12 Points to Check before Buying Health Insurance for Senior Citizen

Did you know India is home to 138 million senior citizens and alarmingly covers only 2% of its population under health insurance?

For those with parents aged 60 and above, ensuring comprehensive health coverage becomes paramount, especially considering the susceptibility to age-based diseases such as high blood pressure, heart disease, diabetes, and more.

WHY?

Getting treatment for these pre-existing diseases requires substantial treatment costs, which are challenging to manage during physical and emotional turmoil. Health insurance thus ensures older people can access quality medical care without financial burden.

When choosing a health insurance plan for senior citizens, there are several important factors to consider. Here are some recommendations from Policybazaar (PB) to help make the decision easier"

1. Coverage Amount (Sum Insured)

The sum insured is the limit to which the health insurance company will pay for your medical expenses covered under the policy.

PB Recommendation: You must prioritize comprehensive coverage over low premiums for senior citizens. Ensure the health insurance plan covers critical illnesses and offers sufficient coverage amount. You should go for at least an insured sum of 10 lacs per person.

2. Waiting Period for Pre-Existing Conditions

A waiting period or cooling period for a pre-existing ailment is when you cannot claim any pre-existing disease (PED). Some of the most common examples of pre-existing diseases among Indians are high blood pressure, asthma, thyroid problems, diabetes, and more.

PB Recommendation: Always opt for health insurance plans with minimal waiting periods or those with pre-existing disease (PED) coverage from day 1. This will ensure immediate coverage and timely access to healthcare during a medical emergency related to your pre-existing condition without worrying about hospital bills.

3. Deductibles and Co-Payments

Deductible is the amount you must pay before the insurance company starts paying. In other words, the insurance company is liable to pay the claim amount only when it exceeds the deductible. Co-pay in health insurance refers to the predetermined amount or a fixed percentage of a claim amount the policyholder must pay.

PB Recommendation: If you are purchasing health insurance plans for senior citizens, you must scrutinize sub-limits and co-payments to avoid last-minute surprises. Ideally, take a policy without deductibles and co-pays; however, they might be expensive. In such a scenario, you can also look to buy a policy with low deductibles and co-payments. Awareness about these is critical, though.

4. Room Rent Type

It refers to the maximum amount the insurer will pay for your hospital room rent. In old plans, the room rent limit was usually capped at around 1-2% of the sum insured. It also includes paying a large part of nursing, ICU, surgery charges, doctor's fees, and more. However, thankfully, most modern health insurance plans now have no room rent limit and no capping on related expenses such as doctor consultations, nursing and ICU charges, and more.

PB Recommendation: For senior citizens, choosing a health insurance plan with no rent limit is advisable. This ensures flexibility in selecting hospital accommodations without compromising on quality healthcare services.

5. Exclusions

Exclusions refer to specific conditions or treatments not covered under the policy. Familiarize yourself with the list of exclusions in your health insurance policy to avoid unpleasant surprises during claim settlement.

PB recommendation: Wherever you buy from, ensure the seller informs you of these exclusions. If they are not informed, it can lead to massive issues at the time of claims.

6. Disease Sub-limits

Some plans impose sub-limits on specific diseases or treatments, capping the maximum amount the insurer will pay for those expenses. For example, a policy might have a sub-limit of ? 30,000 for cataract surgery. Similarly, many plans impose a limit of 10% of the sum insured on modern treatments.

PB recommendation: Senior Citizens must opt for plans with no sub-limits and opt for an advisor who is transparent and explains all the sub-limits.

7. Pre-Post Hospitalization Care

Hospitalization and medical expenses incurred before and after hospitalization, such as diagnostic tests, consultations, and medications, are known as pre-post-hospitalization expenses. Example: If you're hospitalized for surgery, your health insurance plan may cover the cost of pre-hospitalization diagnostic tests, surgeon consultations, and post-hospitalization medications prescribed during your recovery period.

PB recommendation: Senior Citizens should purchase health insurance plans with at least 60 days of pre-hospitalization and 180 days of post-hospitalization expenses. This is relatively standard across plans now.

8. Day Care Treatment

Daycare treatments are medical procedures or surgeries that can be completed within a single day without needing an overnight hospital stay. All health insurance plans cover these treatments.

PB recommendation: Opt for a policy covering daycare treatments without sub-limits.

9. Renewal Age

The renewal age is the maximum age at which you can renew your health insurance policy. It varies depending on the plan.

PB recommendation: Be sure to check the maximum renewal age of the policy. Opt for a plan that offers lifelong renewability, ensuring continued coverage for senior citizens without age restrictions.

10. Add-On Riders

Riders are extra coverage or benefits you can buy alongside your base health insurance policy to expand its coverage.

PB recommendation: Explore the add-on riders or optional benefits offered by the insurance plan, such as critical illness cover, hospital cash benefit, and domiciliary treatment cover. Assess whether these riders provide additional value and suit the healthcare needs of senior citizens.

11. AYUSH Treatment

AYUSH treatment refers to alternative medicine, including Ayurveda, Yoga, Unani, Siddha, and Homeopathy.

PB Recommendation: If you are looking for alternative treatments or are tired of dealing with side effects from medicines, consider adding an AYUSH treatment rider to your policy. Traditional health and wellness treatments are cost-effective and have negligible side effects.

12. Blacklisted Hospitals

A blacklisted hospital is a healthcare facility that is not recognized by the insurance company or has been deemed ineligible for coverage.

PB Recommendation: Confirm the network of hospitals and healthcare providers affiliated with the insurance company. Ensure there are reputable hospitals in the network, preferably near the policyholder's residence, to access quality medical care easily.

Latest Updates about Senior Citizen Health Insurance Checklist

• Maximum age limit restriction removed on purchasing Senior Citizen health insurance.
• Waiting periods for pre-existing disease reduced from 48 months to 36 months.
• Insurers now offer premium installment plans to ease the burden on policyholders.?

In summary, when selecting a health insurance plan for senior citizens, choosing one that offers adequate room rent coverage and aligns with their healthcare needs and preferences is essential. A comprehensive plan with higher room rent limits provides financial security and ensures access to quality healthcare services during medical emergencies.