Best Health Insurance for Arthritis in India
Arthritis is no longer solely a health concern for the elderly in India. It is a growing public health issue affecting people of different ages. In fact, according to a survey done by the Indian Council of Medical Research (ICMR), it is estimated that around 22.5% of adults (one in five) are living with this health condition.
Despite its widespread prevalence, the health coverage for arthritis remains low.
This guide will walk you through everything you need to know about arthritis-focused health insurance in India, from symptoms and causes to the best plans currently available.
Top Health Insurance Plans for Arthritis in India
| Features | Care Supreme - Senior | Niva Bupa Senior First Health Insurance | HDFC ERGO Optima Senior | Aditya Birla Activ One Plan | Bajaj Allianz Health Guard (Senior) | Tata AIG Medicare Premier |
|---|---|---|---|---|---|---|
| Other Type of Pre-existing (PED) Covered | Covers typical PED like diabetes, hypertension after waiting (2-4 years). | Covers declared PED such as hypertension, diabetes, etc., after waiting 24-36 months (variant-based). | Covers multiple PED, including heart ailments, BP, etc. after 24-48 months waiting. | Covers multiple PED including chronic ailments (diabetes, hypertension, etc.). Wait period typically 2-4 years. | All declared PED (BP, diabetes, etc.) covered post wait (usually 36 months). | All declared PED (including diabetes, BP) after 2-4 years, depending on plan slab. |
| Arthritis Coverage | Yes, once waiting for arthritis as a PED is satisfied or if newly diagnosed post 30-day wait. | Yes, included under normal in-patient coverage after specified wait for pre-existing arthritis. | Yes, covers arthritis as a PED post waiting. Also covers new arthritis claims after 30 days. | Yes, covers arthritis (rheumatoid/osteo) after waiting if deemed pre-existing; new cases covered post 30-day wait. | Yes, arthritis included if declared; standard 36-month wait for pre-existing. | Yes, standard coverage once waiting is fulfilled. No specific sub-limit for arthritis unless stated. |
| Pre-post Hospitalization Expenses | 30 days pre / 60 days post (check policy schedule for expansions). | 30 days pre / 60 days post in standard Senior First variants. | 30 days pre / 60 days post typically for Optima Senior. | 30 days pre / 60 days post (some variants allow 60/90; read plan specifics). | 60 days pre / 90 days post for certain Health Guard variants. | 30 days pre / 60 days post (some variants can offer 60/90). |
| Preventive Health Check-ups | Yes, annual check-up (some variants) or once every policy year for seniors. | Yes, annual health check-up from second or third year onward, depending on plan slab. | Yes, but frequency may be 2 years or as indicated in the schedule. | Yes, annual check-up or wellness benefits. Activ One encourages preventive care. | Yes, typically once every 2 policy years or annually in higher variants. | Yes, once every policy year or every 2 years, depending on sum insured. |
| In-patient Hospitalization Expenses | Yes, covers room rent, ICU, doctor fees, OT, etc. up to chosen sum insured. | Yes, up to the sum insured for hospitalization (ICU, surgical procedures included). | Yes, covers in-patient expenses up to SI, some sub-limits on room type possible. | Yes, hospital bills, doctor fees, etc. up to sum insured. | Yes, up to selected sum insured, room category depends on variant. | Yes, comprehensive coverage, typically no disease-based capping for arthritis. |
| Extended Hospitalization Allowance | May provide "daily cash" or "hospital cash" add-on for extended stays. | Some variants may offer daily cash if hospitalization exceeds a certain number of days. | Usually not standard; optional daily cash rider might be available. | Yes, "Hospital Cash" rider or add-on in some plan structures. | Yes, daily hospital cash or convalescence benefit in certain sub-limits. | Yes, daily allowance or hospital cash can be added. |
| Waiting Period for Pre-existing Conditions | 2-4 years, depending on sum insured and condition severity. | 24-36 months for declared PED. Some variants reduce it slightly. | 24-48 months (commonly 2 years for some ailments, 3-4 for others). | Typically 2-4 years for all declared PED (including arthritis). | 36 months standard; can vary for some PED add-ons. | Usually 2-4 years for declared PED, variable by sum insured tier. |
