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Are Senior Citizen Health Policies Restrictive?

In India, the medical inflation is rising at 20 percent per annum. It is more than the double of the total inflation. This is why it is super important to buy health insurance so that any medical emergency doesn’t lead to a financial crunch.

Senior Citizen Medical Insurance

Senior citizen health plans are specially formulated for people over 60 years of age. It covers certain medical costs like hospitalization expenses. It is recommended to buy a mediclaim policy for senior citizens because they are prone to illness and frequent hospitalization and due age factor. If they don’t have an insurance cover, their savings can be washed off within a few hospitalizations.

Insurance Premium

Insurance premium for a senior citizen health policy is computed on the basis of an individual’s age. Generally, the premium set by most insurance providers would be the same for a specific age category.

To Port or to not Port?

The maximum entry age for individual or family floater health plans is 65. These plans come with a lifetime renewability option. If an individual has already purchased a health policy before 60 years of age, it’s recommended that they go on with it. In that case, a senior citizen health policy isn’t required. 
Carrying the same plan forward is helpful as it offers better benefits for pre-existing illnesses (if any) and waiting periods.
One should ditch his/her regular plan and go for a senior citizen policy only if the age factor is not working in his/her favor. Generally, the coverage offered by a senior citizen policy is restrictive as compared to regular policies offered by insurance providers. Senior citizen policies cater to individuals who want to purchase insurance at an older age, when they don’t qualify for regular policies.

Restrictions

When it comes to features, senior citizen health policies can be highly restrictive. Here's what these plans offer.

1. Co-payment

Co-payment is a compulsory feature in all senior citizens policies. At the time of clearing hospitalization bills, the insured person has to pay a pre-decided fraction of the total bill as co-payment. 
Co-payment is applicable to these 3 things.

  1. Specified ailments
  2. Specified hospital expenses
  3. Treatment

Before purchasing the policy, clarify the applicability criteria of co-payment. Ask the insurer if the co-payment can be waived off by paying an enhanced premium.

2. Sub-limits on Hospital Bills

Sub-limit is a percentage (of the amount insured) to which the insurer will bear the expenses. Doctors' consultation fees, surgery/operation fees, nursing expenses, room rent, and medicine cost come with a pre-decided cap known as the sub-limit. 

A plan with sub-limits, regardless of the amount insured, restricts the claim for any incurred expenses.

3. Waiting Period

Not just the senior citizens, everyone should be cautious about a policy’s waiting period. No ailments are covered during the first 30 days of the policy inception. However, accidental hospitalization is covered from the first day onwards.

Some ailments get covered after a particular time duration. For certain illnesses, the waiting period can be as long as 4 years. Pre-existing diseases are also covered after a particular waiting period.

Apart from this period, the plan might come with a cap on the claim for some treatments.

4. Pre-existing Diseases

Coverage for pre-existing diseases is an important aspect of health policies. Be clear about the coverage in terms of its waiting period and the sum insured.  A few health insurance providers offer coverage for pre-existing diseases post 3 years, but they may cover only 50% of the sum assured.

5. Expenses of Medical Tests

Health insurance policies for senior citizens, generally, offer free medical check-ups and medical tests. Most insurance providers do not charge such tests, especially when the tests are done at their network listed hospitals.

Additional Features 

Here are the additional features that may be availed after paying an extra premium. They may also be provided complementarily by the insurer.

1. Few senior citizens policies offer domiciliary treatment i.e. a treatment at home that otherwise would require hospitalization. The insurer will bear the pre-decided expense of such a treatment.

  1. Treatment expenses for organ donation are covered at the time of organ transplant. 
  2. Ambulance service charges up to Rs. 2000 are covered.

One time charges for e-opinion, i.e. a second opinion from a doctor, is covered.

Summing it up

Senior citizen health policies are formulated exclusively for individuals aged 60 years or more. The features of such plans can be restrictive. Because of the age factor, senior citizens face frequent hospitalization and their deteriorating immune system makes them prone to illness. In case one is not eligible to buy a basic health insurance policy due to the age factor, only then should he/she consider buying a senior citizen plan.

Buying an insurance plan is not enough. In order to enjoy continuous insurance benefits, renew the insurance plan every year without fail.

Also, check out the plans offered by Cigna TTK health insurance. They formulate good insurance plans.