What is High Cholesterol?
High cholesterol, or hypercholesterolemia, occurs when there is an increase in fats in the blood. While cholesterol is necessary for creating healthy cells and hormones, excessive amounts can cause problems. Too much cholesterol can accumulate on artery walls as plaque, causing atherosclerosis, which narrows blood vessels and restricts blood flow. This significantly increases the risk of heart disease, heart attack, and stroke.
Does Health Insurance Cover High Cholesterol?
Health insurance usually covers high cholesterol (hyperlipidemia) along with related conditions like heart disease, stroke, and hypertension. This includes diagnostic tests, treatments, and hospitalisations, depending on specific policy terms and waiting periods.
- Coverage Scope: Includes lipid profile testing, consultations with specialists, and prescribed medications.
- Hospitalisation & Treatment: Covers inpatient care, pre-hospitalisation, and expenses due to post-hospitalisation complications.
- Waiting Period: A waiting period of up to 36 months may apply to related treatments if the condition was diagnosed or treated before the policy was purchased.
- Premium Impact: Premiums could be increased depending on your medical history and the underwriting evaluation.
- Specialised Plans: Certain plans include Day 1 coverage via specialised add-ons, reduced waiting times, and benefits for chronic disease management and wellness programs.
Important Note: Always disclose your cholesterol levels when applying to prevent claim rejection.
Cost of Treating Cholesterol-related Complications in India
Managing cholesterol-related issues in India, particularly cardiovascular diseases (CVDs), can be financially burdensome. Hospital costs for heart conditions typically range from ₹3 lakh to ₹5 lakh. The total expense for a cardiovascular event—covering hospitalisation, procedures, and diagnostics—averages about ₹2.47 lakh per patient.
Estimated Treatment Costs for Major Complications
The cost of treating severe cholesterol-related conditions varies widely by procedure, hospital, and location.
- Heart Bypass Surgery: ₹2,00,000 – ₹3,38,900 lakh
- Coronary Angioplasty: ₹1,72,300 – ₹2,34,900 Lakh
- Heart Transplant: ₹18 lakh – ₹29 lakh
- Liver Transplant (due to complications): ₹10 lakh – ₹20 lakh
- Dialysis (renal complications): ₹18,000 – ₹20,000 per session
- Xanthelasma Removal (cholesterol deposits): ₹5,000 – ₹35,000
Important Note: Treatment costs for cholesterol-related complications vary by hospitalisation, medications, and tests, with private hospitals typically being more expensive. Expenses also vary by city and severity.
Benefits of Buying Health Insurance for Individuals with High Cholesterol
Health insurance for high cholesterol provides financial protection against costly treatments such as hospital stays and medications, and covers pre-existing conditions. It also grants access to specialised care, diagnostic tests, and management programs to prevent complications such as heart attacks.
- Financial security & cashless treatment: Insurance policies cover major expenses, including hospital stays, doctor visits, and nursing care. Cashless treatment at network hospitals offers quick care without upfront payments.
- Comprehensive coverage: Many plans include outpatient (OPD) consultations and medical tests as part of the annual health check-up.
- Coverage for Pre-Existing Disease (PED): High cholesterol is usually seen as pre-existing. Still, many insurers now offer coverage from day one or after a shorter waiting period by using a special rider.
- Preventive support: Some plans include wellness benefits such as health coaching, renewal discounts, digital fitness access, and sessions with a nutritionist or wellness coach to help maintain healthy cholesterol levels and reduce future health risks.
- Peace of mind: Health insurance provides financial protection against the high costs of cardiac emergencies and related cholesterol issues.
Important Note: If you have high cholesterol, buying individual health insurance early can help you complete waiting periods sooner and secure coverage before complications develop. Always disclose your medical history accurately and consider plans with chronic care benefits, OPD coverage, and wellness programs for better long-term protection.
Who Should Buy Health Insurance for High Cholesterol?
Since individuals with high cholesterol are at greater risk for serious health problems like heart disease, stroke, and hypertension, having suitable health insurance ensures they receive prompt treatment, financial protection, and ongoing care to manage these risks effectively.
