Senior Citizen Health Insurance

Nearly 1 out 10 people in India are senior citizens, totalling a population of more than 130 million. By 2050, the senior citizen number will double to 20% of total Indians.

Senior citizens (people who’ve attained the age of 60 years and above) are more prone to certain diseases and health conditions as compared to younger people. They might need to get hospitalised due to some age related issues, like joint replacement, heart conditions, etc. And the doctor would recommend multiple X-rays, MRI scans, and other tests to determine the illness.

The treatment of old age-related health problems is not only expensive, but also long-term. And with limited or no income, hospitalisation can be mentally and financially challenging for them.

A senior citizen health insurance plan is the best gift you can give to your parents. It is designed to offer financial aid for medical treatments in their hour of need. In short, it is a gift of health.

Why Do You Need Senior Citizen Health Insurance?

  • To cover critical illnesses

    With increasing age, the human body becomes more vulnerable to several diseases, ranging from the common cold and arthritis to critical illnesses, such as cancer and cardiovascular conditions. Medical insurance for senior citizens gives financial protection against such adverse situations.

  • To tackle hefty medical costs

    Medical inflation is prevalent across the globe. From doctor's consultation to the cost of hospitalisation - any kind of medical treatment can have a big impact on your finances. With the help of a senior citizen health policy, a majority of such expenses can be covered.

  • To shield your savings

    The amount in your bank account that you have meticulously saved should not get spent on the treatment of critical illnesses. A senior citizen health policy helps you protect your savings, and live a comfortable post-retirement life.

One important question you might have in your mind…

"My parents are covered through my employer; Wouldn't that be enough?"

Well, not in the long run!

Your cover is linked to your employment. So, it will stop as soon as you leave the organisation.

It has limited coverage. In case your health expenses are higher than your coverage limit, you may have to cover the rest of the amount out of your own pocket.

Portability, promised by your insurance broker or HR, is subject to underwriting (medical evaluation) of the case. Insurers may reject your portability application.

Group insurance schemes are one year policies, and the policy, its terms, its benefits, its pricing - everything can be withdrawn/changed at the time of renewal.

A corporate policy is designed considering the budget limitations your company might allocate - so you wouldn’t really have any control over it.

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However, a corporate health insurance plan in India may not have any waiting period or exclusions on pre-existing diseases. So suppose, your parents have some pre-existing conditions, like diabetes, and you are being offered a company health insurance plan for free. Leverage that plan for the short term financial risk, while staying invested in a personal health plan - for long-term needs.

Buying health insurance starts with making multiple declarations regarding your parents’ health. Any mistake you make in providing information can result in rejections at the time of claim. Yes, insurers can reject your claim if they are able to prove that you had misinformed them about your parents’ medical history.

steps to get the complete medical history of parents

Step-by-step strategy to help you get the complete medical history of Parents

Make a list of all the diseases and ailments that you know your parents have.

Fill in any blanks you might have left with the information they give you. But that won’t do the trick. You need to dig deeper.

Get hold of their medical files, and make a note of anything they might have missed telling you.

  • Look at all the medication they take and check why they are required.
  • Look for conditions that they might not consider ‘diseases’, and might skip. For instance, most parents feel hypertension (BP) is not a disease/health condition, but it actually is.
  • Make a list of all the surgeries, hospitalizations in the past.

This will give you a deeper insight into their health status, and help you cover them better. It will also ensure that there are no rooms for disputes in claims when the time comes.

Now that you are clear about the medical history of your parents, it's time to choose a health insurance plan for them.

How To Choose The Right Health Policy For Senior Citizens?

First, look for comprehensive plans that do not have an age limit.

There are good health insurance plans available in the market with -

No entry age limit

Best possible benefits

Lowest limits, exclusions, and financial conditions like Copay (the share in the claim that you would be required to pay each time there is a claim)While these plans are expensive, if your parents are relatively healthy, you can apply to them before going for Senior Citizen specific plans.

Fill in any blanks you might have left with the information they give you. But that won’t do the trick. You need to dig deeper.

If one or both of your parents do not get covered in the earlier option, you can choose senior citizen health insurance plans. These are specifically designed for senior citizens that may not require medical tests. However, they are likely to have many financial limitations, like room rent limits, copays, limits on treatment carried out, among others.

Important conditions to understand

  • Copays

    Most senior citizen health plans will have copays. Copay is the share of the claim that you would be required to pay each time there is a claim.

