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International Epilepsy Day is observed on the second Monday of February. In India, the annual incidence of epilepsy (new cases) ranges from approximately 20–50 to over 100 per 100,000 population. This totals to 10 million people living with the condition. The prevalence is roughly 5.59 per 1,000.
Here, we take a look at how epilepsy is covered in health insurance.
Waiting Periods And Disclosures
Epilepsy, a neurological disorder, is treated as a pre-existing disease under a health plan. “Based on the underwriting guidelines of the chosen plan, the insurer may offer comprehensive coverage, apply a waiting period, or impose a specific exclusion for epilepsy. Thus, it is advisable to always disclose epilepsy while buying a plan to avoid claim issues later,” says Siddharth Singhal, business head, health insurance, Policybazaar.com.
Thus, most standard typesof health insurance will cover hospitalisation and treatment if provided for in the plan, but will usually begin at the end of a waiting period associated with the pre-existing condition, which tends to be between a range of two and four years from when the policy was taken out. “There are exceptions where, if an individual is diagnosed with the condition after taking out a policy (i.e., post-purchase diagnosis), the condition will be treated like any other medical condition (i.e., post-purchase diagnosis) with respect to standard waiting periods and policy limitations,” says Arun Ramamurthy, co-founder, Staywell.Health.
If epilepsy is declared as a pre-existing disease (PED), then expenses during the waiting period wouldn’t be covered. “Additionally, if the policyholder has not added an OPD cover to their base health insurance policy, then OPD-related expenses to epilepsy, like neurologist consultations, diagnostics, pharmacy, MRI, etc., will not be covered,” says Singhal.
Choose Adequate Sum Insured
“When purchasing a policy, it is essential that you disclose your full medical and psychiatric history, as a common reason for denial of claims is failing to disclose epilepsy, as well as any other past/current health situation,” says Ramamurthy.
The sum insured should be enough to provide adequate coverage for medical emergencies resulting from seizures or hospitalization in intensive care because these types of medical care are typically costly. A sum insured between Rs 10 to Rs 20 lakh is recommended.
When transferring to a new insurance company from another insurance company, find out if the new insurance company has any waiting periods and/or continuity benefits.
“It is preferable that you select "cashless" hospitals that have neurology departments so that you will have minimal out-of-pocket expenses during an emergency. It is important that you maintain accurate medical records and prescriptions because the insurance company may need specific documentation to support the claim for pre-existing conditions,” says Ramamurthy.
