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Factors to Consider While Buying Health Insurance for Senior Citizens

27 May 2022, 5:21 PM

Health Insurance in adequate amounts is an absolute necessity for the entire family, keeping in mind the rising cost of hospitalisation and the various healthcare services in India. Your elderly parents are more prone to avail of these services owing to their age-oriented health complications. Hence, to take health insurance policy for your elderly parents is the need of the day so that you are ready to handle any exigency at any given point in time.

 It may no longer be enough to include your elderly parents in a group policy for the family, rather it is prudent to take individual health policies for them as it is more likely that with their growing age, their repeated visits to the hospitals will increase.

What does Health Insurance For Senior Citizen Mean?

Health Insurance Policies for a senior citizen implies an insurance policy taken for an individual above the age of 60 years, to take care of all the medical expenses they incur. In such policies, the policyholder pays a premium amount to the insurer and the company pays for the various healthcare services availed by the insured person, like hospitalisation, pre hospitalisation and post-hospitalisation expenses and also daycare expenses in some cases. 

A senior citizen health insurance plan is designed specifically to cover the ailments of the senior citizen like pre-existing diseases (PED), OPD benefits, cashless insurance claims etc. So, if you as a senior citizen have any pre-existing disease, it might make more sense if you opt for a senior citizen specific health insurance plan.

Things to Remember While Getting Health Insurance For A Senior Citizen

There are a few key points which should be kept in mind while buying Medical Insurance policy for the elderly.

Sub Limits
This is the coverage given for all the medical expenses incurred by an insured senior citizen when he or she is admitted to the hospital for more than a day (24 hours). This benefit should cover all hospitalisation costs which include doctor and specialist fees, fees of the nurses, expenses for medicines, the medical tests related to the hospital stay, etc.
It is extremely important to choose and select a policy which gives maximum coverage for in-patient hospitalisation as the number of stays in a hospital for an elderly patient is most likely to be on the higher count. There could be sub-limits to certain expenses in some health insurance policies like fees for the doctors or nurses, whereas the in-patient hospitalisation expenses is fully covered.

Pro Tip: Try to opt for a health insurance plan with no sub-limits or high sub-limits so that you get maximum coverage. 

Restrictions on Post Hospitalisation Expenses
The expenses which are directly oriented to the illness or injury for hospitalisation, incurred by the policyholder after discharge from the hospital, are reimbursed by the insurer within a period of 60 to 90 days, as stated in the policy. In some policies the period for post hospitalisation expenses is reduced while in others, the total post hospitalisation claim is limited to 7% to 10 % of the total claimed amount for hospitalisation. It is important to take note of the applicable term for a particular policy before getting it into your kitty.

Pro Tip: Try to opt for a senior citizen health insurance plan with high tenure for pre and post hospitalisation reimbursements. That way, all related expenses like diagnostic tests, medicines, doctor visits, etc. during this period would be covered.

Limitations on the Day-care Hospitalisation Procedures
The procedures which can be completed in less than a day (24 hours) in a hospital, like, cataract operation, dialysis, chemotherapy, etc, are referred to as the day- care procedures in medical terms. These procedures are covered in most policies for senior citizens. 

Pro Tip: However, in some senior citizen health insurance plans, there could be limitations on the number of day- care procedure facilities that can be availed by way of the policy. Some policies have restricted the number to as low as 8 to 10 which are covered. So, it is definitely important to check on this number before purchasing the policy for a senior citizen.

Conditions Applied for Pre-existing Illnesses: 
Pre-existing illnesses are common among senior citizens. You should check the terms and conditions applied for the pre-existing illnesses before buying any health policy for them. The pre-existing illnesses which are covered, the waiting period for each of them and the co-payment clauses for each should be noted before signing up the policy form.

Pro Tip: If you are applying for a health insurance plan for a senior citizen with a pre-existing ailment, always remember to declare the same at the very beginning in writing, so that there is no ambiguity later. Also, try and opt for a health insurance plan with the minimum waiting period for coverage of pre-existing ailments.

The Waiting Period, Co-payment, Exclusions and Sub-limits should be Examined

You should ensure that you read the policy document when you buy a health Insurance Policy for your parents, who are senior citizens, to understand the waiting period, co-payment, exclusion and sub-limits of the policy.

Waiting Period
This is the period when you cannot put forth any claim in case the insured person has any pre-existing disease or illness. No claims will be admissible during this period. The waiting period for most health insurance policies is two to four years. However, for senior citizens, many insurance companies have reduced the waiting period to as little as one year. 

Pro Tip: You must keep in mind that the lower the waiting period, the better it is for senior citizens as the need for immediate hospitalisation is much higher for them than a younger person.

Co-payment Clause
This is a clause by way of which you are bound to pay a part of the claim of hospitalisation from your personal kitty. Health Insurance policies for senior citizens mostly come with a co-payment clause. The co-payment usually varies from 10% to 30% of the claim value in case of senior citizens.  Co-payment also depends on the waiting period. If the waiting period of the policy is less, then the share of co-payment is higher for the same. 

Pro Tip: So you must read and understand what the policy states regarding the waiting period and co-payment clause before you buy the policy.

Many Health Insurance Policies have some exclusions of certain diseases, medical conditions or expenses incurred for availing certain healthcare services, which are not covered in case of senior citizens. 

Pro Tip: You must keep in mind that the best policies would have no or a minimum number of exclusions of such illnesses or procedures when you get a policy for an elderly person.

Many Health Insurance Policies for Senior citizens have sub-limits. It means that the claim for certain medical expenses or procedures is capped at a specific amount. The policyholder cannot claim any higher amount for that particular procedure as mentioned in the policy document. 

Pro Tip: For example, cataract surgery, kidney dialysis, knee replacement surgery, etc are some procedures that are offered with a sub-limit by the insurance companies. You should ensure that you understand the terms and conditions for each of the procedures to which the sub-limit clause applies.

Benefits offered v/s Premium Amount: When you buy a Health Insurance for a senior citizen, it is a prudent decision to go for the policy which offers maximum benefits for a lower premium amount, rather than going for a policy which is offered at the lowest premium amount. In any case, the premium amount for senior citizens is higher than that of the younger individuals. Moreover, some health insurance companies offer monthly premium paying options, which make it easier for policyholders to pay the premiums.The best gift you can consider for your parents is to get a Health Insurance Plan for them. Do keep in mind the pointers discussed above to choose the best suited Health Insurance Policy for your precious parents. Once the above points are met, you can further consider some more benefits that certain Insurance companies offer in their bouquet!

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