  • Room Rent Limits

    Room rent limits can severely restrict your access to quality healthcare. They cap not only the room charges, but also the related medical expenses, like surgeon fees, diagnostic tests, etc. Be aware of these financial limits And choose the room closest to what you are eligible for, to avoid deductions in your health insurance claim.

  • Sub-limits on treatments for specific diseases

    Sub-limits on surgeries for frequent and major lifestyle diseases ensure the claims are under control for insurers. They usually implement financial limits on cardiac treatments, breakage of long bones, and even standardise their payments for smaller high-frequency surgeries, like cataract and hysterectomy.

    For instance, you have purchased a senior citizen plan for your mother to cover for her cataract surgery. If the policy has a sub-limit of Rs. 25,000, all expenses for the treatment above this amount will have to be borne by you.

  • Pre-existing disease waiting period

    It is the period for which you need to wait before getting the insurance benefits. To get long term financial coverage, you will have to be patient and continue the coverage through the waiting period.

  • An indicative list of people who will find it difficult to get mediclaim for Senior Citizens

    People who suffer from cancer, heart disease, or similar critical illnesses.

    People on Insulin or with Type 1 Diabetes.

    Three or more negative lifestyle markers - lifestyle diseases like Diabetes, Hypertension, or lifestyle conditions - like heavy smoking, alcohol or being overweight.

  • Group Health Insurance from Banks - if you suffer from multiple ailments

    You can explore policies offered by banks, if -

    You find the premiums of comprehensive health plans unaffordable or your parents aren’t covered by them.

    Your parents suffer from the above-mentioned critical illnesses and don't get a senior citizen health plan.

    However, bank policies are group policies that have a very different structure from a retail policy. Here are some key differences you should understand before taking a decision:

    Renewal of group policies may not happen for a lifetime. Even if they are renewed, the terms may not be in your control.

    Banks can negotiate the benefits and terms of group policies every couple of years. The bank can also move you to a different policy that may have different terms and pricing altogether.

    Banks do not really intervene in case of a service issue in a group policy. You need to take up the issue with the insurance company or the TPA (Third-Party Administrator).

    Because the pricing is tightly negotiated, the insurance company faces higher claims. Hence, the service may not be as good as retail policies.

Check These Things Before Getting A Senior Citizen Health Insurance Plan

  • Go for the highest cover you can afford

    If your parents are senior citizens, considering the medical inflation, an INR 15-20 lakhs individual cover should be good. Otherwise, buy the maximum protection you can afford. Do not compromise on the coverage, because you don't want medical expenses to be hard on your pocket despite having health insurance.

  • Before making the payment, share your medical details

    Ask your agent or the salesperson on the phone for an underwriting of the medical papers - before making the payment. This way you can avoid the stressful payment and refund processes.

  • Fill the proposal form all by yourself

    Ensure you fill-up the proposal form all by yourself, providing accurate and honest information about your parents’ medical health. You need to declare all that you know. Being negligent or careless about health conditions can jeopardise your claim.

  • Make clear declarations on video/telephonic call

    Provide the insurer with a summary of the health assessment you carried out. Give clear and detailed answers to all the questions the insurer has. The call is recorded and will be used not only for evaluation, but also in case there is any dispute at the time of claims.

  • Ensure you understand the plan well

    You need to accept the fact that these plans would have coverage restrictions. Check the pre-existing illnesses’ waiting period. If your parents are afflicted with any pre-existing conditions, like diabetes or high-blood pressure, opt for plans with a low waiting period. This way you can get covered, at the earliest.

  • Do not depend on your employer policy alone

    Yes, your corporate health policy might cover for your parents, without a waiting period. But remember that such a policy is controlled by your employer. There are factors you cannot control, like -

    Yearly renewals

    Modifications

    Termination

    In the worst situation, the premiums might even become unaffordable or unreasonable. Also, if you leave the company, you will lose the coverage. And there’s no guarantee that your next employer will provide health insurance. So it's always better to take a health insurance cover for your parents, separately.

  • Ensure you invest in a healthcare savings fund

    Senior citizen health plans have various kinds of restrictions, like copays, room-rent limits, etc. Hence, it is important to separately save in a healthcare fund for your parents. This is all the more relevant for people who suffer from multiple diseases and thus, aren’t able to get a good plan.


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As your parents age, their risk of getting diagnosed with serious illnesses increases. The treatment costs for these illnesses are very expensive and could leave your family financially exhausted. Senior Citizen Health Insurance makes sure old-age doesn't come with huge medical expenses. Carefully check all your options, and choose the one that fits your parents the best.

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