Health Insurance Policies Which Cover Obesity

Obesity is a condition characterized by an increase in the size and amount of fat in the body. The World Health Organization has recognized obesity as a disease and also by several other multinational organizations. According to WHO, obesity is a major risk factor for noncommunicable diseases such as heart disease, stroke, type 2 diabetes, certain cancers etc. The prevalence of obesity in India varies due to age, gender, geographical environment, socio-economic status, etc. According to ICMR-INDIAB study 2015, prevalence rate of obesity and central obesity varies from 11.8% to 31.3% and 16.9%-36.3% respectively.

Bariatric surgery is the surgery conducted by the medical practitioners on high cholesterol patients to remove the unwanted fat. This surgery happens in two scenarios: when a person wants to lose weight or in case of a life threatening situation. This surgery is also known as weight reduction surgery where the weight of a person would be removed by removing the excess fat. The excess fat can be reduced by regular exercise and diet but in certain cases the fat would not reduce naturally and requires medical procedures.

Bariatric surgery is very costly and ranges between Rs.2 lakhs to Rs.4 lakhs. The affordability of the patient as well as the reputation of the hospital has to be taken into consideration before proceeding for the medical procedure. Bariatric surgery is considered as the cosmetic surgery and is therefore not covered by the health insurance policies where the cost of cosmetic surgeries is excluded. As per the latest guidelines from Insurance regulatory and development authority, bariatric or weight loss surgery will be included under the health insurance policies with effect from 1st October 2019.

Aditya Birla – Active health insurance plan:

• Eligibility: Minimum age at entry- 18 years and no maximum age for entry.
• Family definition: Family means Self, Spouse, dependent children (up to 3)
• Renewability: The renewability under the policy is lifelong. The policy can be renewed under the then prevailing health insurance product or its nearest substitute approved by IRDAI.           
• Policy term: The policy can be taken for a period of 1 year and the sum insured and other benefits will be applicable on a policy year basis.
• Sum Insured: The minimum sum insured is Rs.2 lakhs and the maximum sum insured is Rs.2 Crores
• Outpatient medical expenses: Rs.1000 available for sum insured above Rs.15 Lakhs.
• Health checkup: Available once in a policy year.
• Emergency Ambulance: Covered up to actual expenses per event in case of network providers and up to Rs.5000 per event in case of non network providers on reimbursement basis.
• Pre Hospitalization: 60 days before the date of hospitalization.
• Post hospitalization: 180 days after the hospitalization
• Day care procedures: Covered up to sum insured
• Domiciliary treatments: Covered up to sum insured
• Pre existing waiting period: 36 months
• Specific disease waiting period: 24 months
• Initial waiting period:  30 days
• Co-payment for treatment in higher zone: Up to 25% co-payment applicable if the policy is taken in Zone 2 or 3 and claim is made in Zone 1. If the premium is paid in the lower zone and claim is made in the higher zone, then the co-payment would be applicable.
• Recovery Benefit: 1% of the sum insured up to a maximum of Rs.10,000 in case of consecutive 10 days of hospitalization due to an accident.
• Cumulative Bonus: 50% increase in annual inpatient benefit sum insured for every claim free year subject to a maximum of 100%.
• Dental Consultation & Investigation: Available for sum insured of Rs.15 lakhs and above.
• Premium waiver: 1 policy year premium waiver in case of detection of listed illness for adults 18 years and above.
• Mental illness hospitalization: Covered up to sum insured
• Chronic Management Program: Day 1 cover for chronic illnesses like asthma, high blood pressure, high cholesterol and diabetes.
• Bariatric Surgery: Essential in bariatric and varicose vein surgery and may be considered for at least these conditions where surgery itself is payable. The cost of bariatric surgery is paid if it is life threatening.  
• Automatic upgrade at no extra cost: Insured can upgrade to the chronic management program automatically if he/she develops a chronic condition after buying the policy.
• Obesity treatment: The treatment for obesity is covered up to the sum insured mentioned under the policy.
• Preventive Health care: It is a plan that provides coverage for the care that needs to be taken to prevent the onset of diseases. For obesity, counseling would be offered to the insured members.

United India- Individual health insurance plan:

• Eligibility: Minimum age at entry- 18 years and maximum age – 65 years.
• Policy term: The policy can be taken for a period of 1 year and the sum insured and other benefits will be applicable on a policy year basis.
• Sum Insured: The minimum sum insured is Rs.2 lakhs and the maximum sum insured is Rs.20 lakhs
• Room & ICU Charges: 1% of sum insured and 2% of the sum insured
• Emergency Ambulance: Covered up to Rs.2500 per person per policy period
• Pre Hospitalization: 30 days before the date of hospitalization.
• Post hospitalization: 60 days after the hospitalization
• Domiciliary treatments: Covered up to the limits as mentioned in the policy copy
• Organ Donor’s medical expenses: Covered
• Organ Transplant: Hospitalization Expenses (excluding cost of organ ) incurred for/by a Donor within the Sum Insured of the Insured Person
• Health checkup: Every three claim free years up to 1% of average SI per insured person subject to a maximum of Rs. 5000.
• Hospital daily cash allowance: Rs.250/500 per day, Maximum Rs. 2500/5000 per person per policy period
• Ayurvedic treatment: Covered up to the sum insured.
• Pre-existing waiting period: 48 months. However, this exclusion will not be applicable for the ‘Platinum’ Plan.
• Specific disease waiting period: 24 months. However, this exclusion will not be applicable for the ‘Platinum’ Plan.
• Initial waiting period:  30 days
• Bariatric Surgery: Essential in bariatric and varicose vein surgery and may be considered for at least these conditions where surgery itself is payable. The cost of bariatric surgery is paid if it is life threatening.