Best Health Insurance Plans for HIV Patients in India
Finding the right health insurance for HIV patients in India can be challenging. While medical advancements and government initiatives have significantly improved access to treatment, financial security remains a major concern.
Recognising this, the Insurance Regulatory and Development Authority of India (IRDAI) made it mandatory for insurers to offer coverage to HIV-positive individuals. Today, several policies provide hospitalisation coverage, ART expenses, and more, ensuring financial relief for those with HIV.
With that in mind, let’s take a look at the 6 best health insurance policies for HIV patients.
Top 6 Health Insurance Plans for HIV Patients
| Feature | Niva Bupa's Premia Health Insurance Plan | ManipalCigna LifeTime Health Insurance | Aditya Birla Activ Fit Health Insurance | Future Generalli HIV Disability Suraksha | Star Special Care Gold | SBI General Arogya Supreme |
|---|---|---|---|---|---|---|
| HIV/AIDS Coverage | HIV/AIDS are covered up to a specified limit. Coverage is provided for opportunistic infections caused due to low immunity in HIV/AIDS resulting in acute bacterial, viral, fungal, or parasitic infections. | HIV, AIDS or AIDS Related Complex will be covered up to the Sum Insured in a Policy Year | HIV / AIDs and STD also covered up to sum insured | Any person suffering from HIV/AIDS, with a diagnostic test report confirming the evidence of HIV/AIDS would be covered on indemnity basis for In-patient hospitalization. | Individuals diagnosed as HIV/AIDS by a duly qualified Medical Practitioner with a CD4 count above 350 will only be eligible for cover | Medical expenses related to HIV and/or HIV-related illness, including AIDS |
| Instant Cover | No, initial 30days waiting apply | No, initial 30days waiting apply | No, initial 30days waiting apply | No, initial 30days waiting apply | No, initial 30days waiting apply | No, initial 30days waiting apply |
| Number of Critical Illnesses Covered | 20 major critical illnesses like Cancer, Open Heart surgery, Kidney Failure, Strokes, etc | The Critical Illness add-on cover lists 11 covered critical illnesses. | listed 20 critical illnesses 10 | The sources do not specify a separate coverage for a defined number of critical illnesses under this policy. | Not explicitly stated as a separate category with a defined number of illnesses. However, the policy covers various treatments, including modern treatments like robotic surgeries and deep brain stimulation | The "Major Illness Benefit" covers 30 specified major illnesses. This is an optional cover |
| Coverage for Complications | For HIV/AIDS, coverage includes hospitalization due to conditions caused by or associated with it, and opportunistic infections. | The policy covers medical expenses for medically necessary hospitalisation due to Disease, Illness or injury. It also mentions coverage for direct complications of pre-existing diseases after the applicable waiting period. | Coverage is provided for illnesses/injuries covered as per the policy documents | Any medical condition requiring Inpatient Hospitalization for persons with HIV-AIDS covered | The policy covers direct complications of pre-existing diseases (after applicable waiting periods). It also mentions coverage for complications related to HIV/AIDS after the waiting period | Coverage is provided for direct complications of pre-existing diseases after a waiting period of 48 months |
| Cashless Facility | 10000+ Hospitals. | 15000+ hospitals | 10000+ hospitals | 8,400+ hospitals | 13500+ hospitals | 16,500+ hospitals |
| Pre/Post Hospitalization | Coverage for 90 days before and 180 days after hospitalization. | "Pre-hospitalization - This coverage is for a maximum of 60 days preceding hospitalization Post-hospitalization - This coverage is for a maximum of 180 days post discharge." | Covers Pre and Post Hospitalisation expenses 90 days of pre and 180 days of post | For 30 days prior to the date of Hospitalization and For 60 days from the date of discharge from the Hospital | "Pre-hospitalization - 30 days before hospitalization are covered Post-hospitalization - 60 days from the date of discharge" | "Pre-hospitalization expenses are covered for up to 30/60 days before hospitalization Post-hospitalization expenses are covered for up to 60/90/180 days after discharge" |
