Health Insurance Coverage for Cancer Survivors or Cardiac and Diabetes Patients in India

Introduction:

The basic health indices in India have widely improved since we became independent in 1947, the average life expectancy has gone up, the infant mortality rates and maternal mortality rates have improved a lot but we still have a long way to go before we achieve developed or European standards.

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

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

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

The increase 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 contact grocer, pharmacist, maid, electrician, mechanic, etc.

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

Many of us will have trouble remembering last time we walked a distance to catch an auto rickshaw or taxi today we tend 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 most of the urban centers where availability of potable water, sanitation services are under stress along with 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 person is overweight.

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

In 21st century obesity has taken 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 people of Indian origin participated and this SNP was found to be most prevalent in this group.

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

Globally 3-5 million deaths are because of 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 disease 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 biggest percentage of new cases are being reported from Urban areas and the younger men and women are as vulnerable as middle aged men.

Diabetes:

India is projected to become diabetes capital of the globe, it is 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 age group around 20% of population is estimated to be diabetic.

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

Cardiovascular Disease (CVD):

It is 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 that include Acute Myocardial Infraction, Angina Pectoris, Congestive Heart Failure (CHF) and inflammatory heart disease.

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

More and more cases of CVD are being diagnosed among young adult in age group 40 and above.

Cancers:

It is estimated that nearly 10 Lakh new cancers wold have been diagnosed in 2016 and 670,000 deaths were expected because of cancer in 2016.

Across the globe Cancers account for 5.1% of disease burden and 9% of all death, in India cancers account for 3.3% of disease burden and 9% of all deaths.

Response of health insurance companies towards the increased disease burden:

Looking at the large number of people being diagnosed and being affected by increased disease burden, it is a fact that all 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 which offer fix term plans for cancer or cardiac disease but for paying the benefit the diagnosis has to be during policy period.

The survivor benefit plans popularly known as critical illness benefit policy pays only when the disease becomes critical particularly in cancer today many cancer cases are diagnosed and treated completely during the early stage and do not become critical hence most claims under the Critical Illness can only be made 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 but 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 Cardiovascular Disease Patients:

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

Few features of Cardiac Care insurance policy:

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 other than SI.

There is a waiting period of 91 days before a person can claim for any complication because of preexisting cardiac condition under this policy

Health Insurance plans for people with diabetes:

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

A comparison between the two products is as:

Insurance Company : Star Health Insurance

Product : Diabetes Safe Insurance Plan

Who is covered?

Patients suffering from 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

I ncome 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 to Rs. 30,000 per eye person and Rs.40,000 for policy period

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

For SI 300,000 liability limited 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

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

Insurance Company: Apollo Munich health insurance co. Ltd

Product : Energy Health Insurance Plan

Who is covered?

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

Number of plan : Single plan

Waiting period : No waiting period, day 1 hospitalization 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

Income Tax Benefit : Under 80 (D)

Limitation : No limits

VAS (Value added services): Health coach, telephonic consultation, health line, discounts, access to 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 good health management



Source by Chetan Rattan

Granado Jane

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