| Instant Cover | No, standard 30-day wait for new illnesses, day-one for accidents. | No, same approach: 30-day wait for new ailments. | No, 30-day new illness wait. | No, standard 30-day wait for new illnesses (accidents day one). | No, 30-day new illness wait, accidents from day one. | No, 30-day waiting for new conditions. |
| Coverage for Complications | Yes, any arthritis complications are covered after the relevant PED waiting or new-illness wait. | Yes, complications from covered diseases, including arthritis, once waiting is over. | Yes, includes complications if medically necessary hospitalization is required. | Yes, complications are included under in-patient coverage post waiting periods. | Yes, covers complications from arthritis if it is recognized as a covered condition. | Yes, after the wait period, or if newly diagnosed post 30 days. |
| Cashless Facility | Yes, wide Care (Religare) network (~16,500+ hospitals). | Yes, Niva Bupa network (~8,000+). | Yes, HDFC ERGO ~10,000+ network. | Yes, Aditya Birla ~10,000+ network. | Yes, Bajaj Allianz ~7,000+ hospitals. | Yes, TATA AIG ~7,200+ hospitals. |
| 11. Pre/Post Hospitalization | (Covered above in row #3) | (See row #3) | (See row #3) | (See row #3) | (See row #3) | (See row #3) |
| 12. Normal Waiting Period (New Illness) | 30 days for new ailments (accidents day one) | 30 days | 30 days | 30 days | 30 days | 30 days |
| 13. Premium Range (Approx. Annual for Senior Age 60-65) |
~₹12k-₹20k (for SI ~₹5-₹10L) | ~₹14k-₹22k (depending on sum insured & plan slab) | ~₹12k-₹18k for ~₹5-₹10L sum insured | ~₹13k-₹25k (Chronic management can push premium up) | ~₹10k-₹18k for ~₹5-₹10L sum insured | ~₹10k-₹20k for ~₹5-₹10L sum insured |
| 14. Coverage for OPD/Medication | Generally not in base, can add OPD rider. Some Supreme Senior variants might partially cover consults. | Some OPD coverage in higher sum insured or add-ons. | Typically no OPD coverage in base; optional rider if available. | Yes, certain "ActivOne" variants include OPD coverage or reimburse some chronic meds. | Usually no OPD in standard; might have an add-on for OPD. | Some variants have limited OPD or an add-on for consultations. |
| 15. Network Hospitals | ~16,500+ | ~8,000+ | ~10,000+ | ~10,000+ | ~7,000+ | ~7,200+ |
| 16. Claim Settlement % (Overall) |
~93-95% (Care Insurance) | ~89-90% (Niva Bupa's overall ratio) | ~93-95% (HDFC ERGO) | ~90-94% (Aditya Birla Health overall) | ~93-95% (Bajaj Allianz overall) | ~90-92% (Tata AIG overall) |
| 17. Unique Benefits | - Larger "Senior" focus - High hospital network - Automatic recharge for new ailments |
- Senior-centric plan - Some variants with reduced PED wait - 60 days post-hosp in top variants |
- "Optima Senior" specifically tailors to older policyholders - Reasonable premium for seniors |
- "ActivOne" specifically for chronic diseases - OPD coverage for chronic meds - Fitness/wellness programs |
- Varied sum insured from ₹2L-₹50L - Worldwide coverage in top variants - Add-on daily hospital cash |
- Family or individual coverage - High sum insured up to ₹50L or more - Good claim settlement track |
| 18. Is Portability Available | Yes, IRDAI norms | Yes, IRDAI norms | Yes, IRDAI norms | Yes, can port under IRDAI if continuous coverage maintained | Yes, IRDAI guidelines | Yes, IRDAI guidelines |
| 19. Sum Insured (in ₹) | ₹3L-₹1Cr, though Supreme Senior typically ~₹5-₹50L. | ₹5L-₹25L or ₹50L in certain Senior First variants | ₹2L-₹50L for Optima Senior (some expansions up to ₹1Cr). | ₹3L-₹2Cr (ActivOne can vary widely, check plan). | ₹1.5L-₹50L or more (Gold/Platinum variants). | ₹5L-₹50L (Premier plan up to ₹1Cr in some advanced versions). |
| 20. Entry Age | 61+ for Supreme Senior (some variants might start at 60); max no upper limit in renewal. | 60+ for senior plan, no upper limit in renewal. | 61+ for Optima Senior, typically no upper renewal limit. | Usually 18-70 for ActivOne, but can be purchased up to 80 in some. Check if separate. | Health Guard can be purchased up to 65-70 (some variants allow older entry), indefinite renewal. | Up to 65-70 for new policy. Renewals indefinite if continuous coverage. |
| 21. Policy Type (Individual / Family Floater) | Typically Individual for seniors, but some 2-adult floaters possible. | Individual or couple floater for seniors (two adults). | Typically Individual coverage for each senior. | Individual or Family Floater if multiple family members. | Both - can do individual or floater if spouse also covered. | Both - can be taken as individual or family (including spouse if both are seniors). |