| Waiting Period | "30 Days Initial Waiting Period. For Critical Illness cover, benefits will not be available for pre-existing conditions as per your policy plan until 24 months of continuous coverage from first policy start date." | There is a 30-day waiting period, except for accidental claims. This does not apply if the insured has continuous coverage for more than 12 months. | There is an Initial Waiting Period of 30 Days | 30 days from the first policy commencement date. 36 months for PED (other than the pre-existing disability and HIV/AIDS). | 30 days from the first policy commencement date are excluded, except for claims arising due to an accident. | Pre-existing diseases: 36 months, Initial waiting period: 30 days, except for accidents, Specific illnesses: 24/36 months |
| Premium Range (Approx. Annual) | The premium starts from ₹ 11,572 | starts from 17,942 | ₹6,863* /annum | Not mentioned | Starts from ₹12,272 | starts from ₹2136 |
| Coverage for OPD / Medication | "Get coverage for OPD Treatment and/or Diagnostic Services and/or prescribed medicines for the OPD Treatment taken" | OPD is not covered. | OPD Expenses are covered on a cashless basis through Empanelled Service Providers in selected cities during the policy period | Ccoverage primarily for In-patient hospitalization. Outpatient diagnostic, medical and surgical procedures or treatments, non-prescribed drugs, and medical supplies are generally not covered. | Standalone OPD or medication costs outside of hospitalization are not explicitly mentioned as covered | "Generally covers in-patient hospitalization expenses. Oral Chemotherapy is covered as OPD under Advance Procedures" |
| Claim Settlement % (Overall) | 91.60% | 90% | 90% | 80.50% | 94.44% | 98% |
| Unique Benefits | "- Loyalty additions increasing the sum insured by 10% or 20% each year - Refill benefit reinstating the base sum insured if exhausted - Health check-up from Day 1 - Maternity benefits covering up to two deliveries (after a waiting period) and newborn baby from day 1 - International coverage under the Platinum plan - Get a free extension of 1 year if the policyholder passes away or is diagnosed with any of the specified illnesses - Coverage for AYUSH treatments - Coverage for organ donor's treatment" | "* Worldwide Emergency Cover. * Restoration of Sum Insured * AYUSH Cover for in-patient hospitalization * Health Maintenance Benefit (HMB) for outpatient and inpatient expenses * Optional Covers like Hospital Daily Cash Benefit, Deductible, Reduction in Maternity Waiting, Voluntary Co-pay, Waiver of Mandatory Co-pay, Cumulative Bonus Booster" | "- Get up to 50% of your premium back as HealthReturnsTM on staying active for 275 days in a year* - Earn 10% upfront Good Health Discount on first policy year premium basis on your health risk assessment - Get up to 10% additional early bird discount if you are less than 35 years" | "- AYUSH Treatment is covered up to the Sum Insured (sublimit of 50% was deleted) Modern Treatments are covered up to 50% of the Sum Insured - Cataract Treatment is covered up to ₹40,000 per eye in one policy year - Emergency Ground Ambulance expenses are covered up to ₹2,000 per hospitalization" | "- AYUSH treatment covered up to 100% of Sum Insured - Option to waive off co-payment on payment of additional premium - Lifetime policy renewal option" | "- InPatient Hospitalization or as part of Day Care Treatment up to 25% of Sum Insured - Recovery Benet up to the limit specied in policy schedule if Hospitalization exceeds 10 consecutive and continuous days. - Expenses up to 1,00,000 per eye incurred for treatment of Cataract - If hospitalization exceeding 5 days, the cost of economy class air ticket up to 1% of Sum Insured or maximum up to 20,000/ whichever is lower - Health checkups not required for people up to 45 years with no medical history" |
| Is Portability Available | Yes | Yes | Yes | Yes | Yes | Yes |
| Sum Insured (in ₹) | Cover starts from ₹ 5 lakh to ₹ 3 crore | Typically from ₹5 lakh to ₹3 crore | Available Sum Insured options are 5 Lac to 1 Cr | 4 Lacs and 5 Lacs | Rs. 4,00,000/- and Rs. 5,00,000/ | Rs 1 Lac to 1 Crore |
