Energy is a regular health insurance policy: it pays hospital bills and other insured expenses such as pre- and post-hospitalization expenses for a certain number of days. However, it differs from a regular health insurance plan in two aspects. First, it’s meant for people who already have diabetes. Second, it covers this pre-existing ailment right from the time the policy is issued. So if you are suffering from pre-diabetes and type-2 diabetes (type-1 diabetes is not included), this policy will cover you. The insurer, however, will insist on a medical check-up to assess your health. “Each individual will have to undergo a medical test on the basis of which the cover would be offered. We will bear the entire cost on cashless basis. Individuals who have had major complications from diabetes or who have been dependent on insulin for a long time will not be covered,” says Antony Jacob, chief executive officer and managing director, Apollo Munich Health Insurance. The policy also covers policyholders who suffer from hypertension. The policy covers hospitalization expenses arising out of diabetes and hypertension immediately. Even for other cases of hospitalization there isn’t the typical initial waiting period of 30 days. But for certain specified diseases there is a waiting period, even pre-existing diseases have an initial waiting period of three years.
What also sets this policy apart is its reward programme that encourages policyholders to keep the medical conditions under control. The policy has two variants: silver and gold plan. The superior gold version offers to reimburse the cost of two medical check-ups to assess the status of your diabetes and hypertension. “Ordinarily, these tests would cost Rs.5,500-6,500,” adds Jacob. Depending upon these wellness tests results, a wellness score is calculated and the policyholder gets monetary benefits in the form of discounts on premiums and cashbacks that can be reimbursed for other medical expenses, such as consultation, medicines, and dental expenses. The discounts can go up to 25% every year in renewal premium and along with this a further cashback of up to 25% is available. The wellness tests, however, have to be undertaken at one of the network hospitals if you want the cost to be reimbursed. For tests done at a non-network hospital, only Rs.2,000 is reimbursed. Silver plan customers will have to be bear the costs on their own, and the tests have to be conducted at approved centres. Without the tests, one cannot use the reward programme.
“This policy not only insures individuals with pre-existing ailments but also encourages them to manage their health. This is a welcome direction, but right now this being the only (such) policy, the premiums are very high,” says Deepak Mendiratta, managing director, HII Insurance Broking Services Pvt Ltd. The policy offers a health insurance cover or sum insured ranging from Rs.2 lakh to Rs.10 lakh. A 35-year-old will have to pay a premium of Rs.18,559 (gold plan) or Rs.13,853 (silver plan) for a sum insured of Rs.5 lakh.
A comparative regular health insurance plan would cost around Rs.5,000. Energy offers to lower the premium if you are willing to pay a portion of the claim amount. So on a co-payment of 20%, the premiums under the gold plan and silver plan would come down to Rs.15,827 and Rs.11,121; still quite high. “Energy is the first comprehensive plan for diabetics. It’s good but expensive. The good news is that this is the onset of disease specific health insurance plans and more such plans will line up soon. Market competition will then force the premiums down,” says Kapil Mehta, principal office and managing director, SecureNow Insurance Brokers Pvt Ltd.
What should you do?
Given the premiums, we suggest you don’t jump into this plan right away. Give other health insurance plans a try. It’s not as if you will be completely denied a cover under other health insurance policies. “Individuals with diabetes are covered even under a regular health insurance policy. And if their diabetes is under control, insurers don’t even load the premiums. They would, however, have to wait out the initial period during which pre-existing ailments are not covered,” says Sreeraj Deshpande, head-health insurance, Future Generali India Insurance Co. Ltd.
So, declare your health condition. “Fill out the proposal form honestly and declare all pre-existing conditions. There is a good chance the insurer will cover you. And if you can manage your health, then a waiting period of up to four years should not be a problem,” says Mendiratta.
If the Apollo Munich Energy policy looks attractive to you, you could buy it and switch later—thanks to portability—if you are are dissatisfied with it. “Portability lets you port the number of years you have covered under various waiting periods in a policy. So, if a cheaper version of this plan comes by or you are able to get health insurance at a cheaper premium you can always port at a later date,” says Mehta.
Given the premiums in this plan, there is merit in trying out regular health insurance first. Overall, however, it is good to see insurers turning focus on disease specific plans. This space is likely to see more action, and we will surely keep you updated.