| 22. Policy Tenure | 1 / 2 / 3 years (renewable) | 1 / 2 / 3 years (multi-year discount) | 1 / 2 years typically for Optima Senior (some expansions). | 1 / 2 / 3 years (discounts apply if multi-year). | 1 / 2 / 3 years (renewable) | 1 / 2 / 3 years (renewable) |
| 23. Refill / Restoration Benefit | Yes, "Automatic recharge" if entire SI is used for previous claims. | Yes, typically 1-2 times in a policy year for different ailments. | Not always included in base; optional "restore" in certain variants. | Yes, "Reload" or "Activ" restoration once SI is exhausted, for unrelated claims. | Yes, partial restore if base SI is used, might vary by plan level. | Yes, sum insured restoration in certain variants once exhausted (unrelated claims). |
| 24. No Claim Bonus | Yes, can accumulate 10-50% each claim-free year, up to a limit. | Yes, up to 100% in some senior plan variants over consecutive claim-free years. | Yes, incremental increase up to 50-100% if no claims. | Yes, 10-50% yearly increments on no-claim renewals, capping at 100-150%. | Yes, 10-50% annual increments up to 100% max. | Yes, typically 10-50% each year, capping around 100-150%. |
*Please read the disclaimer at the end of this page before purchasing this policy.
Our Best Picks for Health Insurance Policies Covering Arthritis
While the plans in the above table are all packed with unique features, below are three of the arthritis health plans that stand out the most. Each recommendation is based on overall coverage, benefits, user reviews, and common user scenarios (immediate coverage needs, robust sum insured, or comprehensive wellness features).
Care Supreme Senior
Care Supreme Senior by Care Health Insurance is a dedicated health plan for individuals aged 61 and above, offering extensive coverage for arthritis and other age-related conditions.
Why It Stands Out
Tailored for Seniors: Specifically designed for individuals aged 60 and above, ensuring that common senior ailments (like arthritis) are considered in the plan’s coverage structure.
Large Hospital Network: Ties into Care (Religare) Insurance’s extensive network (~16,500+ hospitals), enabling broad cashless access.
Automatic Recharge: If you exhaust your sum insured on one claim, the policy can automatically refill it for future, unrelated claims in the same policy year.
Potential Limitations
PED Waiting: Pre-existing arthritis coverage triggers only after a waiting period of 2 to 3 years, which may delay coverage for ongoing treatments.
OPD Coverage: The basic versions of their plan may not include outpatient consultations for arthritis (e.g., physiotherapy), requiring an add-on or higher variant.
Niva Bupa Senior First Health Insurance Plan
Niva Bupa’s Senior First Health Insurance Plan is designed for individuals aged 61 to 75, offering comprehensive coverage for conditions like arthritis. Below are the reasons why this plan stands out:
Why It Stands Out
Reduced Waiting for PED: Some variants offer a 24 to 36-month wait for pre-existing conditions, slightly shorter than many senior plans requiring up to 4 years.
Senior-Focused Benefits: Covers typical eldercare needs, with features like 30 days pre- and 60 days post-hospitalisation, plus optional OPD in higher variants.
Wide Sum Insured Range: Offers coverage up to ₹25 lakh or higher, making it suitable for moderate to extensive hospitalisation costs.
Potential Limitations
Limited OPD in Base Plans: You may need a higher sum insured variant or rider to cover outpatient physiotherapy, consultations, or routine arthritis check-ups.
No Immediate Coverage: Like most senior plans, it imposes a 30-day wait for new ailments and 2+ years for arthritis-related treatments if declared as PED.
Aditya Birla ActivOne Plan
Aditya Birla Activ One provides comprehensive health insurance coverage for individuals aged 18 and above, including seniors, with no upper age limit. Below are some good points and potential limitations of this health plan coverage for arthritis:
Why It Stands Out
Chronic Care Management: This plan is specifically beneficial for chronic ailments such as arthritis, diabetes, or hypertension, as it offers features like medication tracking and possible OPD coverage for routine check-ups.
Wellness and Rewards: Encourages fitness activities, healthy living, and offers incentives (like HealthReturns™) that can reduce effective premiums.
High Sum Insured Options: Goes up to ₹2 crore in some variants, providing ample coverage for joint replacement surgeries or advanced treatments if needed.