| Entry Age | aged 18 years & above | "The minimum entry age - 91 days for children and 18 years for adults. No limit for maximum entry age. Children up to 23 years can be covered under a floater, and beyond 23 years under an individual policy." | "* Individual Policy: Minimum age at entry for adults is 18 years, and the maximum age is 45 years * Family Floater Policy: Minimum age at entry for adults is 18 years, and the maximum age is 45 years. For children, the minimum age is 91 days, and the maximum age is 25 years" | "Minimum age at entry Adult - 18 Years Child - Newborn Maximum age at entry Adult - 65 Years Child - 17 Years Maximum renewal age - Life long" | "For Adults – Minimum - 18 years & Maximum - Up to 65 years For Dependent Children – Newborn to 17 years" | "Adult: 18 to 65 years Children: 91 days to 25 years" |
| Policy Type (Individual / Family Floater) | Both Individual and Family (Upto 6 Members) | Both Individual and Family Floater - maximum of 2 adults and 3 children. | Available for Individual, Multi Individual & Family Floater | Individual basis only | This policy provides benefits only on an individual basis | Available on an Individual Basis & Family Floater Basis |
| Policy Tenure | Annual | 1/2/3 years | Policy tenure options are 1, 2, and 3 years | 1 Year | The policy can be taken for a term of 1 year | Can be issued for 1, 2, or 3 years |
| Refill / Restoration Benefit | When same or different illness strick in the same policy year, your base sum insured is re-filled and made available to you | "We will provide for a 100% restoration of the Sum Insured for any number of times in a Policy Year" | Binge Refill - Cover up to 100% Sum Insured unlimited times for any illness/injury | The sources do not mention any refill or restoration benefit. | Not explicitly mentioned in the sources. | "Sum Insured Refill benefit is available, refilling 100% of the basic sum insured upon complete or partial utilization in a policy year. Available once per policy year" |
| No Claim Bonus | NA | NA | There is also a Super No Claim Bonus where on having 2 consecutive claim-free years, your Sum Insured will be doubled | The sources do not mention any No Claim Bonus. | No Claim Bonus with an increase in sum insured is not explicitly mentioned. | Upon renewal of the policy, 15% of the Basic Sum Insured will be payable, up to a maximum of 100%, provided no claim has been made during the year. |
*Please read the disclaimer at the end of this page before purchasing this policy.*
Our Top 3 Picks for the Best Health Insurance Plans Covering HIV Patients
Each plan is different and has unique benefits and limitations. While we curated the top 6 best health insurance policies for HIV patients in India, here are our personal 3 picks based on their features, specifications, and limitations for covering HIV patients:
Niva Bupa Premia
The Star Diabetes Safe Insurance Policy is a diabetes insurance plan that covers not just the complications of Type 1 and Type 2 diabetes but also outpatient expenses, regular hospitalisation, and personal accidents.
Why It Stands Out
International Coverage: Offers coverage for medical expenses abroad under the Platinum plan.
Loyalty Additions and Refill Benefits: The sum insured increases by 10-20% annually, and if exhausted, it is reinstated.
Health Check-Up from First Day: Unlike many plans, preventive check-ups start immediately.
Comprehensive AYUSH Coverage: Covers alternative treatments such as Ayurveda and Homeopathy.
Organ Donor Expenses Covered: Covers costs for organ donation procedures.
Potential Limitations:
Higher Premium Costs: Compared to similar plans, premiums are expensive.
HIV/AIDS Coverage Limited: Only covers opportunistic infections related to HIV/AIDS, not all related expenses.
Possible Sub-Limits: Certain treatments may have restrictions on claim amounts.
Aditya Birla Activ Fit
Aditya Birla Activ Fit is a health insurance policy that extends coverage for HIV, ensuring patients have access to essential healthcare and financial support. This plan helps HIV-positive individuals manage medical expenses while promoting inclusive health insurance.
Why It Stands Out
Fitness-Based Rewards: Earn up to 50% of your premium back as HealthReturns™ for staying active.
Super No Claim Bonus: Doubles the sum insured after two consecutive claim-free years.
Good Health Discounts: 10% upfront discount based on health risk assessment.
Binge Refill Benefit: Unlimited refills of the sum insured for different illnesses/injuries.
OPD Coverage Available: Covers OPD expenses via a cashless network in select cities.
Potential Limitations
Age Restriction for Entry: Maximum entry age is 45 years, limiting access for older individuals.
Limited OPD Reimbursement: OPD claims are only cashless at network providers and are not reimbursed.
