- Eligibility Criteria of Diabetes Plan
- Inclusions & Exclusions of Diabetes Insurance
- Best Health Insurance for Diabetics in India
Lives In: Delhi, NCR Expertise: Health & Term Insurance Simran has an experience of 4 years in content writing. She transitioned from hospitality and digital marketing to the insurance industry after her emerging interest in how vast insurance is. With her ability to write complex insurance concepts in a simple, relatable manner, she keeps her audience hooked and solves their doubts smoothly.
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Updated on Apr 08, 2025 4 min read
Health Insurance for Diabetics
You must have seen somebody around, who has suffered from diabetes and its dangerous consequences at once. Being in the category of a lifetime disease, diabetes is dominantly chronic and barely goes away if a person has got it once. Diabetes can be a threat to your life as it comes with various complexities related to your health, financial damage, and mental distress. In such scenarios, a health plan with coverage of diabetes can save you from all the worries of life.
This particular article covers in detail health insurance for sugar patients, the benefits of having diabetes insurance, and several other aspects of buying it in this era. Read further to know more about what health insurance for diabetics unfolds.
What is diabetes?
A diabetic condition arises when our body stops responding to the production of insulin or when our pancreas stops secreting the required insulin hormone. Due to this, the blood sugar level increases and causes our blood cells (bloodstreams) to neglect using glucose (a form of sugar) for energy generation inside our body.
Diabetes is caused when there is extreme glucose circulating in our body which increases our blood sugar level. Diabetes can be caused due to certain conditions of insulin resistance, autoimmune disease, imbalanced hormones, damage caused in the pancreas, or even genetic mutations/hereditary or neonatal conditions.
What are the types of Diabetes?
Below mentioned are the kinds of diabetes which are majorly categorised into three types:-
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Type 1 Diabetes
Type 1 diabetes is a condition where our body stops producing enough insulin and the patient needs to intake insulin supplements or injections to maintain the normal level of sugar. In this type of diabetes, our body's immune system attacks the cells of the pancreas which produces insulin. This kind of diabetes can be developed at any age including youngsters and children. -
Type 2 Diabetes
This kind of diabetes is caused due to an inappropriate lifestyle that triggers your immune system to not respond against insulin. The resistance to insulin-producing cells decreases inside our body. -
Gestational Diabetes
This diabetes type is developed inside a female's body while pregnant. In most cases, the symptomatic risk of gestational diabetes goes away post-pregnancy, but it can aid in developing a type 2 category of diabetes later in life.
Eligibility Criteria of Health Insurance Plans For Diabetics in India
Below mentioned prospects are the eligibility criteria for buying health insurance plans for diabetic patients:-
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Age
An individual between 18 to 65 years (for adults) and 19 days to 18 years (for children, under family floater health plans) of age, can apply for diabetic health insurance. -
Pre-existing diabetes disease
You must look after the coverage of the policy you're buying. Some of the policies may cover Type 1 or Type 2 diabetes or maybe both. You can buy a plan depending on your diabetes level and the need for treatment. The insurer will ask the diabetic policyholder to go through a medical examination for diabetic symptoms such as insulin resistance, drug dosage, level or type of diabetes, etc. If the applicant is going through a higher level of diabetes conditions or gets extremities during the policy year, the health insurance company will impose loading charges over the policy. -
Waiting period
You must check for the waiting period while buying a plan, as some plans may have a waiting period of 2-4 years. Whereas, some health plans may come with zero waiting period. -
Medical examination
A thorough medical examination helps the insurance company recognise any pre-existing medical condition a policyholder has possessed other than diabetes. -
Family medical history
If you have a family history of diabetes, it's more likely for you to pay a higher premium or there must be a criterion of an elongated waiting period in such cases.
Premium Calculation of Diabetics Health Insurance Plans
The premium for any health insurance policy, including a diabetes-specific policy, depends on various factors, and these calculations are approved by the IRDAI.
Some of the basic factors that are considered while calculating the insurance premium are:
- The age of the insured person
- The medical history of the individual and his family
- Pre-existing diseases
- The seriousness of diseases related to diabetes like type 1 or type 2 diabetes, usage and frequency of insulin injected, and dosage of medications related to diabetes.
