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  • Writer's pictureNiharika Joshi

Finding Comprehensive Coverage for Individuals with Heart Disease

One thing that many of us realise when searching for a comprehensive health insurance plan is that there are not many that include all our medical needs. Some just cover the basic expenses that we can pay and the others provide half benefits which still makes us pay out-of-pocket.. The most surprising part is that there is not enough health insurance in the market that covers preexisting conditions. 

It seems like there is no comprehensive coverage for Individuals with pre-existing diseases, these days, isn’t it?

Every year, on September 29, we mark "World Heart Day," highlighting the importance of cardiovascular health. Cardiovascular diseases (CVDs) are capable of throwing everything into a mess with heart attacks, strokes, and heart failures. This is especially true if you have a family history of heart disease because it can be genetic.

So, why is it so challenging to find a plan that truly delivers when it comes to heart disease? And are there enough options that prioritize our hearts and are not heavy on the pocket? And what are the things that we must be aware of before buying a life insurance that covers heart disease? Let’s get some verified answers to these questions.

Health Insurance for Heart Patients in India

Heart disease in general is caused due to multiple factors, genetics being one of them and some others being disorders related to the heart and blood vessels, raised blood pressure levels, cholesterol levels, and other underlying causes.


The current statistics on heart disease in India are overwhelming, to say the least. 

Heart disease is responsible for almost 25% of yearly deaths in India (1) and accounted for 20.5 million deaths in 2021 (2)

Why is it important for heart patients to have health insurance?

One of the startling revelations that come with health insurance for individuals with heart disease is the mortality rate. 

Do you know that the chances of a person surviving a heart disease are higher if he/she has health insurance

A study done on this aspect shows that private health coverage is associated with lower all-cause mortality. Private insurance is related to about a 17% lower risk of total mortality (4). 

Now, that we have established the fact that we do need comprehensive coverage that covers heart diseases, we come to the next part. What should you look for in health insurance for heart patients? Let’s dive in.

What things should you keep in mind before choosing health insurance for heart patients?

Before buying health insurance that covers heart disease, you need to ask the following questions to your insurer.

Are heart surgeries and treatments covered by the insurance?

  • An insurance that claims to cover heart diseases must give you comprehensive coverage MUST cover heart treatments, surgeries, and OPD expenses. 

  • Prefer health insurance from insurers who cover pre-existing heart conditions for less hassles during emergencies.

Which are the network hospitals of your insurer?

  • You have to make sure that the best hospitals diagnostic centers and heart specialists are part of the network of your insurer.

  • If not, see if your doctor can be included in a network like Kenko Health which gives you the flexibility to add your family doctors to Kenko and get your doctor listed within 24 hours.

What is the waiting period and cool-off period?

  • Have a proper talk to your insurer about the waiting time. Enquire about the required waiting time from the start of your policy, to be able to use the benefits of the insurance.

  • Some health insurers have a cool-off period for patients who have just recovered from heart-related diseases.

  • This is the period after recovery during which a person cannot buy health insurance.

What is the waiting period for pre-existing heart diseases?

  • This is the first question you should ask your insurer because the waiting period for pre-existing conditions changes from insurer to insurer. It’s better to get a heads-up on this to decide if you should go ahead with the insurer.

What is the Sum assured and premium to be paid? 

  • Be particularly mindful of the sum assured- i.e. the amount the insurance company pays to the policyholder in the case of unpredictable events. 

  • Buy health insurance that is reasonably priced and gives you additional benefits in the premium charges.

  • Opt for a comprehensive plan that covers all expenses including small OPD expenses and large surgery charges.

Are there any out-of-pocket expenses? 

  • Remember to verify if there are any other payments that you might need to make that are excluded from the policy

  • Some insurers need policyholders to pay a certain amount during a claim.

Does your insurer provide some additional benefits? 

  • Not every insurer provides pre-hospitalization coverage such as diagnostic reports, lab charges, ambulance coverage, and coverage for post-hospitalization expenses.

  • Some insurers, like Kenko Health,  with its everyday plans cover all needs without hospitalization and provide additional benefits in the form of annual benefits and healthcare products from its SOHO store.

Why should you purchase health insurance that covers heart disease?

There are certain visible limitations of standard health insurance that cannot be overlooked.

There are some undeniable gaps in typical health insurance plans and it is imperative to proactively seek a more comprehensive coverage.

  • Most regular health insurance companies offer basic health coverage.

  • These basic insurances don’t cover pre-existing diseases or major surgeries related to the heart.

  • Some insurers that do vouch for pre-existing disease coverage don’t reveal the finer print and leave you in times of emergencies.

  • Comprehensive insurance that covers your heart saves you from sudden financial vulnerabilities.

What should comprehensive coverage for individuals with heart disease certainly cover?

Hospitalisation Expenses: When we say hospitalisation costs, it include but is not limited to surgeries, medical procedures, and stays in the ICU or other cardiac care units.

Diagnostic Tests: A heart patient needs to go through multiple tests, such as angiograms, echocardiograms, and stress tests, and they must be part of the cover.

Medication Costs: Individuals who suffer from heart disease are prescribed various preventive medicines that curb other critical diseases every month. A good health insurance plan should include cashless medical bills.

Post-Hospitalization Care: In certain cases, a surgical procedure may become necessary that requires follow-up treatments, and ongoing monitoring after a hospital stay, hence care should be taken to ensure that it is part of the cover.

Critical Illness Coverage: If the individual gets a heart attack, stroke, or other severe cardiac events, he/she may go through a lot of financial crisis, hence critical illness coverage is a must.

Specialized Feature: OPD Health Insurance: If there is one area that the insurance companies are still to work on it is the OPD charges. They are a big chunk of lifelong medical expenses for heart patients and have the potential to burn the biggest hole in the pocket.

Heart disease is not limited to surgeries, it requires regular doctor visits, medicines, and diagnostic tests. Kenko health insurance with OPD revolutionizes this space with health insurance with OPD plans.

Finding comprehensive coverage for individuals with heart disease is easy if individuals start making informed health insurance decisions. This will not only avoid financial burdens but also ensure that your heart remains healthy and stress-free.

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