT), Echo, and angiography history," says Arun Ramamurthy, cofounder, Staywell.Health.
The insured could face a waiting period of two to three years for cardiac-related claims.
Insurers may offer a standard health insurance policy. "But they may impose a higher premium through risk loading and waiting periods for cardiac-related claims. Policies may come with permanent exclusions for certain cardiac procedures or sub-limits on procedures like angioplasty and bypass surgery," says Bharindwal.
Ramamurthy adds that premiums may increase by 30 to 80 per cent, and the co-pay clause could range from 10 to 30 per cent.
If the condition is severe or recent, insurers may decline coverage for a standard health policy.
When a Specialised Policy Makes Sense
A specialised indemnity heart policy (which covers heart and other ailments and procedures as well) makes sense for someone diagnosed with a coronary disease, or one who has undergone a procedure like angioplasty or bypass surgery.
"Buyers may also consider a specialised cardiac policy when their proposals for a standard policy are denied, heavy premium loading is imposed, or the person wants faster and certain coverage," says Ramamurthy. These plans may also come with a shorter waiting period.
How These Policies Work and Key Checks
Specialised heart policies are of two types: Indemnity-based and benefit-based.
An indemnity-based cover reimburses hospitalisation expenses related to cardiac (and other) ailments. A fixed-benefit plan provides a lump sum payout on diagnosis.
In this category, the buyer may choose either a cardiac-specific plan or a critical illness plan (which pays a benefit for a range of ailments).
People who already have a cardiac condition may have to pay a higher premium for a specialised indemnity policy.
The sum insured may be limited. High out-of-pocket exposure is another concern.
"Policyholders may end up paying from their own pocket due to sub-limits, co-pay clauses, or non-payable items," says Shilpa Arora, cofounder and chief operating officer, Insurance Samadhan.
Choose a sum insured that can absorb the full treatment cost. "If one prefers treatment in tertiary care centres or by senior cardiologists, the sum insured should be sufficient," says Arti Mulik, chief technical officer, Universal Sompo General Insurance.
Ensure that the policy does not impose restrictive sub-limits on room rent or ICU charges. Choosing the right room rent limit is crucial.
"All associated medical costs increase or decrease in proportion to the type of room chosen during hospitalisation," says Mulik.
Watch for disease-wise caps on cardiac treatments. Review the co-payment clause and the strength of the hospital network.
"Avoid policies that look affordable upfront but come with hidden restrictions," says Arora.
Be cautious about employer-provided coverage. "They are often insufficient for serious cardiac events and may not continue if one changes jobs," says Arora.
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Feature Presentation: Rajesh Alva/Rediff
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