Health insurance policy for the elderly: How to choose the right one

Rising healthcare costs and inflation are making it increasingly important for senior citizens o have  health insurance. As we age, our bodies become more vulnerable to diseases and lifestyle disorders, which can lead to unexpected medical expenses.

Insurance can help to protect fom financial ruin in the event of a medical emergency. . Some factors to consider include your health history, your budget, and your desired level of coverage. Before choosing one insurance policy, While, there is no one-size-fits-all solution, the right insurance plan can give you peace of mind knowing that you are financially protected in the event of a medical emergency.

Pick a comprehensive plan

"Comprehensive Health Insurance plans offer a wide range of sum insured options to cater to diverse premium paying capacities. They offer coverage for all inpatient needs including critical illnesses and coverage for existing conditions with reduced waiting periods. The provision for reinstatement/ refill of sum insured ensures continuous coverage and better utilisation in case of claims," said Anand Pejawar, Whole-time Director, SBI General Insurance
Additionally, such policies offer value-added services like annual health check-ups for proactive health monitoring. Benefits like OPD cover and AYUSH cover further enhance the insurance offerings.

"Our suggestion is to provide the elderly with flexible, comprehensive, and supportive insurance solutions that will help prioritize their well-being and peace of mind,: said Pejawar.

Don't opt for a dedicated plan just for the elderly 

The ideal health policy for the elderly would be a policy that is not a dedicated plan for the elderly or senior citizens but a normal plan because normal plans come with lesser number of restrictions and better features.

"However, the underwriting checks are stringent for these normal plans and there are high chances you may not be able to purchase the plan. Dedicated senior citizen plans come with co-pay clauses, higher waiting periods and other restrictions. If eligible, you should opt for a normal plan," said Anuj Parekh - Co-founder and CEO, Bharatsure. 

Opt for critical cover 

 

Critical cover add-ons are a great way to protect against major diseases that generally turn up later in life. "The challenge is again whether the customer is eligible because of their age and medical history. Add-ons such as cover for non medical consumables, shorter waiting periods, OPD covers etc are great to have," said Parekh.

But it is important to evaaluate the base health insurance policy coverage. If it already provides comprehensive coverage, additional riders may not be necessary.

Don't bet on family floaters 

While most family floater health insurance plans can cover elderly family members, it is advisable to buy a standalone senior citizen health insurance plan to meet the different medical needs of senior citizens.

Some of the key factors which should be considered while taking up a health insurance plan for senior citizens

Day Care Facilities: Advancement in technology has meant a lot of medical procedures and surgeries e.g. cataract surgery, dialysis, etc.; can be done in a few hours and thus, do not require hospitalisation. It is better to buy a senior citizen plan that covers both hospitalisation and day care procedures, as per Parthanil Ghosh, President- Retail Business, HDFC ERGO General Insurance.

Claim Settlement Process: Claim settlement ratio and the time taken by an insurance company to approve and settle claims should be taken into consideration while purchasing a senior citizen health policy. "If an insurance company’s claim settlement time is less and the claim settlement ratio is high, it means that the chances of your claim getting settled quickly are more," said Ghosh.

Network Hospitals: All health insurance company have their network of hospitals where one can avail cashless hospitalisation facilities. Enquire about the list of network hospitals before buying a plan to ensure good hospital in your locality is on the list.

Free Medical Health Check-Up Facility: Look for a policy that allows the policyholders to avail free medical check-up on an annual basis. 

Waiting Period: Most elderly people suffer from pre-existing diseases whose treatment are expensive. Hence, it is ideal to opt for a senior citizen health insurance plan that comes with a minimum waiting period for pre-existing diseases.

Domiciliary Hospitalisation: In case of unfortunate situations, an elderly person’s health condition may not allow him/her to get admitted to a hospital. In such a case, health plans with domiciliary hospitalisation cover will take care for home treatment expenses.

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Cashless: The elderly might want to consider inserts that have specific  hospitals in their cashless network list. "Select zero co-payment option to enjoy cashless and hassle-free insurance experience," said Siddharth Singhal, Business Head – Health Insurance, Policybazaar.com. He also recommends choosing a plan that includes no-claims bonus to increase the base sum insured with a fixed percentage and one that offers OPD benefit to cover for doctor consultations as may be required more frequently in old age.

In short, "A product which offers cover against hospitalisation, health care at home and routine health check-ups should be preferred. Value added services like a dedicated personal health manager, home nursing will make a product more suitable for elderly. Compassionate Care cover should also be considered while shortlisting a product. One should also consider Pre-existing waiting period and claim management services of the insurer before finalizing a senior citizen product," said Dr. Santosh Puri, Senior Vice President - Health Product & Process, Tata AIG General Insurance.

Below is a premium table of affordable health plans for a senior citizen couple living in Delhi, as curated by Policybazaar

HDFC Fargo's Ghosh also explains the factors that will determine the amount of premium you have to pay annually: 

1. Age: Premiums tend to increase with age, as older people are more likely to require frequent medical care.
2. Health Status: Individuals with pre-existing medical conditions may face higher premiums.
3. Sum Insured: Higher coverage levels lead to higher premiums.
4. Policy Type: The type of health insurance policy, such as individual, family, or group coverage, will impact the premium.
5. Coverage Options: The scope of coverage, including inpatient, outpatient, and critical illness coverage, can influence the premium. Broader coverage options come with higher premiums.
6. Co-pay and Deductibles: The presence of co-pay (a percentage of the claim to be paid by the insured) and deductibles (an initial amount to be paid by the insured) affects the premium. Higher co-pay and deductibles result in lower premiums.
7. Sub-Limits: Some policies have sub-limits on specific medical expenses like room rent or doctor fees. Policies with lower sub-limits may have lower premiums.
8.  Location: Healthcare costs can vary as per the location of the policyholder.
9.  Add-Ons/Riders: Additional coverage options like critical illness riders or hospital cash can increase the premium.
10.  Policy Tenure: The duration of the policy can affect the premium. Longer-term policies may offer discounts and more stable premiums.
11. Lifestyle Factors: Some insurers consider lifestyle factors such as smoking habits and BMI (body mass index) when determining premiums.

It is important to compare policies and consider the specific needs and budget of the senior citizen when choosing a health insurance policy.