Diabetes can prove to be quite expensive. Glucometers, medications, insulin shots, and the risk of diabetes-triggered health complications...... Opting for the right kind of insurance can keep you hassle-free, but knowledge is key.
After spoke to an insurance professional, here are some Questions and relevant Answers which can help an insurance user to find the right facts.
Q.What are the IRDA (Insurance Regulatory Development Agency) guideline for medical insurance for diabetic people?
A.There are no specific guideline for diabetic people. There are general guidelines for medical insurance and diabetes comes under that like any other disease.
Q.Is daily medication, which is very important in diabetes and goes on for years, covered under insurance?
A.No, day to day medication and regular tests are not covered. Testing devices such as glucometers are also not covered. To get insurance benefits, a person has to get admitted for at least 24 hours.
Q.Then why should a diabetic person take medical insurance,knowing that most of his expenses will not be covered?
A.While it is true that you normally don't get admitted to hospital due to diabetes, there are other complications which may arise due to diabetes and need to be treated in the hospital. In that case medical insurance helps.
Q.What are the compensation structures and processes?
A.Again there is nothing specific for diabetes. There are two ways of getting claim under medical insurance. One is to pay all the expenses at the time of treatment and then get them reimbursed from the insurance company according to your policy. The other option is to use cashless cards issued under the Preferred Provider Petwork (PPN). Here all a person needs to do is to provide his cashless card to the hospital which is under PPN. Then the insurance company regarding the payments. You don't need to pay anything in cash.
Q.Tell us more about cashless treatment and PPN?
A.A card issued after taking a policy from a Third party Administrator. the card contains all the required details about you and the policy you have taken and it can be used anywhere in India with hospitals who are registered under PPN. It applies when a person gets admitted to a hospital for a minimum period of 24 hours for the treatment of a disease which comes under the policy insurance you have taken. It covers the cost of hospitalization and other charges and cost of tests and medicines 30 days prior and 60 days after admission to the hospital for treatment. This hospitalization for minimum 24 hours clause applies to both cashless and pay-now-get-reimbursed-later cases.
Q.What are the problems with cashless facilities?
A.IRDA has prescribed a room cap for policies. It says that if a person has taken a policy of say 5 lakhs then charges for room in hospital which he can take for treatment should exceed Rs 5000/- day. This was done to control the exorbitant money some hospitals were charging once they came to know that the patient is under medical insurance.
But now, some of the leading high-end hospitals have withdrawn from the PPN facility, arguing that they cannot lower their charges and thus their quality of treatment, considering the room cap.
Q.How much time does it normally take for a person to get reimbursed?
A.After the documents are submitted to the insurance company it normally takes 1-1.5 months. Sometimes though not often, the insurance company might investigate a claim if the document provided is not sufficient or during filling the form for taking a policy the policyholder intentionally did not reveal the fats.
Q.Your views on Mediclaim facilities provided by companies for their employees?
A.Its a good thing. It covers pre-existing disease from which an employee may be suffering, including diabetes. Also regular medical expenses can be reimbursed like tests and medicines.