Autoimmune Diseases Covered under Health Insurance Plans In India

Does Your Health Insurance Policy Allow Coverage Against Autoimmune Diseases?

Yes, the recent changes in some of the insurance policy regulations done by IRDAI in 2019 regarding ‘pre-existing diseases’ made coverage for autoimmune diseases possible.  So, now we have health insurance policies in India that cover autoimmune diseases.

In fact, many insurers are offering health plans with coverage for autoimmune disease. The coverage and features of such a plan varies depending on the insurance company. And depending on the type of coverage, the waiting period for such diseases might vary from a month to three months duration.

However, in general there are two different ways in which an insurer can provide autoimmune disease health cover –

• Disease-specific health insurance for autoimmune diseases
• Coverage under critical illness benefits

Disease-Specific Health Insurance Plans –  These are customized plans dedicated specially to particular diseases. For example, special and best health insurance plans are there for Type 1 diabetes, which is an autoimmune disease and is covered under a particular plan.

Critical Illness Cover – There are some insurers who provide health policies for critical illness and cover most autoimmune diseases under such plans. For example, your medical insurance provides benefits such as hospital charges, ambulance charges etc. under critical illness cover.

Autoimmune Diseases that are Covered Under Insurance

Below are some common autoimmune diseases mostly covered by insurers. However, it mainly depends on a particular insurance company as to how many autoimmune diseases are covered by them:

Some of the common autoimmune diseases are Type 1 Diabetes, Multiple Sclerosis, Pernicious Anemia, Addison’s Disease, Rheumatoid Arthritis (RA), Systemic Lupus Erythematosus (SLE), Psoriatic/Psoriasis-Arthritis, Autoimmune Vasculitis, Inflammatory Bowel Disease, Sarcoidosis, Celiac Disease, Sjogren’s Syndrome etc.

Health Insurance Benefits Received for Autoimmune Diseases

Though it depends on the insurance company regarding the coverage and features offered for autoimmune diseases. However, most health insurance plans allow Rs. 1 lakh to Rs.1 crore or more coverage for autoimmune diseases. And as per the particular sum insured, the benefits and features also change.

Below are some of the features included under a health insurance plans offering coverage for autoimmune diseases:

• Cover against hospitalization charges
• Cover against OPD or outpatient treatment expenses
• Cover against charges for various tests
• Coverage for Day-care facility charges
• Ambulance charges etc.

Waiting Period for Raising Claims for Autoimmune Diseases

Like in many other diseases, for autoimmune diseases also Health insurance policies have a waiting period. It varies from a period of one month from the date of policy initiation to over three months or 90 days in case of health insurance for critical illness cover.

During the time of waiting period, the insured cannot raise a health insurance claim against autoimmune diseases. So,  one has to wait for the waiting period to end before making claims for autoimmune diseases.