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Does Cardiac Health Insurance Cover Pre-existing Diseases?

Nowadays, the general trend is towards people becoming more health conscious. While that fact is undisputed, it is also true that people tend to focus more on external fitness than the health of internal organs. Crash diets, fasting, excessive exercise are as bad for internal health as overeating and leading a sedentary life. With all these evils combined, our natural immunity and strength has deteriorated. 

Surprisingly, medical advancements have compensated for this decline and helped increase our average life expectancy. We cannot really do much about the rapid change in our lifestyles, although many of us are liberty to manage it better. With COVID-19, especially, our lives have been pretty much indoors for at least 80-90% of the time. This degree of inactivity can have disastrous consequences for the health of organs and organ systems like the heart, brain, stomach etc. But instead of being pessimistic about the situation, let’s look at some interesting techniques that can be used to mitigate the risk of ill-health. 

It is common knowledge that insurance is the best way to ensure that your health costs are taken care of. It is also a fact that your heart is the one organ that keeps you going, literally and metaphorically. Piecing these two together, we have a marvel called cardiac health insurance. Cardiac health insurance is exactly what it sounds like; Insurance for afflictions of the heart. With rising healthcare costs, having insurance for a critical illness like cardiac issues is a need of the hour. So, what does cardiac health insurance include and can you purchase cardiac health insurance if you have pre-existing cardiac disease? Read on to find out! 

What is cardiac health insurance?

Cardiac health insurance is a type of critical illness policy. Critical illness policies usually pay out a lump sum amount when the policyholder is diagnosed with an illness or chronic condition covered under the critical illness policy. Cardiac health insurances are designed to provide exclusive financial protection focused on cardiac diseases and procedures. A major bonus of having a cardiac health insurance policy as compared to a critical illness policy is that there are certain exclusions in the critical illness policy but a cardiac health insurance policy covers all heart related ailments and treatments, including (yes, you read it right) pre-existing diseases! 

Difference between a cardiac health insurance and a regular health insurance 

One of the prominent differences between cardiac health insurance and your regular health insurance plan is that critical illnesses including severe cardiac illnesses are usually excluded from the regular health insurance plan whereas in a cardiac health insurance plan, you get comprehensive coverage of all cardiac-related illnesses and procedures. With cardiac illness insurance, you do not have to be hospitalized to avail insurance benefits. Just a cardiac diagnosis is enough. 

Some cardiac plans also offer certain benefits on out-patient treatments, while with your regular health insurance plan, OPD visits are excluded under the policy most of the time. Cardiac health insurance plans may have a longer waiting period, depending upon the insurance provider. It also covers pre-hospitalization and post-hospitalization costs up to a certain limit. For example, your plan may cover 30 days pre-hospitalization and 60 days post-hospitalization costs. 

What can you expect from a cardiac health insurance plan? 

A cardiac health insurance has multiple benefits. Most cardiac health insurance plans are fixed benefit plans which means that you get a fixed benefit that is payable on diagnosis of any of the heart-related conditions covered under your cardiac insurance plan. The amount payable usually varies depending upon the severity of the condition. The categories of severity will be mentioned in your policy document, so make it a point to read the fine print.  

You can also have reimbursement-based cardiac insurance plans which are like regular health insurance plans which pay for your heart-related treatment costs. In such cases, you can avail cashless as well as reimbursement facilities depending upon what your personal preference. Like other health insurance plans, cardiac insurance plans also carry a no-claim bonus which is in the form of either an addition to your sum-assured (For example 10% increase in sum-assured for every year with no claim) or a discount in your premium (For example, you might get a 10% discount in the annual premium for every year with no claim). Normally, NCB is in the form of additional cover and not in the form of discount on premium.

Some plans also cover daycare procedures, Ayurveda and Unani treatments, but this varies amongst different insurance providers. You can have cardiac health insurance plans for yourself as well as your family.

How do you know that you need a cardiac health insurance plan?

