Understanding The Waiting Period For Senior Citizen Health Insurance
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Being young is not a guarantee of health; rather, as people age, their health requirements and vulnerabilities rise. Pensioners, which usually include all patients aged 60 and above, have more frequent and severe illnesses that need quality healthcare. It is also important for the elderly to possess a health insurance policy in order to pay big bills. However there is normally an initial exclusion period within which no claims can be made with regard to most health insurance policies for the elderly. Now, let us try to know what this waiting period means.
These mediclaim policy are specifically intended for elderly individuals who are 60 years or older. These plans have incorporated the fact that the elderly have more illnesses, hospitalisations, and medical needs. They offer cashless hospitalisation in the event of a medical crisis, in addition to coverage on pre- and post-hospitalization charges.
Others may also encompass outpatient treatment, critical illnesses, preventive health check-ups and others depending on the type of policy that has been taken. While the premiums are slightly higher than traditional health plans, the coverage offered is sufficient to ensure that senior citizens are well protected.
What is meant by a waiting period in the context of health insurance?
In health insurance, a waiting period signifies an initial time period after the purchase of a policy, after which the policyholder cannot make a claim. This period may vary from 30 days to 4 years, depending on the type of coverage and medical condition of the individual. Pre-existing diseases often include waiting periods of 2 - 4 years, while other diseases have waiting periods of 30 days to 2 years. Thus, if you make a claim on any specific medical condition during the waiting period, it will not be covered under the policy.
There are different kinds of waiting periods that are offered in health insurance plans. Mainly here are three main kinds of waiting periods in senior citizen health insurance as discussed below:
1. Waiting period for the initial period:
For many policies, the initial waiting period ranges from 30 days to 90 days in all the claims.
2. Waiting period for pre-existing diseases:
For pre-existing ailments, the waiting period is 2 - 4 years if the condition developed before purchasing the policy.
3. Waiting period for specific Illnesses:
Conditions like joint replacement surgery, cataract surgery, hernia, and piles require a waiting time of 1-2 years.
Information concerning how health insurance for senior citizens works
Senior citizen health insurance plans offer cover only in case of hospitalization and do not cover outpatient treatment. It also encompasses hospital room rent, medical charges, prescribed medicines and diagnostic tests in the event of hospitalization as per the policy document. There is also coverage of expenses that accrue before and after admission – this is often for 60 days before admission and 90 days after.
There is also the cashless claim facility in which the insurance provider pays the hospital for the treatment. Otherwise, the senior citizens can make the expenses and then go through the documentation to get the reimbursement up to the amount and limits insured. There is no restriction in terms of age for renewal and most policies permit lifelong renewal. Amount insured can be Rs. 1 lakh and minimum Rs. 10 lakhs or more depending on the insurer and the particular plan.
Hence, let us take a look at some of the important features of senior citizen health insurance plans.
Some key features and benefits of senior citizen health plans
Following are some of the key features of the plans which make them a good option to save on health costs:
- Not required to have medical check-up depending on the age
- Pre-existing disease waiting periods removed in some cases
- Extra limitations for modern treatments
- Treatment for chronic illnesses is the foremost reason for cover.
- Special claims administration and hotline for elderly people
- EMI for the payment of premium from the facility
- Larger tax deductions on premium paid
Senior citizens should have a health insurance policy for what reason?
With age, the chances and expenses of health problems increase significantly, and this is more than enough to explain why the elderly require more care and medical insurance. Hence, it is extremely important for senior citizens above 60 years to have adequate health insurance cover for the following reasons.
- Guard against high medical inflation and costs.
- Enjoy the benefits of cashless hospitalisation with an increased sum insured.
- Obtain insurance for pre-existing conditions.
- Avoid burdening family/dependents.
- Experience smooth claiming with benefits set based on lifecycle.
- Acquire security, both in terms of guaranteed money and freedom from anxiety.
Top 4 challenges that senior citizens face while selecting a health insurance plan:
Listed below are the challenges senior citizens face while selecting a health insurance plan:
1. Understanding Complex Policies:Health insurance policies have many technical terms, restrictions, and benefit provisions that the elderly may find difficult to comprehend. It is often challenging to navigate copays, co-insurances, deductibles, difference between in-network and out-of-network, etc., as well as to understand what is actually reimbursable.
2. Comparing Multiple Plans:
Original Medicare is combined with Part D prescription plans, Medicare Advantage, Medigap plans, etc. So, the costs, coverage, and networks of providers, formularies, and ratings of plans can confuse people. It is challenging to keep track of all these plan details.
3. High Costs:
Many senior citizens who are on fixed incomes find health insurance for senior citizens and out of pocket expenses for medical services unaffordable. Selecting a plan that is affordable while at the same time covering the present and future healthcare needs is difficult. Another challenge is the high and fluctuating nature of the costs which complicate the choice of coverage.
4. Determining Appropriate Coverage:
Healthcare needs of seniors continue to change as they age. Selecting a plan that will have enough coverage for doctor visits, tests, chronic condition medications, hospitalization, etc. based on an individual’s health profile and probable usage is challenging. It is easy to over or under-insure oneself in the context of today’s insurance offerings.
Tax benefits for senior citizens
The Income Tax Act also allows senior citizens to claim higher deductions under section 80D – Rs. 50,000 for health insurance premium payments for themselves and their spouses.
However, suppose you are paying the premium for your dependent parents. In that case, you can avail yourself of an additional amount of Rs 50,000 of income tax deduction, up to the amount of premium paid, under section 80D, which is over and above the basic Rs. 25,000 deduction permitted under this section.
Therefore, the various insurance policies allow consumers, especially senior citizens, to reduce their taxes if they purchase enough health coverage legally.
Conclusion
The senior citizen medical insurance plans are a special type of health care plan that is intended to look into the health needs of the elderly. It, therefore, helps the senior citizens to be aware of the waiting periods in order to avoid any complications later on. Buying these health insurance for senior citizens also offers other advantageous tax deductions thus making these plans important as well as wise to buy.
Disclaimer: The above information is for illustrative purposes only. For more details, please refer to policy wordings and prospectus before concluding the sales.
Disclaimer: No Business Standard Journalist was involved in creation of this content
Topics : health insurance policy
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First Published: Sep 18 2024 | 3:01 PM IST