Longer Waiting Periods: Specific illnesses have a waiting period of 24–36 months.
SBI General Arogya Supreme
SBI General Arogya Supreme is a comprehensive health insurance plan that provides coverage for individuals with HIV. It offers financial security and quality healthcare support catered to the unique needs of HIV-positive patients.
Why It Stands Out
High Claim Settlement Ratio: This health plan has one of the highest claim settlement ratios in the industry at 98%, ensuring smooth claim processing.
Sum Insured Refill: 100% restoration of the sum insured upon full or partial utilisation in a policy year.
No Pre-Policy Medical Check-up: No check-up is required for individuals up to 45 years old with no medical history.
HIV/AIDS Coverage: Covers hospitalisation for HIV/AIDS up to 25% of the sum insured.
Additional Perks: Covers cataract treatment and air travel expenses if hospitalisation exceeds 5 days.
Potential Limitations
Long Waiting Period for Pre-existing Conditions: Requires 36 months before pre-existing diseases are covered.
No Fitness-Based Discounts: Unlike some competitors, it does not reward policyholders for maintaining an active lifestyle.
Limited OPD Coverage: OPD is only covered for certain treatments like oral chemotherapy, not general consultations.
What is HIV?
The Human Immunodeficiency Virus (HIV) attacks a person’s immune system, especially targeting the CD4 cells that help your body fight infections. Over time, HIV weakens the immune system, making it more difficult for the body to defend itself against illnesses.
In its most advanced stage, HIV develops into AIDS. However, not everyone with HIV develops AIDS, especially with early diagnosis and proper treatment.
Types of HIV and AIDS
The two main types are HIV-1 and HIV-2, with HIV-1 being the most common worldwide. While both can lead to AIDS if untreated, HIV-2 tends to progress more slowly and is largely found in West Africa, with some cases reported in America, India, Africa, and Europe.
Do Health Insurance Plans Cover HIV in India?
Yes, health policies cover HIV treatment but the extent of coverage depends on the policy you choose. The Insurance Regulatory and Development Authority of India (IRDAI) mandated insurers to cover HIV/AIDS treatment. This step was taken to ensure that everyone has access to quality healthcare, regardless of their financial situation and medical history.
Who is Eligible?
Importance of Health Insurance for HIV Patients
Managing HIV is a lifelong journey that comes with regular medical check-ups, expensive antiretroviral therapy (ART), and hospital visits. Without proper financial support, the cost of treatment can become overwhelming. This is where health insurance plays a vital role as it reduces the financial strain on patients and their families.
Here’s why you should have a health policy to cover HIV treatment:
What is Covered in Insurance Coverage for HIV Treatment?
*Note that every health plan is different and covers different needs. Hence, you should always read the fine print before getting an insurance policy.*
What is NOT Covered in Insurance Coverage for HIV Treatment?
Knowing what’s not covered in health policies for HIV treatment can avoid unexpected expenses and ensure you are financially prepared for any gaps in your insurance.
Why do HIV-Positive Patients Struggle to Get Health Insurance?
Patients with HIV are more prone to catching diseases due to their weakened immune systems. Even a common cold may turn into something severe, leading to hospitalisation, diagnostic care, and other treatments. Hence, insurance companies consider them high-risk individuals, making it difficult for HIV patients to get insurance coverage.
Challenges Faced by HIV Patients for Insurance Coverage
Offering health insurance for people with HIV comes with several challenges, making access to healthcare even more difficult for them. Here are some common ones:
Limited Access to Centres
Many HIV patients have to travel long distances to reach healthcare and insurance service centres, which is a struggle given their financial constraints as commuting costs alone can add a significant burden.
Lack of Specialised Support
The number of dedicated counselling centres is limited, making it harder for patients to access specialised care and guidance.
Low Awareness
A lack of awareness about HIV/AIDS among the general public and medical professionals leads to delayed referrals, affecting timely treatment and support.
Strict Policy Conditions
Most insurers in India have traditionally excluded HIV/AIDS from coverage due to the high cost of treatment. While the IRDA urged insurers to provide some level of cover, many plans still offer minimal support.
High GST on Financial Services
A GST rate of 18% applies to financial services, adding to the overall cost burden of insurance.
Disclaimer
