Top 6 things one should watch out for while buying health insurance policy for senior citizens

Insurance Regulatory and Development Authority of India (IRDAI) came up with a revolutionary step last month when it removed the ceiling of 65 years for a person to buy a health insurance policy. With these changes, many health insurers are offering health policies to citizens up to 99 years of age. It has given relief to a number of senior citizens across India who were unable to buy health insurance at an age when they needed it the most.

With the path to getting a health insurance policy for senior citizens becoming easier, there are many things that strike our minds when we purchase a health insurance policy for senior citizens.

Some of the questions that arise are: What should be the waiting period? Should it include a no-claim bonus? Should there be a co-pay option? Will it have specific coverage and inclusion?

Amit Bhandari, Chief Technical Officer, Magma HDI General Insurance, shares his tips about important factors one should consider while buying a health insurance policy for senior citizens. Here they are:

Waiting periods 

Considering the likelihood of pre-existing conditions among seniors, it’s essential to choose health insurance plans with shorter waiting periods.

Many products in the market offer reduced waiting periods of just one year for healthy seniors.

However, it’s crucial not to forget to declare any pre-existing conditions during the application process. Failing to do so could result in a claim being rejected.

Co-pay options 

Senior health insurance policies often include co-pay, where the policyholder pays a portion of the claim while the insurer covers the rest.

It's important to understand that reducing premiums can lead to higher co-pay percentages.

Striking a balance between premium and co-pay is crucial for affordability during purchase and comprehensive coverage during claims.

Additionally, some companies offer relaxed or no co-pay for specific incidents.

For example, there is a ‘no co-pay’ benefit for claims arising from certain accidents, like falling from bed, which are very common amongst senior citizens.

Healthy seniors can choose policies with a higher co-pay option to lower premiums.

Doing so, they can then set aside the money saved on premiums and use it for co-payment only in case of a medical emergency.

No claim bonus (NCB) 

A no claim bonus, also known as a cumulative bonus, is a perk provided by insurers to policyholders who have not made any claims during the policy period.

This bonus can be accumulated over successive years and helps beat medical inflation as well.

Hence, one should opt for health insurance that offers NCB.

Senior citizen-specific coverages 

One needs to check if your policy offers extended post-hospitalisation benefits, nursing care at home, and an option for domiciliary (in-home) treatment, which is often essential at this stage of life.

Also check for additional benefits like health check-ups, tele-health services, and pharmacy discounts to address day-to-day healthcare needs.

Furthermore, dedicated on-call support for claims and grievances of senior citizens is mandated by the Irdai, ensuring access to assistance when required.

This support is available across industries and in various vernacular languages for ease of communication.

Lifestyle requirements

One needs to choose a plan that also aligns with one’s preferences and lifestyle.

For example, if you enjoy travelling, opt for a plan that offers coverage during trips or provisions like an air ambulance for emergencies.

Coverages and exclusions

Staying informed about your policy terms, maintaining accurate records, and understanding the claim process are essential to preventing claim rejection.

Often, in lieu of fulfilling their familial responsibilities of providing for the family, e.g., children’s education, marriage, etc., Indians miss out on preparing for their old age healthcare needs.

A report released in 2021 revealed that only 15 out of every 100 people in the age group of 60–80 have health insurance.

Postponing the purchase of health insurance until your senior years can present notable hurdles, including limited access, higher premiums, and coverage issues.

Hence, it is always advisable to buy insurance when you are still healthy and hearty.

Nevertheless, if you're 60 and have yet to purchase health insurance, obtaining coverage is still attainable through tailor-made insurance products available in the market.

By thoughtfully evaluating factors such as waiting periods, coverage options, and renewal terms, you can confidently navigate the health insurance landscape, ensuring you have the necessary protection in place to safeguard both your health and peace of mind.