A few other subsidiary factors are:
- Marketing expenses by the insurance company
- Policy underwriting
- Mortality rate
- Investments (in the case of ULIPS)
Why Should You Buy Diabetes Cover Health Insurance?
Health insurance for diabetics allows individuals to look after their healthcare needs and helps them tackle diabetes. With an effective specialized diabetes insurance plan, one can ensure to avail of the best possible treatment.
- Out-patient expenses will be covered, allowing you to visit with the top physicians without being concerned about the consultation expenses.
- A diabetes insurance plan covers the price of diagnostic costs, encouraging you to closely check your health status.
- Instead of stressing about hospital fees and costly medicines, you may concentrate on your recovery with your diabetic health insurance.
- Diabetes health insurance provides insurance holders with tax benefits under Section 80D of the Income Tax Act.
- Insurance holders are covered for other complications that arise due to diabetes.
- No requirement to go through a waiting period for diabetes coverage, unlike the majority of health insurance plans that cover diabetes after a certain waiting period (say, 2-4 years).
- Diabetes Health Insurance covers dialysis for diabetic patients which is a huge part of diabetes treatment.
What does a diabetes insurance plan cover
A comprehensive health insurance policy with coverage benefits for diabetes provides an extended cover for the policyholder. Let's have a look over the coverage benefits of diabetic health insurance:-
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AYUSH treatment
AYUSH Treatments (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) are covered under the health insurance for diabetes patients. -
In-patient treatment
Hospital admission for 24 hours or more for the treatment of diabetes-related issues depending on the severity is covered under the policy. -
Domiciliary hospitalisation
Those who are unable to receive diabetes-related treatment at the hospital due to some reasons, can avail of domiciliary treatment which means hospitalisation at home. -
Daycare treatment
The diabetic treatment that needs not more than 24 hours of hospitalisation such as small surgeries, or a medical procedure is covered under the plan. -
Ambulance services
For a situation of emergency, diabetes health insurance plans also cover the transporting expenses or ambulance services to provide the patient with a hassle-free hospitalization. -
Pre & post-hospitalisation expenses
This kind of health insurance for sugar patients allows them to get free treatment throughout. All the medical expenses incurred before and after getting admitted to the hospital would be borne by the insurer itself. -
Advanced diagnostics coverage
Medical treatment has become more convenient and time-saving with advanced technology. So, a health plan with diabetes coverage bears all such advanced diagnostic expenses. -
Portability benefit
The policyholder has the freedom to port their policy to another insurance company with similar policy features from the existing insurer. Insured can port their policy to another insurer only at the time of renewal and the policy can even be customised according to current coverage requirements. -
Dialysis coverage
Most of the patients with sugar condition who is suffering from a higher level of diabetes (say Type 2) needs to be treated with frequent dialysis. Hence, all the dialysis expenses are covered in the policy depending on your coverage amount and the specifications of the plan type. -
Alternate/regular health check-ups
Diabetes is a serious health illness that needs regular checkups. But spending hefty amounts for an annual or monthly checkup may be tough. In such cases, you need not worry about medical expenses or consultation fees, as your policy for sugar issues covers that all. -
No-claim bonus
If the policyholder does not raise a claim in the policy year, they are likely to get a no-claim bonus benefit over their policy renewal. -
No waiting period
Some insurance companies offer health plans for diabetes patients with zero waiting periods. However, the criteria of zero waiting period are only valid when a certain type of diabetes is covered under the policy or the diabetes insurance plan is standalone. -
Tax Benefits
The policyholder can also avail of tax benefits under Section 80 D of the Income Tax Act with a diabetic health plan.
Exclusions of Diabetes Health Plans
However, a health plan with diabetes coverage in India particularly provides all the accessibilities related to diabetes-related issues. But, depending on the type of policy and your insurance provider, a diabetes health plan may not have the below-mentioned coverage:-
Pre-existing diseases excluding diabetes
Any other medical condition than diabetes such as joint replacement surgery, arthritis, cancer, tuberculosis, osteoporosis, etc are not covered in a diabetes plan.
