What to Look for in a Health Insurance Plan If You are Diabetic or Have Hypertension

Posted on: Jun 10, 2025 | 3 mins | Written by: HDFC ERGO Team

What to Look for in a Health Insurance Plan If You are Diabetic or Have Hypertension

Both diabetes and hypertension are long-term medical conditions. If left unmanaged, they can lead to severe complications such as kidney failure, heart disease and stroke. According to figures, over 100 million Indians are diabetic, and more than 300 million suffer from hypertension.

Given the high treatment costs associated with these illnesses, it is essential to choose a health insurance plan that provides adequate financial support.

How Pre-Existing Conditions are Viewed in Health Insurance

Insurance providers treat diabetes and hypertension as pre-existing conditions. This affects your:

• Premium: You may have to pay a higher premium.

• Waiting Period: Coverage for your condition might begin only after a specific time (typically 2-4 years).

• Coverage Limits: Certain insurers may cap how much they’ll pay towards treatment for these illnesses.

So, when you buy health insurance, reading the fine print becomes crucial.

Key Features to Look For in a Health Insurance Plan

When selecting a plan, here are the features you should prioritise:

1. Shorter Waiting Period

Most plans have a waiting period for pre-existing conditions. Opt for one with a shorter waiting period.

2. Coverage for Related Complications

Look for plans that cover complications arising from diabetes or hypertension, such as:

• Eye disorders (retinopathy)

• Kidney issues (nephropathy)

• Heart conditions

• Stroke

3. No Co-Payment Clause

Some plans require you to pay a percentage of the hospital bill. Try to pick a policy with no or minimal co-payment clauses.

4. Regular Health Check-Ups

Annual check-ups are crucial for chronic conditions. Choose a plan that offers free preventive health screenings.

5. Cashless Hospital Network

Make sure your insurer has a wide network of cashless hospitals. This saves time and effort during emergencies.

6. Domiciliary Hospitalisation

Some conditions may require treatment at home. Ensure your policy includes coverage for home treatment.

Important Documents Required

When applying for a health insurance plan with pre-existing conditions, be ready with:

• Medical history reports

• Diagnostic test results (blood sugar levels, ECG, etc.)

• Doctor’s certificate on your condition

These documents help insurers assess your risk profile.

What to Avoid in a Policy

Here are a few red flags:

• High Co-Payments: This increases your out-of-pocket expenses.

• Restricted Coverage: Some policies may only cover diabetes or hypertension, but not their complications. Check the policy’s terms and conditions.

• Limited Network Hospitals: This could be problematic in emergencies.

Tips to Reduce Premium Costs

Even with pre-existing conditions, you can manage your premiums by:

• Starting Early: The earlier you buy health insurance, the better the premium.

• Maintaining Healthy Lifestyle: Demonstrating control over your condition can help reduce premium costs.

• Using Installments: Opt for monthly or quarterly payments at 0% interest to ease your financial burden.

Understanding Riders and Add-Ons

Riders are optional benefits that you can add to your base policy. Some useful ones include:

• Critical Illness Rider: Covers life-threatening complications.

• Personal Accident Cover: Helpful in case of an accident.

• Hospital Cash Benefit: Pays a daily allowance during hospitalisation.

When Should You Review Your Policy?

Reassess your plan in the following scenarios:

• Worsening of your condition

• New diagnosis (like kidney damage)

• Family medical history updates

Regular reviews help ensure that your plan continues to meet your needs.

Conclusion

Living with diabetes or hypertension doesn’t mean you can’t find quality health insurance. Be thorough in your research, prioritise essential features and make informed decisions. Whether you are buying a new plan or switching to a more suitable one, make sure you know what you are signing up for.

To buy health insurance with chronic conditions like diabetes or hypertension, you need to evaluate more than just the premium.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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