Customers should also watch out for sub-limits on room rent and specific treatments
Heart disease
In recent years, heart disease has become one of the leading causes of health insurance claims. Not just the old but even younger people are falling prey to cardiac ailments.
Such diseases impose a heavy financial burden on patients and insurers. According to recent data from Policybazaar, an online portal for purchase of insurance, heart-related conditions accounted for around 10.5 per cent of all its health insurance claims in 2019-2020, with an average claim size of Rs 4.5 lakh. By 2023-24, their share had climbed to around 19 per cent, with the average claim size reaching Rs 13.5 lakh.
Insurers have responded by offering specialised cardiac plans tailored to the unique needs of cardiac patients. “ A customer with no illness can choose a regular health plan, while those with a heart condition now have the option of buying a specialised plan,” says Siddharth Singhal, head-health insurance, Policybazaar.com.
Key features
Specialised cardiac plans cater to those with pre-existing heart issues. They are designed for individuals who have undergone procedures such as angiography or bypass surgery.
Second, they offer annual check-ups to monitor heart health, diabetes, hypertension, and cholesterol. “We ensure that customers undergo tests to monitor their heart health and manage various parameters,” says Manish Dodeja, head-claims & underwriting, Care Health Insurance.
Lastly, these plans include standard hospitalisation coverage, pre- and post-hospitalisation coverage, and features like no-claim bonus.
Different from regular health plans
Specialised cardiac plans often provide limited coverage compared to comprehensive health plans. For example, a standard health policy covers a wide array of treatments and allows multiple refills. Specialised cardiac plans tend to have restrictions. “Many specialised plans impose sub-limits on expenses like room rent and specific treatments, which can increase out-of-pocket costs,” says Aayush Dubey, co-founder and head of research, Beshak.org.
In recent years, some insurance companies have begun to accept heart patients under regular plans, though often with sub-limits or risk-based loading. “Now, many standard insurance plans accept heart patients as well, but with some restrictions,” says Singhal.
Pros and cons of specialised policies
Specialised cardiac plans can be a lifeline for individuals with existing heart conditions. “These plans allow people who may find it difficult to secure coverage through standard comprehensive plans to obtain insurance,” says Dubey.
“Coverage typically begins after a short waiting period of 90 days,” says Kapil Mehta, co-founder, SecureNow Insurance Broker.
However, some specialised policies may have sub-limits or require co-payment. “For example, if treating a cardiac issue costs around Rs 4 to Rs 5 lakh, these plans may only cover Rs 3 lakh to Rs 4 lakh, requiring you to pay the difference,” says Mehta.
Premiums for these plans tend to be higher than standard health policies. “Additionally, crucial benefits—like domiciliary treatment cover—might not be included, and there could be co-payment requirements and limits on specific treatments,” says Dubey.
Costlier than regular policies
Specialised cardiac plans are generally more expensive than standard policies. “The cost varies by age and city, but generally, they are slightly more expensive,” says Dodeja. The additional cost is attributed to the focused coverage and extensive health monitoring these plans offer.
“Typically, they are one and a half times more expensive, sometimes even more,” says Mehta.
Cardiac care plans are ideal for individuals with pre-existing heart conditions or a family history of heart issues. “Given the high costs associated with cardiac treatments, having coverage is crucial,” says Singhal.
For those without heart conditions, Dubey suggests buying a standard health policy as they offer better overall coverage.
Points to heed
For individuals with heart ailments, selecting a higher sum insured is critical. “We recommend at least Rs. 20 lakh sum insured. As heart-related ailments can lead to multiple hospitalisations, a small sum insured of Rs 5 or Rs 7 lakh may not suffice,” says Singhal.
He also advises being aware of co-payment requirements, which may be up to 20 per cent of a claim. “Check with your insurer if there is an option to waive the co-payment by paying a higher premium,” says Singhal.
Waiting periods for pre-existing conditions are also key. “Check the waiting periods for pre-existing heart conditions. Most plans have a three-year waiting period. However, some offer the option to reduce the waiting period to just 31 days,” says Singhal.
Careful review of the coverage offered by the policy is essential, as cardiac problems encompass a range of issues. “There can be non-invasive procedures, invasive procedures, stent placements, and open-heart bypass surgeries. Additionally, pay attention to the policy’s restrictions regarding room rent and total coverage,” says Mehta.
Finally, customers must buy health insurance at a younger age so that they are able to secure a comprehensive policy. “Waiting until a health condition develops can limit choices,” says Dodeja.
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