I’m a 50-year-old marketing executive; I purchased a ₹10-lakh health insurance policy 10 years ago. Recently, I’ve been diagnosed with hypertension and require daily medication. Will my policy cover the costs of these medications, or are they considered part of a pre-existing condition since hypertension often develops gradually? If it’s viewed as a pre-existing condition, how long will I have to wait before related expenses are covered? Also, will future complications arising from hypertension, such as cardiac issues, be covered under my policy?

Sunita

Navigating health challenges is a reality many individuals face, and having comprehensive health insurance is essential for safeguarding your well-being. It is recommended to maintain health insurance coverage of two-three times your income, so based on that you might want to reassess the ₹10-lakh health insurance policy, purchased 10 years ago. This coverage becomes especially critical as health needs typically evolve with age.

Regarding your recent diagnosis of hypertension, you can be confident that all hospitalisation expenses related to this condition will be covered under your policy. Since hypertension often develops gradually, it’s important to clarify that because your diagnosis occurred after the policy was issued, it will not be classified as a pre-existing condition in your case. This means you do not have to wait for coverage for future hospitalisations related to hypertension.

Moreover, your policy includes provisions for pre-hospitalisation and post-hospitalisation expenses. This means that any necessary medications and consultations related to your hypertension — both before and after hospitalisation — are covered. Specifically, expenses incurred up to a defined number of days prior to your admission, as well as costs for a certain duration after discharge, will be reimbursed according to your policy terms. This can include diagnostic tests, consultations with your healthcare provider and prescribed medications, all within the policy limits.

Key riders

It would be advisable to opt for an Outpatient Department (OPD) cover so that your coverage will be even more comprehensive. OPD benefits allow you to claim expenses for consultations, diagnostic tests and medications without requiring hospitalisation. This feature is particularly advantageous for managing chronic conditions like hypertension, which often necessitate ongoing medical care and regular medication. If you have chosen an OPD cover, routine doctor visits and prescription medications will also be covered, subject to the terms of that rider.

Any complications arising from hypertension, such as cardiac conditions, will also be covered under your policy. This comprehensive approach ensures you are protected from the financial burden of medical expenses associated with serious health complications related to hypertension.

According to WHO, one in five adults have hypertension. Effectively managing hypertension, however, is crucial for maintaining overall health and reducing the risk of serious complications, such as heart disease, stroke, and kidney problems, enhancing your overall well-being. A few insurers offer wellness programmes specifically designed to help manage chronic conditions like hypertension. These programmes can provide valuable resources and strategies to empower you to take control of your health. Choosing an insurer that has a long track record of settling claims and also invests in providing you with wellness initiatives can be an important step in proactively managing your condition while ensuring you remain covered for any future medical events.

The writer is MD and CEO, Star Health and Allied Insurance

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