Coverage for Eczema Treatments in Health Insurance

Eczema & Health Insurance: Coverage, Plans & Tips for India

The global prevalence of eczema exceeds 10%, with an increasing number of cases reported in urban India, attributed to pollution and lifestyle changes. Marked by itching, redness, and inflammation, eczema disrupts daily life.

For long-term management, treatment coverage plays a key role in financial protection. Health insurance support can significantly reduce long-term treatment costs.

But does your health insurance actually cover eczema, and to what extent?Know more here.

Is eczema treatment covered under health insurance in India?

Yes. When medically necessary, eczema treatment is covered by most Indian health insurance plans. This includes consultations with dermatologists, diagnostic tests, prescription medications, and procedures such as phototherapy. However, the extent of coverage varies depending on the insurer and plan.

What types of eczema treatments are typically covered?

Most comprehensive health insurance plans cover medically necessary treatments for eczema. The extent of coverage may vary by insurer, but commonly included services are:

• Consultations: Visits to board-certified dermatologists within the insurer's network.
• Medications: Prescription drugs like corticosteroids, antihistamines, immunosuppressants, and biologics such as dupilumab.
• Diagnostics: Tests including skin biopsies, blood tests, and patch testing for diagnosis and disease monitoring.
• Therapies: Phototherapy (narrowband UVB) is covered under daycare procedures when deemed medically necessary.
• Hospitalisation: Severe eczema-related complications, like secondary infections, that require admission are generally covered.

Are there any waiting periods for eczema treatment coverage?

Yes, most health insurers have a waiting period for pre-existing conditions, including chronic eczema. Typically, this ranges from 2 to 4 years, during which claims related to eczema will not be accepted.

However, some insurers offer options to reduce the waiting period through add-ons or higher premiums. Individuals with a known eczema history should consider policies with shorter waiting periods.

Does Star Health Insurance cover eczema treatments?

Yes, Star Health Insurance offers multiple plans that include coverage for eczema as a pre-existing condition. Here's a detailed overview of the relevant policies:

• Comprehensive Insurance Policy : Covers pre-existing conditions like eczema after a 36-month waiting period. An optional “Buyback PED” feature allows this to be reduced to 12 months by paying an additional premium. OPD consultations and medicines are covered up to a sub-limit. These plans are especially suitable for individuals seeking outpatient dermatology care.
• Young Star Insurance Policy : Covers pre-existing diseases after a 12-month waiting period. The plan offers outpatient benefits on payment of an additional premium and is suitable for individuals between the ages of 18 and 40.
• Senior Citizens Red Carpet Health Insurance : Policyholders aged 60 and above can have eczema and other chronic conditions covered after a 12-month waiting period, subject to a pre-acceptance medical screening.

Are cosmetic dermatology procedures for eczema covered?

No, cosmetic or aesthetic procedures are not covered. Treatments like chemical peels, laser therapy for scars, or microdermabrasion, even if related to eczema, are classified as non-essential.

Only treatments prescribed by a licensed dermatologist and deemed medically necessary are eligible for reimbursement.

How can I ensure my eczema treatment is covered by insurance?

To make sure your insurance actually covers eczema treatment when you need it, keep these points in mind:

• Visit network hospitals: To avail cashless claims, always choose hospitals that fall in your insurer’s network.
• Get a prescription from a dermatologist: Make sure treatment and tests are prescribed by a licensed medical professional to demonstrate medical necessity.
• Establish medical records: Collect and file all the prescriptions, bills, and diagnostic and treatment records whenever necessary.
• Go for OPD inclusion policies: If you are recommended for a plan that covers outpatient consultations and pharmacy expenses at any nearby clinic or hospital, then opt for such plans.
• Understand the waiting period: Pre-existing skin condition policies also have a waiting period, and a shorter or customisable waiting period is always preferred.

Are there government health schemes that cover eczema treatments?

Yes, several government health schemes in India provide coverage for eczema treatments, primarily focusing on inpatient care. Here's an overview:

• Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) : Covers up to ₹5 lakh per family per year and includes hospitalisation for eczema when medically necessary. Outpatient care is generally not included.
• State-Specific Schemes : Programmes, like the Mahatma Jyotiba Phule Jan Arogya Yojana (Maharashtra) and Arogya Karnataka, also cover hospitalisation for dermatology-related conditions for eligible populations. However, outpatient services are often excluded or offered in a limited capacity.

What should I consider when choosing a health insurance plan for eczema?

• Treatment coverage: Ensure the policy covers outpatient department (OPD) consultations, prescription drugs, and therapies, such as phototherapy.
• Waiting Periods: Consider plans with the shortest waiting periods or those that offer add-on features.
• Exclusions: Look for exclusions that apply to purely cosmetic or non-therapeutic procedures.
• Network Hospitals: A broad network with dermatology expertise allows easier access to care.
• Claims process: Consider insurers with strong claim settlement ratios and user-friendly mobile apps.

Selecting the right policy helps eczema patients access the care they need while managing costs.