- Individuals with Pre-existing High Cholesterol: Individuals diagnosed should select comprehensive plans with diagnostic tests, specialist consultations, and long-term medications for ongoing management.
- People with a Family History of Heart Disease: People with a genetic risk of high cholesterol or heart issues should get coverage early to avoid delays caused by pre-existing conditions (PEDs).
- Individuals Over 40 Years: The risk of lifestyle-related diseases, such as hyperlipidaemia and hypertension, increases considerably after age 40, highlighting the importance of adequate health cover for both prevention and emergency care.
- Primary Breadwinners: Individuals managing family finances should choose comprehensive plans to protect savings from unexpected medical emergencies, such as heart attacks, which can cost ₹2.5–5 lakhs in cities.
- High-stress Professionals: Individuals in high-pressure jobs face a higher risk of cholesterol-related conditions and should have proper health insurance.
Eligibility Criteria for Health Insurance with High Cholesterol
When choosing health insurance for high cholesterol, eligibility depends on the insurer’s age limits, coverage type (like individual or family plans), and policy durations. These factors decide applicant eligibility, coverage length, and renewal flexibility.
| Feature |
Details |
| Age of Proposer |
18 years or above |
| Entry Age- Minimum |
Adult: 18 years; Child: 91 Days (FF) |
| Entry Age- Maximum |
Adult: No Upper Age Limit; Child: 24 Years |
| Exit Age |
Adult: Lifelong; Child: 25 Years |
| Cover Type |
Individual: max up to 6 persons; Floater: max up to 2A2C |
| Tenure Options |
1/2/3 Years |
Key Factors to Consider While Buying Health Insurance for High Cholesterol
When buying health insurance with high cholesterol, choose a plan with short waiting periods for pre-existing conditions, comprehensive OPD coverage, a high sum insured, and the following factors:
- Pre-existing disease (PED) waiting period: High cholesterol is typically considered a pre-existing condition. Choose a policy that has the shortest waiting period available.
- Comprehensive OPD benefits: Since managing cholesterol primarily involves regular check-ups rather than frequent hospitalisations, a policy with extensive OPD coverage is highly advantageous.
- Annual Health Checkups: Ensure the plan includes yearly health checkups that cover key tests, including lipid profiles, blood sugar, liver and kidney function, complete blood count (CBC), ECG, and other routine screenings to monitor cholesterol and overall heart health.
- Extensive cashless hospital network: Select an insurer that has an extensive network of hospitals and diagnostic centres to ensure cashless treatment and prevent upfront payments in emergencies.
- Co-payment and sub-limits: Thoroughly review the policy terms to prevent high co-payment clauses, where you pay a percentage of the claim, and verify if there are any caps on room rent or treatment sub-limits.
- Wellness and Preventive Benefits: Some plans include wellness programs, lifestyle rewards, or premium discounts for maintaining healthy habits, helping improve cholesterol management.
Important Note: Review waiting periods, sub-limits, premium loading, and exclusions for cholesterol and heart conditions before buying a policy. Select comprehensive coverage with chronic care and lifelong renewability for better long-term protection.
How to Reduce the Waiting Period for High Cholesterol?
Waiting periods for high cholesterol can delay access to related treatments. Selecting the appropriate plan or add-ons can help shorten this period. Care Health Insurance offers specialised options with shorter waiting times and, in some cases, coverage starting on Day 1, along with additional care and support features.
- Modification of the PED Wait Period: Opting for this optional benefit shortens the usual 36-month waiting period to either 1 or 2 years, based on your choice.
- Instant Cover: The optional Instant Cover benefit bypasses the typical PED waiting period for declared conditions like diabetes, hypertension, hyperlipidemia, and asthma. Coverage starts 30 days after the policy begins.
- Instant Cover Advanced: An optional add-on that can reduce or eliminate the usual 3-year waiting period for existing health conditions. It provides coverage for common long-term illnesses, such as diabetes, hypertension, and asthma, in select cases, starting on Day 1.
Important Note: The above-mentioned riders are available under Care Supreme. Rider availability, features, and waiting periods may vary based on the selected plan and applicable policy terms.
