How do Lifestyle Diseases Affect Insurance Eligibility?

Lifestyle Diseases in Health Insurance: Impact on Eligibility, Premiums and Coverage

Lifestyle diseases do not affect your eligibility to avail health insurance coverage, but they come with some limitations. You may need to pay a higher premium to seek coverage for lifestyle diseases. Besides, if you have a pre-existing condition, it will be covered under your health insurance plan, but only after a waiting period.

However, if you have not disclosed your health condition to the insurer while buying the policy, then your claim can be rejected, and you may face legal consequences. So, while purchasing a health insurance policy, always disclose pre-existing conditions, medical history, etc., to ensure hassle-free coverage.

What are Lifestyle Diseases?

As the name suggests, lifestyle diseases refer to the health issues caused by the lifestyle habits of an individual. This includes non-communicable diseases such as hypertension, diabetes, obesity, stroke, cardiac issues, colon cancer, etc. Diseases caused by the consumption of alcohol, drugs, and even smoking are also termed lifestyle diseases.

In recent years, lifestyle-related diseases have shown a concerning rise in their numbers, with half of the population being affected, which was only 31% a decade ago. Thus, health insurance coverage is necessary to provide coverage against the rising treatment expenses of lifestyle diseases.

How Do Lifestyle Diseases Influence Your Health Insurance Choice?

As lifestyle diseases are rising day by day, individuals buying health insurance plans are now looking for the following aspects in their plans:

1. Higher Coverage Amount

Lifestyle diseases increase the expenses of treatment as they include recurring diagnostic tests, frequent doctor visits, and medications for proper management of the condition. Considering the rising medical costs in India, having a higher sum insured is necessary to cover these costs.

2. OPD Coverage

As already mentioned, management of lifestyle diseases includes regular checkups and screenings, which can drain your savings. Having an OPD coverage with your health insurance plan helps cover the expenses of wellness checkups, diagnostic tests, etc., saving you from excessive expenses.

3. Coverage for Chronic Disease Management

Management of chronic diseases like cancer, cardiac issues, and kidney failures includes certain medications that need to be purchased for the long term. Health insurance that offers coverage for this type of long-term medication helps save your finances.

4. Flexibility

When families need additional protection, top-ups, critical illness riders, and other such add-ons provide tremendous relief. Having health insurance riders can help a family avoid last-minute problems if they anticipate increasing health risks.

What are the Common Things to Look for in Health Insurance Policies Covering Lifestyle Diseases?

Here are some of the things to keep in mind while choosing a health insurance plan that covers lifestyle diseases:

1. Co-Payment Clauses

Some policies come with co-payment clauses where the insured needs to pay a part of the treatment expenses incurred. Before buying the policy, check how much of the bill you will need to pay yourself.

2. Waiting Period

Many policies come with a waiting period for pre-existing health conditions. Check the period before buying the policy, as you cannot claim insurance during this period, so any health issues occurring during this period will drain your money.

3. Network Hospitals

It is necessary to check whether your insurance company has any network hospitals nearby that specialise in the treatment of lifestyle diseases. Network hospitals offer cashless hospitalisation, which removes the hassles of reimbursement claims.

4. Critical Illness Rider

When serious lifestyle-related illnesses like cancer, heart attacks, or strokes are diagnosed, a critical illness rider might be advantageous since it offers a lump sum payout to the policyholders to cover the expenses.