Potential Limitations
Premium Costs: The added focus on chronic care and wellness benefits can drive up premiums, especially for higher sum insured brackets.
Waiting Period: Pre-existing arthritis (if declared) still faces the standard 2 to 4-year wait before full coverage kicks in, which can delay treatment reimbursements.
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What is Arthritis?
Arthritis is a condition that causes pain, swelling, and stiffness in the joints, making everyday movements difficult. It commonly affects the knees, hands, hips, and spine, and can worsen with age, impacting your mobility and overall quality of life.
What are the Different Types of Arthritis?
Arthritis is not a single disease but a broad term used to describe different joint-related conditions. Each type affects the body differently, and understanding the distinctions is key to seeking the right treatment.
Here are some common forms seen in India:
Osteoarthritis
Also known as wear and tear arthritis, this common form is caused by the wear and tear of the cartilage that cushions the joints. It affects the joints that bear your weight, like hips, knees, and spine, reducing mobility and causing stiffness and pain.
Rheumatoid Arthritis
In this autoimmune disease, the body’s immune system mistakenly attacks the joint lining, leading to inflammation, joint damage, and pain. It often affects smaller joints first, such as those in the hands and feet.
Psoriatic Arthritis
Related to the skin condition, psoriatic arthritis sometimes affects people with psoriasis, causing joint pain, swelling, and stiffness. It can affect any joint and may also cause inflammation in the eyes and changes in the nails.
Ankylosing Spondylitis
This type of arthritis affects the spine, leading to inflammation, chronic pain, and stiffness in the spinal joints.
Gout
Gout is a form of inflammatory arthritis caused by the build-up of uric acid crystals in the joints, leading to painful attacks in the joints. It commonly affects the big toe, however, it can also cause pain in other joints like the hands, knees, and ankles.
What are the Symptoms of Arthritis?
Recognising the signs of arthritis early can make a significant difference in managing the condition and preventing joint damage. While symptoms may vary depending on the type of arthritis you have, here are some commonly observed warning signs:
How to Diagnose Arthritis
Diagnosis of arthritis usually involves a combination of clinical evaluation, imaging, and lab tests to confirm the type and severity of the condition.
What are the Causes of Arthritis?
Often, more than one cause may contribute to the onset of this condition. Understanding these underlying causes is crucial for prevention and management. Below are some of the key contributors:
Inactive Lifestyle
Genes
Autoimmune Disease
Infection
Other Causes
Importance of Health Insurance for Arthritis
Since arthritis is a long-term health condition, it requires ongoing medical treatment, regular check-ups, and in some cases, expensive treatments or surgeries. Having a suitable arthritis coverage insurance plan can significantly reduce the financial burden and ensure access to timely and quality care.
Below are some reasons why you need coverage for this health condition:
Inclusions and Exclusions of an Arthritis Health Policy
When choosing health insurance for arthritis, you need to keep in mind what is covered and what is not. Here are some common pointers that you may find in different plans:
*Please note that every health plan is different and may not cover the same terms and conditions. Always read the fine print carefully before purchasing a policy.
Factors to Consider Before Buying Health Insurance for Arthritis
While going for low-premium health plans may be tempting, they might have fewer features than a high-premium plan. Hence, selecting the right health policy to cover arthritis is necessary. Below are some general factors to keep in mind:
Cashless Payments
Pick a plan that offers cashless treatment across a strong network of hospitals. This ensures you don’t have to worry about arranging funds at the time of admission or treatment.
Wellness Programs
Some insurers covering arthritis also offer wellness benefits, such as discounts for maintaining healthy habits, online fitness consultations, or access to arthritis management tools and resources.
Physical Therapy
Arthritis management often involves regular physiotherapy. Choose a policy that includes cover for outpatient physiotherapy sessions or offers a rehabilitation benefit.
Surgery
In advanced cases, joint replacement or corrective surgeries may be required. Check if your policy covers such procedures, including pre- and post-operative care.
Doctor Visits
Arthritis is a long-term condition that requires frequent doctor visits to specialists like rheumatologists or orthopaedic doctors. So, ensure that your health policy covering arthritis also has outpatient consultations or OPD benefits.
Nursing Help
Some plans offer home healthcare benefits, which can be especially useful for elderly patients needing nursing support or physiotherapy at home.
Medications
Long-term medication is often essential for managing pain and slowing disease progression. A good policy should provide coverage or discounts for prescribed arthritis drugs.
Disclaimers and Important Conditions