What is Covered and Not Covered After the Maternity Waiting Period is Over?
After the maternity waiting period, the policy activates with specific coverages and limits. Knowing what's covered and excluded helps avoid surprise expenses during maternity care.
- In-Patient Hospitalisation: Covers medical expenses for hospital stays of 24 hours or longer.
- OPD Treatment: Includes consultations, prescribed medications, and minor treatments that do not need hospital stays.
- Road Ambulance Charges: Covers the cost of ambulance services during medical emergencies.
- Day Care Treatments: Covers procedures that involve less than 24 hours of hospitalisation, thanks to advanced medical technology.
- Modern Treatments: Includes coverage for advanced medical procedures such as robotic surgeries and minimally invasive treatments, subject to policy terms.
- Non-medical Expenses: Covers consumables and other non-medical items if they are included in the policy.
- Health Check-ups: Includes coverage for regular preventive health check-ups as outlined in the plan.
- Chronic Disease Management Benefit: Under Care Supreme Senior, coverage includes support for hyperlipidemia management, doctor consultations, pharmacy expenses, and cashless diagnostic tests for cholesterol and cardiac monitoring at network centres.
- Non-allopathic Treatment: Treatments under alternative medicine systems might not be covered unless explicitly specified.
- Obesity and Weight Control Procedures: Bariatric or weight-loss treatments are generally not covered unless they are medically necessary and explicitly specified.
- Treatment for Alcohol or Substance Addiction: Expenses for de-addiction programs are typically not covered.
- Unproven Treatments: Experimental or investigational procedures are generally not covered.
- Treatments Availed Outside India: Medical expenses incurred outside India are only covered if the plan provides global coverage.
- Artificial Life Maintenance: The policy may exclude extended life support if there is no potential for recovery.
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Important Note: Coverage and exclusions may vary by plan, so carefully review the policy wording, waiting periods, and specific terms related to cholesterol and heart-related conditions before purchasing.
How to Buy Health Insurance for High Cholesterol Online?
Purchasing health insurance for high cholesterol is quick, straightforward, and entirely online. Follow these steps for a seamless buying experience.
- On the quote page, review the sum insured, coverage for cholesterol-related conditions, waiting periods, and additional benefits, then click ‘Buy Now’ to proceed.
- Enter the proposer’s information on the following page and click Next to proceed.
- Fill in the insured member’s details, ensuring medical history and cholesterol information are accurate.
- Complete the purchase by making the online payment. Your policy documents will be instantly shared on your registered email ID and mobile number.
Important Note: Make sure you accurately disclose your cholesterol levels, current medications, and relevant medical history during the application. Failure to do so could result in claim denial or policy cancellation.
How to File a Claim for Cholesterol-related Treatment?
You can file a cashless or reimbursement claim for cholesterol treatment through your health insurance by following these steps:
| Cashless Claim Process |
Reimbursement Claim Process |
| Step 1: To receive treatment for high cholesterol, you must be admitted to a hospital in our network. |
Step 1: To file a claim, you must first pay the hospital expenses. Then, submit the completed claim form, along with the original bills and all necessary supporting medical documents, including the discharge summary and prescriptions. |
| Step 2: Complete the required pre-authorisation process with the hospital's insurance desk and inform the insurance company. |
Step 2: Once your claim is submitted, it will be reviewed, and you will receive an acknowledgement when the process begins. |
| Step 3: The insurance desk will send the finished documents to the insurer's claims management team for approval. |
Step 3: If the claims team requests additional information or documentation, please provide it. |
| Step 4: Once the insurer has verified the claim, an approval letter will be sent to you. |
Step 4: Upon claim evaluation and approval, the approved amount will be credited to your registered bank account as a reimbursement. |
| Step 5: Respond quickly to any further questions. Following approval, the insurance provider will directly settle covered hospital expenses in accordance with the policy's terms and conditions. |
Step 5: Should a claim be rejected, the insurance company is obligated to provide you with the detailed reasons for the denial. |
Important Note: Inform your insurer in advance of planned hospitalisations and maintain all relevant documents—such as medical reports, prescriptions, test results, and bills—to help ensure a hassle-free claims experience.