Photo: iStock
Photo: iStock

Difficult to get health insurance cover for Type 1 diabetes

Type 2 and gestational diabetes are routinely covered. Type 1 diabetes, that is insulin-dependent, is much more difficult to insure

I bought my health plan 5 years ago, and have not made any claim. I have been suffering from diabetes for 2 years. Can I port to another insurer?

—Chandan Tripathi

You can port your plan to another insurer. A few insurers would be consider a diabetes case, provided the ailment is managed well. Check with an advisor about the underwriting outlook of various insurers. It will help you manage portability effectively and avoid rejection. Make sure you have clear acceptance from the new insurer before you lapse your original health insurance. Type 2 and gestational diabetes are routinely covered. Type 1 diabetes, that is insulin-dependent, is much more difficult to insure.

If I have a health insurance plan from one insurer, do I have to buy a top-up from the same insurer? Are top-ups cashless?

—Raghav Ganguly

No, you are not required to buy a top-up plan from the insurer of your base health insurance plan. With the same insurer, it may make sense to buy a larger sum assured in the base plan itself. The choice of insurer for your top-up insurance should be made independent of your base plan.

Top-up plans offer cashless facility. If your medical expenses exceed the deductible amount, then you can apply for cashless settlement in a top-up plan. You will need to provide evidence of the medical costs already incurred. This could be in the form of actual hospital bills paid or details of insurance settlement done within your base policy. It is difficult to combine two cashless claims for a single hospitalisation bill. This is because the top-up insurance will require a copy of the claim settlement letter for the base insurance. This sequencing makes it administratively difficult for two insurers to offer cashless claims for the same hospitalisation. In such cases, you should opt for a reimbursement claim in your top-up plan.

I have a medical insurance policy of 5 lakh in which co-payment is 10%. If my admissible claim amount is 6 lakh, how much will I receive?


In a standard case, insurers apply co-pay on the total claim amount and then check sum assured limits. This means that in your case, you will get the full sum assured of 5 lakh. Some insurers apply co-pay after checking for sum assured limits. In such a scenario, your claim payable amount will be 4.5 lakh. The specific approach for your insurance should be in the policy wordings. If the contract is silent on this, then you should push for the first method where the co-pay is applied on the total claim amount.

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Abhishek Bondia is principal officer and managing director,

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