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Old age comes with more chances of contracting diseases and falling sick that may cost huge medical expenses that you have to pay from your pocket. Going for medical treatment is quite distressing, especially in the advanced ages when one does not have a regular or limited source of income.
The senior citizen health plan is a customized health plan catering to the health-related needs of elderly people. Such plans are somewhat costly compared to regular health plans basis the plan benefits, features, inclusions, etc. You have the option to buy an individual senior citizen health plan or choose an umbrella plan that covers you and your spouse if you fall in the category of senior citizens or can take for your parents as well. It is thus a wise move to buy a Senior Citizen Health Insurance Plan for older people that covers expenses incurred due to unforeseen medical emergencies.
There are various factors listed below that will make it imperative for people aged 60 and above to buy a Senior Citizen Health Insurance Plan.
Senior elderly people require frequent and urgent medical attention and a basic health plan may not be able to cater to the health care needs of the elderly. Buying a senior citizen health plan is the best option to take care of all the required medical & health care needs of people aged 60 years and above.
According to recent estimates, medical costs are rising at an alarming rate of 15% on an annual basis. When an elderly person goes for the medical treatments, it requires huge medical bills to be paid off that may disturb the financial equilibrium of a person. A senior citizen health plan pays the expenses incurred in case of medical emergencies, and the insured doesn’t have to pay from his/her own pocket. These health plans also pay for long-term medical treatment treating critical illnesses.
People in old age are more susceptible to major illnesses that may need urgent and frequent medical attention that cost them huge medical expenses. Having a senior citizen health insurance plan covers the medical expenses and provides financial backup in case of medical requirements.
When a person is working, the employer must have covered him/her with an adequate group health policy. In post-retirement life, a person might not be covered by the employer's health policy. Buying a senior citizen health insurance plan helps you to cover the medical expenses and allow a financial backup to rely on in the event of medical treatments or exigencies.
People after attaining the age of 60+ years retire and there is no regular source of income for most of them. Some may become financially dependent on their heirs. With limited or no income it becomes difficult to manage the gigantic medical costs. Going for medical treatment would pose an additional financial burden on the family. A senior citizen health plan helps the person to pay the medical bills with ease and retain financial independence. A senior citizen health plan provides you financial protection against medical costs and treatments of various illnesses.
Senior Citizen Health Plans are basically of two types.
Under Indemnity based health plans, the claim or payout is paid as per the actual expenses sustained by the insured for getting the treatment done subject to the health cover taken. Indemnity plans don't pay you the total sum assured under the single event of hospitalization, and the insured is indemnified to the extent of the actual payout.
Fixed benefit health plans are the plans which offer you a fixed amount of benefits and are paid as lump-sum benefits under your health plan. Fixed benefit health plans pay you the complete policy sum assured on the occurrence of the insured event without taking into account the actual hospitalization or treatment expenses. Examples of such plans are Critical Illness Plans.
Following are the key determinants for computing the premium amount for your chosen Health Insurance Plan.
The sum assured you opted for, determines the premium amount for the senior citizen health plan. You should select the adequate sum assured that can easily cover all your medical conditions. Choosing a higher sum assured requires you to pay higher premiums also, but an inadequate health cover will not cover your medical expenses.
The age factor plays a key role in determining the premium amount for a senior citizen health plan. These health plans are available for those with the age of 60 years and above. Insurers tend to charge the higher premium amount considering higher health risks of senior citizens. Some insurers charge different premium amount for different age brackets, such as 60-65 years, 66-70 years, 71-75 years. Extra loading is applied on higher age brackets, such as 81-85 years, 86-90 years as applicable under the policy.
Personal health is a vital determinant that decides the cost of the premium. If you are suffering from any genetic disease, you will be charged with a higher premium amount, or the disease would be excluded from the coverage, basis the terms and conditions laid by the insurance company. Also, if you are in the habit of taking drugs, chewing tobacco, or smoking, you are charged with the increased rates of premium. These unhealthy habits directly put you at a high health risk and thus affect the premium rate as well.
If you have any pre-existing health condition, your insurance company will charge a premium at a higher rate. It is recommended to inform them about your pre-existing condition to the insurer while buying the health plan, so you can easily get the claim afterward.
Getting a claim-free year may result in a discount on the premium rates on the next policy renewal or an increase in the sum assured. No claim bonus you earn under the health plan may reduce your premium amount in the subsequent years.
Following are some of the key buying tips you can follow to buy the Senior Citizen Health Insurance Policy.
Buy an Adequate Health Cover: When buying a plan, apart from judging its benefits, you also need to select the sum assured (health cover) that can easily cover the medical expenses and is adequate for health treatment expenses. If you are under-covered, you need to pay bills from your pocket, and if over-covered, you need to pay high premiums to get a health cover that you don't require at the current moment. So, be prudent in choosing the sum assured amount. Opt for the right amount of health cover considering medical inflation, treatment and surgery costs, hospital room rents cost, your health condition, etc.
