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Health Insurance For Autoimmune Diseases In India

Published On Dec 23, 2021, Updated On Sep 05, 2023

What are autoimmune diseases? Autoimmune disorders are illnesses or situations in which the body's immune system mistakenly assaults its own cells. When a person has an autoimmune illness, the immune system misidentifies specific elements of the body as foreign cells, such as the skin, joints, and so on. As a result, autoantibodies are released, which assault healthy cells.

Women are much more likely than males to have autoimmune disorders. According to the National Health Portal of India, women make up roughly 75 percent of those who suffer from autoimmune illnesses. Furthermore, autoimmune illnesses are more common in young adults and middle-aged persons. A family history of autoimmune illnesses puts people at risk. People who have previously been exposed to bacterial and viral infections, as well as medications and metals such as silver, mercury, or gold, may develop autoimmune disorders. To know more about health insurance for autoimmune diseases, read on.

Health Insurance For Autoimmune Diseases In India

What are Autoimmune Diseases?

Autoimmunе disordеrs еncompass mеdical conditions in which thе body's immunе systеm mistakеnly targеts its own cеlls. In individuals afflicted by autoimmune diseases, the immune system misidentifies specific body components, such as skin or joints, as foreign entities, prompting the release of autoantibodies to attack these otherwise healthy cells.

According to data from India's National Health Portal, these conditions exhibit a higher prevalence among women than men, constituting approximately 75% of autoimmune disease cases. Furthеrmorе,  young adults and individuals in middlе agе facе a grеatеr suscеptibility to autoimmunе disеasеs. Those with a family history of autoimmune disorders carry an elevated risk. Additionally, exposure to prior bacterial or viral infections or certain substances like silver, mercury, or gold may contribute to the development of autoimmune diseases.

Which Diseases Come Under Autoimmune Diseases?

Among the population of India, several autoimmune diseases are frequently diagnosed. These include:

  • Systemic Lupus Erythematosus (SLE)
  • Type 1 Diabetes
  • Multiple Sclerosis
  • Addison's Disease
  • Rheumatoid Arthritis (RA)
  • Inflammatory Bowel Disease
  • Psoriatic/Psoriatic Arthritis
  • Graves' Disease
  • Celiac Disease
  • Sjogren's Syndrome
  • Pernicious Anaemia
  • Hashimoto's Thyroiditis
  • Autoimmune Vasculitis
  • Myasthenia gravis
  • Sarcoidosis
  • Scleroderma
  • Crohn's Disease

While certain autoimmune disorders target specific organs, others can affect the entire body. For instance, Type 1 diabetes primarily impacts the pancreas, whereas SLE disrupts the overall functioning of the entire body.

Treating Autoimmune Diseases

The early symptoms of most autoimmune disorders are the same, such as weariness, muscular soreness, hair loss, skin rashes, tingling or numbness in the hands and feet, and so on. Furthermore, most autoimmune illnesses cannot be diagnosed with a single test. As a result, a clinician can identify an autoimmune illness using a combination of testing and a long-term examination of symptoms.

Unfortunately, most autoimmune disorders are incurable. The doctor's recommended medication can only control the immune system's hyperactive reaction and give symptom alleviation. Medicines can help to decrease swelling, discomfort, and rashes, but they can't cure the condition.

Does Health Insurance Cover Autoimmune Diseases?

Yes. In India, health insurance policies cover a variety of autoimmune illnesses. Depending on the plan, the coverage amount might range from Rs 1 lakh to more than Rs 1 crore. Some autoimmune disorders are covered by tailored policies, while others may be covered by critical illness insurance. Several insurers, for example, provide diabetes-specific plans that cover Type 1 diabetes. Systemic Lupus Erythematosus and Addison's disease, on the other hand, are covered by critical illness policies offered by various insurers.

A health insurance policy for autoimmune illnesses covers hospitalisation, outpatient therapy, day care treatments, diagnostic test fees, and road ambulance fees, among other things. On the first diagnosis of the ailment, critical illness plans pay out a lump sum payout. However, the coverage provided by one health insurance may differ from that of another. As a result, before purchasing a health insurance policy, it is advisable to review the forms of autoimmune disorders as well as the coverage advantages. Always compare health insurance policies that cover autoimmune illnesses before deciding on one.

Waiting Period Under Health Insurance

Awaiting periods may apply to health insurance policies that cover autoimmune illnesses. A 30-day waiting period applies to regular health insurance policies that include coverage for autoimmune illnesses. This implies that the insured may be required to wait at least 30 days before filing an autoimmune illness claim. If the customer purchases critical illness coverage, however, there will be a 90-day waiting period followed by a 30-day surviving term.

The condition will be considered pre-existing if the insured already has an autoimmune disease at the time the policy is purchased. In India, most health insurance policies cover pre-existing disorders after a two- to four-year waiting period. The policyholder can look up the appropriate waiting time in the policy's terms and conditions.


In India, autoimmune illnesses have become fairly widespread. Because the illnesses are incurable, frequent therapy is essential to keep the immune system and symptoms under control, resulting in high medical costs. Health insurance policies that cover autoimmune illnesses can help policyholders lessen their financial burden and get the care they need when they need it.


Q. What are autoimmune diseases?
A. Autoimmune diseases are conditions in which the immune system mistakenly attacks the body's own cells and tissues.

Q. Are autoimmune diseases covered by standard health insurance plans in India?
A. Some standard health insurance plans may cover autoimmune diseases, but coverage can vary. It's important to check the policy details.

Q. Do I need a specialised health insurance policy for autoimmune diseases?
A. Depending on the condition and its severity, you may consider specialised plans or critical illness policies that specifically cover autoimmune diseases.

Q. Is there a waiting period for coverage of autoimmune diseases in health insurance plans?
A. Yes, many policies have waiting periods before coverage for autoimmune diseases kicks in. These waiting periods can vary, so it's crucial to understand them.

Q. How can I find out which autoimmune diseases are covered by my insurance policy?
A. Review the policy documents and contact your insurer or agent for a comprehensive list of covered autoimmune diseases.

Q. Can I get health insurance for a pre-existing autoimmune disease?
A. Yes, but you'll typically need to wait for a specified period (usually 2-4 years) after purchasing the policy before coverage for pre-existing conditions begins.

Q. Are there any lifestyle changes that can help manage autoimmune diseases?
A. Maintaining a healthy lifestyle through diet, exercise, and stress management can potentially alleviate symptoms and improve overall health.

Q. What documents do I need when making a health insurance claim for autoimmune diseases?
A. You'll generally need medical records, diagnostic reports, bills, and other relevant documents to support your claim.

Q. Can I switch health insurance policies if I'm not satisfied with the coverage for autoimmune diseases?
A. Yes, you can switch policies, but it's essential to compare new policies thoroughly and consider the waiting periods and coverage terms.

Q. Is it advisable to consult an insurance advisor when selecting a health insurance plan for autoimmune diseases?
A. Yes, seeking advice from an insurance expert can help you navigate the complexities of insurance policies and make an informed choice based on your specific needs and conditions.

Also read: 

Best Health Inusrance Plans With COVID-19 Cover

Tips To Choose Best Health Insurance Company

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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