By A P Singh & Sunil Kadyan
There are two kinds of health insurance policies available for senior citizens. First, comprehensive plans with an entry age of up to 65 years, which is more expensive but gives wider coverage. The second, senior citizen-specific plans, which are cost-effective but have fewer benefits.
Here are some important factors which you should consider while buying medical insurance for senior citizens.
Entry and renewal age
Most insurers offer health insurance plans with entry age of 60-80 years and a few have no entry age for these plans. Go with those plans where no entry age restrictions are there. Purchase those plans where the long-life renewability features are offered by your insurer as this varies from insurer to insurer.
A waiting period in a health plan is applicable to specific diseases. It usually lasts up to two to four years. Look for medical insurance with the least waiting duration and fewer number of diseases under the waiting period.
A co-payment clause simply means that a percentage of the hospital expenses is borne by the insured person whenever a claim comes. The co-pay is pre-decided at the time of buying the policy, could be 20-50% of the amount of the approved claim. Go for purchase those plans that have no co-payment or least co-payment.
The deductible is the amount you pay yourself before the policy begins to pay benefits. To reduce the premium, one can opt for deductibles instead of co-pay. Deductibles are better than co-pay since the former is a fixed amount while co-payment is a percentage of the total claim.
Many medical insurance policies for senior citizens come with exclusion of medical conditions or healthcare expenses that are not covered by your health plan. Read the fine print of the policy to understand which diseases are excluded from the policy. Go for the policy which has no or the minimum number of exclusions.
A sub-limit is a cap on how much a policyholder can claim for a particular expense/procedure. Several senior citizen mediclaim policies come with sub-limits. For example, sub-limit per day for room rent and ICU like 1% of SI per day and other limits like cataract surgery, knee-cap surgery, kidney dialysis, etc. Check what are the procedures/treatments that have sub-limits. Compare premium amount versus the benefits offered.
With senior citizens, there are chances of multiple hospitalisations in a year. The restoration feature reinstates the entire sum insured in case it gets exhausted during a policy year. Some insurers offer it after you completely exhaust the sum insured while others offer it after partial exhaustion. For example, if you have exhausted the base sum insured of `5 lakh in the first claim, you will still be eligible for `5 lakh in the second claim in the same year.
With some insurers, medical check-ups are mandatory. The insurers ask the proposed insured to fill a questionnaire before the policy proposal is accepted or rejected. The underwriters decide whether medical tests are needed based on these declarations. The cost of such medical examinations may not be fully borne by insurers.
Limitations on pre and post-hospitalisation expenses
This is the reimbursement of any expenses incurred by the policyholder before hospitalisation and after being discharged from the hospital. Typically, the pre-hospitalisation eligibility is 30-45 days and for post-hospitalisation is 60 -90 days. However, for many health insurances for senior citizens, the pre and post-hospitalisation period is less.
Number of day-care claims
Some procedures can be completed in less than 24 hours at a hospital and require no hospitalisation. Though most health insurance for senior citizens does cover day-care facilities, some plans restrict that number. Before buying any health plan, know the number of day-care facilities available under the policy.
Singh is director and Kadyan is assistant professor, Amity School of Insurance Banking & Actuarial Science