Check on the List of Illnesses Covered: You should ascertain the number of illnesses covered under the health plan. It would be a prudent decision to choose a health policy that covers a wide range of diseases. As with advanced age, the elderly person is more prone to illnesses and other kinds of treatments. The health plans also include some illnesses which are not covered under the senior citizen health plan, which needs to be reviewed before buying. You can buy a plan that covers the maximum number of illnesses, including critical illnesses.
Opt for Plan with Least Waiting Period: Health insurers usually put a waiting period after which you are covered for specific illnesses or medical treatments. When going to buy a senior citizen health plan, it is recommended to choose a plan that covers illnesses with the least waiting period.
Check for Co-Payment Clause Carefully: By opting for this clause, your premium amount may reduce, but you need to pay a specific percentage of the incurred medical claims. When it comes to health plans for people aged above 60 years when the chances of becoming ill are quite higher, you need to assess the co-payment clause prudently so that it does not put a huge financial burden on your pocket. When you go for the treatment of serious illnesses, you need to pay a huge amount from your pocket considering the expense to treat such illnesses.
Check for Renewal Age limit: Renewal age is the age limit up to which the insured can opt to renew his/her medical insurance policy. For example, if you have a health plan having a renewal age of 80 years, it means you would not be able to renew your health policy after this age limit. Some insurers offer lifetime renewability for health plans. Different insurers offer different renewal age limits, so it’s recommended to check it before buying the plan.
Opt for Plan with Domiciliary Treatment Cover: With the domiciliary treatment option, you can avail of the medical treatment at home on the advice of the attending medical practitioner. There are stances when seniors or elderly people need emergency care and thus, it is quite essential for you to buy a senior citizen health plan covering expenses incurred in case of domiciliary treatment of the insured.
Check on Sub Limits: A Sub-limit clause under the health plan provides a monetary cap towards the amount of coverage available for health insurance claims. Usually, the sub-limits are available for room rent and certain illnesses or treatments. For example, if a cataract operation costs you Rs. 1 Lakh and you claim for the amount, the insurer will pay only Rs. 30,000 due to the sub-limit clause. For senior citizen health policies, it would be a right move to choose a policy that applies nil or minimal sub-limit.
Opt for Top & Super Top-up Health Plans to Enhance Coverage: Seniors are more susceptible to critical illnesses that may eat their sum assured under the health plan and it may result in paying huge medical bills from your pocket. Taking into consideration this scenario, it’s a right move to opt for top or super top-up health plans that cover the medical expenses over and above the basic sum assured at the cost-effective premium cost.
Listed Network of Hospitals: You never know when seniors would require urgent medical attention and emergency care and address this concern, one needs to buy a senior citizen health policy that covers a broad network of hospitals having emergency care and hospitalization facilities, close to your location.
Check Claims Efficiency: It is important to know the claim settlement ratio and turnaround time of settling the claim by the insurance company before buying the health policy. Also, it’s imperative to check the efficiency of the Third Party Administrator (TPA) involved. For medical emergencies, the need of the hour is immediate financial support from the insurance company. Choose the insurance company with a higher claim settlement ratio and the fastest claim settlement turnaround time.
Read Fine Print: Prior to buying a policy, it is advisable to read through the policy terms & conditions and inclusions exclusions attached to the health plan. Read the policy wordings so you can easily assess whether the policy is the right fit for your medical needs.
Compare & Buy Online: It is important to compare the available senior citizen health plans in the market online to know about the key features, benefits, inclusions, exclusions, etc., and compare among the best ones. Also, online buying will enable you to compare the health plans from multiple insurers. Buying plans online will help you save some money as online insurance products are cheaper than offline ones. You can take an informed buying decision by choosing the best fit.
Riders with senior citizen health plans may differ from plan to plan or insurer to insurer. You have the flexibility to customize the health plan while buying.
Following are the conditions/exclusions that are not included in your Senior Citizen Health Plan.
• Pre-existing conditions: Any illness that had symptoms or received medical treatment within a stipulated period (as mentioned in the policy) of the commencement of the first policy.
• First 30 days: You can’t claim for the first 30 days from the commencement of the health policy. Accident injury claims, however, don’t require a waiting period.
• Non-allopathic treatment including.
• Medical conditions resulting from the consumption of alcohol, smoking, drugs, etc.
• Health conditions arising due to war, nuclear weapons, radiation of any kind, etc.
• Medical expenses incurred for treatment of STDs and AIDS.
• Cost of contact lenses, hearing aids, and specs.
• Convalescence, congenital external defects, intentional self-injury, general debility, expenses for diagnostic tests related to the disease for which the insured has not been hospitalized.
• Ailments such as non-infective arthritis, joint replacement, etc. are covered after completion of 2 consecutive policy years.
• Naturopathy treatment.
• Dental treatment/surgery.
(Exclusions may differ from insurer to insurer and plan to plan.)
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