Self-inflicted injuries
Intentional self-inflicted injury that aggravates existing diabetes is not covered under the policy.
Prenatal and postnatal care
Any condition of pregnancy, either pre-natal or post-natal treatment would be excluded from the sugar treatment plans.
Voluntary hospitalisation
If the policyholder is unable to show a doctor's medical prescription for hospitalisation, insurance companies are entitled to reject the insurance claim for such voluntary hospital admission.
Sports/war injuries
Warships, deadly nuclear spots, adventurous activities, injuries that are caused by participating in professional sports like racing, scuba diving, aerial sports, or any other dangerous sports, etc that trigger diabetes are not covered.
Cosmetic or aesthetic treatments
Any beautification treatment, facial or body surgery is not covered under the diabetes plans. Apart from this, obesity or liposuction treatment is excluded from the diabetes health plan.
Features of Diabetes Health Insurance Plans
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Star Diabetes Safe Insurance Policy
The Star Diabetes Safe Insurance Policy specifically designed for individuals diagnosed with diabetes covers both type 1 and type 2 diabetes and complications arising from the illness. Other illnesses associated with diabetes are also covered under the plan.
Key Features
- The policy is designed for individuals and dependent family members.
- Star Diabetes Safe Insurance Policy offers flexible plan options.
- Automatic Sum restoration is offered under the plan.
- Personal Accident Cover.
- The policy premium can be paid in instalments.
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HDFC Energy Diabetes Policy
The HDFC Energy Diabetes Policy is Unique health insurance for diabetics with multiple attractive features such as an active wellness program, no waiting periods, reward bucket, sum insured restoration, and more.
Key Features
- Day Care treatments are covered under the HDFC energy plan.
- Up to INR 2k road ambulance is available for insurance holders under the HDFC Ergo Energy Plan.
- Organ Donor expenses are covered.
- Lifelong renewability.
- The wellness program offers insurance holders a personal health coach to manage their health.
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Care Freedom Plan
The Care Freedom Plan offers coverage against pre-existing diseases such as diabetes, high BMI, and hypertension. The plan offers a high range of sum insured up to INR 10 lakh and focuses on providing the best health care services to its customers.
Key Features
- The plan offers lifetime renewability to provide lifetime coverage benefits to its customers.
- The plan is available as an individual and family floater plan with the provision of covering a newborn baby for 90 days.
- Provides free annual health check-ups to help customers keep their health on track.
- The plan covers day Care Treatments.
- The plan offers dialysis coverage to the customer.
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Aditya Birla Activ Health Platinum Enhanced
The Aditya Birla Activ Health Platinum Enhanced plan covers modern treatment methods and a chronic management program that covers chronic illnesses such as diabetes, hypertension, high cholesterol, and asthma. Insurance holders can focus on the recovery and treatment of chronic illnesses.
Key Features
- Avail of Cashless Home Treatment.
- Chronic illnesses are covered from day 1.
- Access to expert health coaches for all customers.
- Coaching on nutrition, fitness, and medical consultation under the plan.
- Insurance holders can avail of the feature of doubling the sum insured in 2 claim-free years (max up to 1 cr).
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ICICI Health AdvantEdge
ICICI Health AdvantEdge plan is a customizable plan that offers multiple add-ons to its customers. It is a holistic plan designed to cater to every individual for their healthcare needs.
Key Features
- Pre and post-hospitalisation are covered under the plan.
- A wellness program is available for individuals to encourage everyone towards a healthier lifestyle.
- Domestic Air Ambulance coverage is available up to the sum insured to insurance holders.
- Lifelong renewability feature.
- Annual Health Check-up is available under the plan.
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Niva Bupa Reassure 2.0
The Niva Bupa Reassure 2.0 plan has three different variants namely, bronze, silver, and platinum. It is an individual and family floater plan providing coverage for diabetes and hypertension from day 1 as an additional disease management feature.
Key Features
- High-sum insured variants are available starting from 5 lac to 1 crore for efficient coverage for insurance holders.
- Unlimited e-consultations are offered under the plan.
