From Stroke To Alzheimer’s: Getting The Right Health Cover For Neurological Ailments

• Neurological disorders like Alzheimer’s and Parkinson’s are rising in India

• Health policies cover hospitalization; OPD and rehab depend on policy terms

• Check exclusions, co-pays, and add-ons like OPD and home caregiving

• Opt for Rs 20 lakh base cover plus Rs 1 crore super top-up for full protection

A neurological disorder can vary from a simple condition like cerebral stroke to a much more complicated chronic disorder like alzheimer’s/parkinson’s disease. In fact, incidences of neurological disorders are increasing.

For example, in 2019, an estimated 3.8 million people in India were living with dementia. The figure is projected to rise to 11.4 million by 2050. Lifestyle changes, which include a poor diet, sedentary lifestyles, and increased use of alcohol, plus environmental conditions like high pollution, have led to the rise of neurological diseases. Also, with aging, such conditions become more prevalent among the population.

“If a policyholder is diagnosed with some neurological disorders post inception of policy, then they will get coverage for IPD costs,” says Sameer Samdani, director, Insurance Brokers Association of India (IBAI).

A few plans/policies do cover OPD, diagnostic, and rehabilitation costs, including pre- and post-hospitalization.

Be Careful Of Policy Terms And Conditions 

Neurological conditions are accepted by companies based on their specific underwriting guidelines; some companies may provide exclusion clauses like pre-existing disease (PED) exclusion or permanent exclusion, depending on the condition. Policyholders must check the policy terms and conditions for clauses like sub-limit, deductible, or co-pay. 

“While purchasing a health insurance policy, customers can check for add-ons like outpatient department (OPD) cover, rehabilitation care, home caregiving, and assisted living, etc., offered by various health insurance companies,” says Samdani.

To determine the right sum insured and add-on covers for lifelong protection against high rehabilitation and caregiving costs, it’s important to account for medical inflation, which typically rises at 12–15 per cent per year.

Have Adequate Sum Assured 

A treatment costing Rs 5 lakh today could cost Rs 20–25 lakh in the next 15 years. Hence, it’s prudent to opt for a base health cover of at least Rs 20 lakh, supplemented by a super top-up policy of Rs 1 crore or more.

“Super top-ups offer substantial additional protection at a relatively low premium, and the cover amount can be gradually increased over time to keep pace with rising medical costs and evolving healthcare needs,” says Samdani.

Policyholders can also opt for critical illness protection covers, which are generally on a benefit basis (a lump sum claim amount paid on diagnosis). These can provide a more comprehensive coverage of such disorders.