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Factors to Consider for a Senior Citizen Health Insurance Plan

Advances in medical technology have caused healthcare costs to increase exponentially, making goodmedical treatment affordability a problem. This is where a good health insurance plan for our senior citizen parents saves the day, helping us tend to our parents’ medical needs, without financial stress.

Importance of Health Insurance For Senior Citizen:

  • Rising medical costs
  • Limited, unstable or no income after retirement
  • Financial dependency on children
  • Year-on-year decrease in savings
  • Increased vulnerability to accidents and illnesses
  • Unexpected financial contingencies, unforeseen expenses
  • Ceasing of employer’s health insurance policy post retirement

Factors to consider while buying health insurance for Senior Citizen:

Entry age

Most PSU insurance companies provide Mediclaim for senior citizens aged between 60-80 years. Therefore, even if your parents have crossed 60 years and still do not have health insurance, you can approach PSU Mediclaim insurers.

However, certain insurance companies limit the entry age to 69 years, beyond which your parents will not be eligible for a policy. Some private insurers like Apollo Munich and Max Bupa provide health insurance without any entry age restrictions.

Renewal age

Renewal age is the age until which the Mediclaim policy can be renewed and not beyond that. The age limit here is generally 90 years, however, this too may vary from company to company.

Pre-existing diseases

Pre-existing diseases are usually covered after the policy has been in force for two continuous years – this period may differ between different insurance companies.In some policies, all pre-existing diseases are covered, and in others, policyholders must wait a few years before making a claim. When taking a healthcare plan for parents suffering from pre-existing diseases, it is critical to check if those diseases are covered in the policy.

Some policies have exceptions. For instance, National Insurance’s Varistha Mediclaim for Senior Citizens Policy categorically mentions that they will only cover hospitalisation expenses under their health insurance cover and never cover any pre-existing disease under its critical illness rider. This policy also does not pay a lump sum on diagnosis, only reimburses for incurred medical expenses.

Waiting period

The policyholder needs to wait for a certain period before claiming expenses.

Alternative treatments

Some health insurance policies provide cover for alternative treatments like Ayurveda, homeopathy, etc.

Sum assured

Public insurers offering Mediclaim for senior citizens provide a low cover, usually INR one or two lakhs. On the other hand, private insurers offer higher covers, as much as INR 15-20 lakhs under family floaters. However, with a higher sum assured, the premium and co-payment may be proportionally higher.

Premium

The premium for policies for the elderly is usually high, because the age of the life to be insured exceeds 60 years. Further, if your parents suffer from a pre-existing disease, the insurance company charges an additional premium to cover that specific disease. This extra premium is to compensate for the additional risk the insurer is taking on.

Sub-limit

Some health insurance companies specify limits for certain treatments/illnesses. For instance, the policyholder may be permitted to claim only INR 20,000 for a cataract operation despite having a sum assured of INR three lakhs.Policies without sub-limits are better but premiums are higher.

Co-payment

Co-payment means the policyholder bears a specified percentage of the claim amount. The percentage is defined in the policy document while buying the policy. Therefore, in an 80%-20% clause, the policyholder will bear 20% of the cost while the remaining 80% can be claimed. Co-payment is usually around 10-20% for health insurance policies for senior citizens. For certain policies, it could be as high as 40%.

Points to remember

Certain policies for senior citizens may cover ambulance charges, some may offer critical illness riders. However, there is usually a limit on ambulance charges and only specified critical illnesses are covered.

Some health insurance plans cover specified diseases, such as stroke, cardio vascular disease, knee degeneration (requiring a knee replacement surgery), etc. Under such policies, despite paying a premium for the full sum assured, the policyholder is eligible to receive only a part of itfor certain specific diseases.

Benefits of insuring parents through your own personal mediclaim policy:

  • Parents are covered under an independent mediclaim policy, regardless of the company you work in and where you may be located in the future.
  • Some senior citizen health insurance policies offer lifelong cover.
  • Some policies do not require medical tests until the age of 69, subject to certain terms and conditions. For parents who live alone making it necessary to get tests done themselves, this becomes a convenient option.
  • You have the freedom and flexibility to decide the coverage you want for your parents.
  • If you purchase a senior citizen’s policy and make no claims in a policy year, during the subsequent policy renewal, the sum assured will increase by 5%, going to a maximum of 30-50%. This is called a No Claims Bonus/Discount. The % varies from company to company.
  • The premium paid for policies taken for senior citizen parents are exempt from tax under Section 80D of the Income Tax Act.

Tips when buying health insurance for Senior Citizen

  • Check the renewal ceasing age in the policy.
  • Consult a professional advisor specializing in health insurance services and offering special assistance during claims. These advisors also advise on different insurers’ reputation and offer detailed solutions.
  • Correctly mention all health facts about your parents in the proposal form. The smallest misrepresentation/omission of facts may lead to policy cancellation.

Popular health insurance products in India for Senior Citizen:

  • Star Senior Citizen Red Carpet Plan - Star Health Insurance
  • Silver Health Plan – Bajaj Allianz
  • Optima Senior - Apollo Munich
  • Heartbeat – Max Bupa
  • VaristhaMediclaim - National Insurance
  • Senior Citizen Mediclaim Policy - New India Assurance
  • Senior Citizen Plan - United India
  • iHealth Plan – ICICI Lombard

Note: Read the policy document carefully to understand policy restrictions, inclusions and exclusions.

Concluding

Before zeroing in on a health insurance plan for your parents, study and compare different plans and see what works best. Clarify all doubts with your insurance agent, check everything in detail –terms and conditions, premiums, etc.

Health insurance policies taken for parents must be suited to their particular needs and health conditions. It is better to have parents insured under individual health insurance plans instead of clubbing them under a family floater plan.

Caring for parents is a priority for all and they deserve nothing but the best - a great healthcare plan is an excellent start in that direction.