- The plan offers personal accident benefits equal to 5 times the Base Sum Insured. Maximum up to INR 1 Crore.
- Niva Bupa Reassure 2.0 offers health check-up coverage from day 1 to its customers.
- Avail second medical opinion for any condition in one policy year.
How To Buy an Insurance Policy For Diabetes from PolicyX?
PolicyX.com is an insurance portal that has been designed to allow you to search, compare, and buy an insurance policy in an easy and hassle-free manner. The IRDAI has approved the portal and is one of the best platforms for selecting insurance policies that suit your financial and physical needs. If you need to buy an insurance policy for diabetes, the following steps will help you:
- Scroll down to the bottom of this page and click on 'Buy Now' or "Get a Quote".
- You will get a list of all the different insurance plans and insurance companies.
- Select the insurance plan that suits your needs and proceed with the instructions given.
- Fill in all the asked details like your name, contact number, age, etc.
- You will be then taken to the insurance company's portal, where you can make the payment using the available payment options. Once the payment is verified, the soft copy of your policy document will be mailed to you.
Claim Process for Diabetes Health Insurance
Below are the steps that you can follow to proceed with raising a claim against your health plan with diabetes coverage:-
Process for Cashless Claim
- Submit the duly filled claim form at the networking hospital facilitation. Ensure that you've already pre-authorized your hospitalisation
- Once your form is submitted and verified, you'll get approval from the authorities
- Once the documents are approved, you'll be able to avail your claim against the policy's terms and conditions.
Process for Reimbursement Claim
- Submit the duly filled claim form for reimbursement to your insurer
- Take your original policy documents, KYC documents, and other documents along with other requested documents from your insurance provider
- Submit the hospital/medical bills, doctor's consultation records, Prescription lists, and other documents asked to submit for verification
- Once all the documents are submitted for approval, the claim management authorities will enquire about further information
- If the claim is proven to be true, your claim will be accepted and settled.
Conclusion
Since the complexities of diabetes are so tricky to manage for an average individual. Therefore, health insurance plans for diabetic patients come to the rescue. The only way to stay fit and beat diabetic symptoms is with a healthy lifestyle. To maintain your health, you should intake nutritious food, do physical workouts, limit alcohol doses, maintain your sleep cycle, and manage mental stress. Similarly, if you've any possibility of getting diabetic any further in life, you should choose one of the best health insurance plans for diabetic patients. The best way to buy a diabetes health plan is to reach out to the experts at Policyx.com and get a quote for the best sugar health insurance plans available.
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Health Insurance for Diabetics: FAQs
1. Can I buy health insurance if I have diabetes?
Yes, anyone who wants to buy health insurance, can enjoy the coverage benefits of regular check-ups, treatments, diagnosis, etc out of the sum insured of their policy. In the case of diabetes, you should check what your policy covers related to diabetic treatment.
2. What could be the maximum sum insured in the case of diabetes health insurance?
Most insurance companies offer a sum insured of 5-10 lakhs under the health plan with diabetes coverage. Depending on the type of policy you prefer, the sum insured can go up to rupees 1 crore.
3. Is it compulsory to inform my insurer about my diabetes?
Definitely yes. To not get your health insurance claim rejected, you must inform your health insurance provider about any pre-existing illnesses or a disease including diabetes or anything else.
4. Does all health insurance cover diabetes?
Coverage for diabetes along with a base health plan depends on your policy type which can vary from one company to another. Some insurance companies provide additional coverage for diabetes with the standard health plan. Whereas some companies like Star Health Insurance offer standalone health plans for diabetic patients.
5. What is the government scheme for diabetes in India?
NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke) is the major government scheme for diabetic patients in India which focuses on development, research, early diagnosis and disease treatment, etc.
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Written By: Simran Nirala
Lives In: Delhi, NCR Expertise: Health & Term Insurance Simran has an experience of 4 years in content writing. She transitioned from hospitality and digital marketing to the insurance industry after her emerging interest in how vast insurance is. With her ability to write complex insurance concepts in a simple, relatable manner, she keeps her audience hooked and solves their doubts smoothly.
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