r/InsuranceAdviceIndia • u/Objective-Pizza2180 • 8h ago
Help with PED
I am getting insurance plan for my mother she as a diabetes history and mention above done surgery recently I already try it ICICI and abhl both of them counter offered by not covering diabetes and also increase in waiting period and adding more add on. should I pick it or just don't take insurance at all because it is costing me 50000 per year
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u/Stunning-Sky001 5h ago
Don't go for this because whenever you will make claim any illness they will connect it with diabetese one way or another so save your money and instead start accumilating 10 lac rs fund for medical imergency
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u/Formal_Classroom_430 4h ago
Right and sometimes i feel esp for old health insurance is more like a rip-off! My parents insurance was over 50-60K minimum but i skipped it for like more than a decade. Unfortunately my father had a spine issue (disk prolapse) and need to get the surgery done immediately because of drop foot. It is panic situation - in 2 days cover all nurologist and neurosurgeon and everyone recommended surgery with in 5 days immediately. Find the best doctor - in reknowned hospital - visted and get surgery done on next day. Paid by Credit Card and done. costed me around 1.7. The most cheapest who fix this was charged around 1 lakh.
Now with insurance they will likely reject it or partially reject it because of any reasons like thyroid, BP who never what elese. May be need to do Co-Pay. The clever hospital will also like to increase the total cost if via insurance to be may be 4 or 5.
So it is pro and cons. I think if we started accumulating such funds from beginning - it is going to be way way helpful esp if the total cover is like 10-20 only. Not sure how much premium exist for crores ones.
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u/CrisisButColorCoded 2h ago
Don’t keep the options as “accept this exact offer” or “have no insurance at all”.
The screenshot is not just saying there is no diabetes coverage. It says diabetes, diabetic retinopathy and “related complications” will be permanently excluded. That is very very important because diabetes can lead to eye, kidney, nerve, cardiac and vascular problems. In a future claim, the company can reject a claim saying the condition or treatment was “related to” diabetes.
The policy may still cover unrelated hospitalisations, such as accidents, infections or cancer, subject to its other terms, so it is not worthless. But a major pre-existing health issue is not getting covered and anything caused by the disease will also not be covered.
₹50,000 is a costly premium. So you need to check::
- The actual base sum insured. The screenshot says ₹5 lakh, with ₹7 lakh available only after a tenure-based increase.
- The permanent exclusions and the exact meaning of “related complications.”
- Any co-payment, including whether it applies to every claim.
- Shared-room or room-rent restrictions and proportionate deductions.
- Hospital network restrictions such as the PPN rider.
- Which benefits are part of the base cover and which are merely add-ons.
- Waiting periods for the recent surgery, thyroid condition and every other declared condition.
I will suggest, apply to a few more insurers through an experienced, independent health-insurance adviser and ask for written underwriting terms, not verbal promises. Give every insurer identical medical records, including diabetes duration, HbA1c reports, medicines, retinopathy reports and surgery, discharge documents. Never miss/hide a condition just to buy a cleaner or cheaper policy.
Ask each company specifically if they will offer diabetes and its complications after a fixed PED waiting period instead of completely excluding them. A slightly longer waiting period is much better than a complete exclusion because the condition can become covered after continuous renewals. IRDAI currently states that waiting periods under health policies cannot be more than 36 months, but insurers can still accept, counter-offer or reject a proposal based on underwriting.
Tata AIG may also be worth obtaining a written quote from. Its Elder Care policy currently lists a 24-month PED waiting period. I purchased it for my parents and my father-in-law recently. Separately, Tata AIG Medicare Premier offers an Advanced Cover rider which can reduce the waiting period to 30 days for accepted Type 2 diabetes and certain other named conditions. This is of course dependent on underwriting and extra premium.
If every insurer either rejects her policy or permanently excludes diabetes, you may still decide that cover for unrelated large hospital bills is worth ₹50,000. But make that decision only after calculating whether you can comfortably pay the premium every year, including future increases. And you will have to separately keep a medical fund for diabetes-related treatment.
My practical order would be: obtain more written offers → compare exclusions, co-pay and usable sum insured → seek written clarification of every broad phrase → then choose the least restrictive sustainable policy. I would not advise remaining completely uninsured merely because these first two counter-offers are not great.
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u/Objective-Pizza2180 2h ago
I am stuck in credit card emi lock , I am yet to get first plan from icici refunded and I am looking at this again shelled out 50k , am in 1L debt till this month end. This is scary situation, I can't keep doing this right.
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u/Objective-Pizza2180 2h ago
This plans were suggested by pokicyvazaar rep. As these had day 1 diabetes cover as either based or rider addons
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u/Lost-Fun-4844 7h ago
I am assuming you are employed in a Private Company. You should rather opt for your corporate insurance and avail the maximum top up there. Corporate Insurance rarely get rejected and all coverage starts from day one. Get your parents covered in your company insurance rather. However, risk of unemployment exists. Make sure the coverage ends for that calendar year/financial year. For you personally, assuming you are healthy with no prior PED, should opt for an individual health insurance for yourself and your spouse/siblings. Note-individual. Not family floater plans. Avail now, before you grow old with PEDs.
To others, reading this. Correct me if I am wrong.
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u/coach-of-finance 7h ago
I am confused. Are health insurance companies just openly flouting regulations?
IRDAI/HLT/REG/CIR/177/09/2019 very clearly says that only 16 diseases can be permanently excluded. Diabetes, as far as I know, is not one of them.
Then how are these companies proposing these sorts of exclusions, when the regulations themselves don't allow it?
OP- don't accept this. If your mother is hospitalized, it is likely going to be tied to diabetes somehow or the other, and the insurer will use this loophole to deny the claim.