Cardiac health insurance plans are cost-effective and convenient. For example, you can get a sum assured of Rs.20 lakhs by paying just Rs.7.80 per day with a term of 10 years. So, cost is usually not a barrier when it comes to securing your cardiac health. But should everyone buy a cardiac health add-on or a standalone cardiac health insurance plan? Probably not. Here are some risk factors that you should look at before you make your purchase. 

Your lifestyle:

Whether or not you should buy a cardiac health insurance plan is a personal decision and the first thing should look at while considering it is your lifestyle. If you lead a primarily sedentary lifestyle involving sitting at a desk for long hours with not much scope for physical exercise then you may be at risk for developing heart issues. 

In these changing times, it is too much to hope that you’ll suddenly lead a relatively relaxed and stress-free life. Moreover, stress and lack of exercise are two of the biggest contributing factors towards blockages in your heart. So, if your general lifestyle leans towards regular stress then you should consider investing in a cardiac health insurance plan. 

Family history:

If you have a family history of cardiac related illnesses, you are definitely in the risk zone of developing a cardiac ailment yourself. Diseases like hypertension are hereditary and can lead to more serious complications in the future. Having a family history of cardiac or other critical ailments makes purchasing cardiac health insurance a viable option for you. 


If you are above the age of 40 and are the sole breadwinner of your family with moderate to high levels of stress, you should definitely consider opting for a cardiac health insurance plan or a cardiac insurance add-on cover. This extra amount that you will spend on the premium will be worth it as it promises to safeguard your heart which is one of your most vital organs. 

You can choose to buy a cardiac health insurance plan even after you have been diagnosed with a cardiac ailment as cardiac health insurance plans cover pre-existing diseases. You might have to sit through a waiting period depending upon your specific health insurer, but the wait will be absolutely worth it in the long run!


Can I have coverage for other critical illnesses if I have a cardiac health insurance rider?

No, in a cardiac health insurance rider you will only get coverage for cardiac illnesses and related procedures. However, most critical illness insurance plans or add-ons come with a wider coverage of around 36 critical illnesses. If you want a wider healthcare coverage for other critical illnesses like strokes, first heart attacks, organ transplant, bone marrow transplant, multiple sclerosis, ALS, deafness, liver disease, major burns, muscular dystrophy, cancer etc. then you should buy a critical illness policy instead of a cardiac health insurance policy.

Does a cardiac health insurance plan have income tax benefits?

Yes, a cardiac health insurance plan has income tax benefits under Section 80D of the Income Tax Act, 1961. However, if you have a cardiac health insurance plan for your family then income tax benefits will be available only for the person who is paying the premiums. That is, only one individual can avail income tax benefits from paying premiums for a cardiac health insurance plan. A point to be noted is that income tax benefits are just auxiliary benefits in your insurance plan. The primary goal of a cardiac health insurance plan is comprehensive coverage for all cardiac issues and treatments, unlike regular health insurance or other critical illness plans.

Will I get my entire sum assured for any heart-related diagnosis under a cardiac health insurance plan?

Usually in cardiac health insurance, the amount reimbursed depends upon the diagnosis and the terms and conditions of your policy as laid out in the health insurance contract. If you have a mild condition then you might be eligible for 25% of the sum assured and if you are diagnosed with a severe condition then you might receive 100% of the sum assured. For example, some plans offer 100% sum assured on detection of severe conditions or serious procedures like open heart surgery, 50% sum assured on medium risk procedures like carotid artery surgery and 25% sum assured on low-risk conditions and procedures like angioplasty and fitting a pacemaker.

Cardiac health insurance plans also have multiple customizable benefits like income benefits, hospitalization benefits etc. The specifics of the benefits from your cardiac health insurance plan will be mentioned in the policy document and you can customize them by consulting your insurance provider at the time of purchase or during policy renewal. Reading the terms and conditions of the contract and familiarizing yourself with the fine print is of utmost importance.

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