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Home News 10 Secrets to Getting the Most Out of Your senior Citizen Health...
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10 SECRETS TO GETTING THE MOST OUT OF YOUR SENIOR CITIZEN HEALTH INSURANCE

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October 1, 2023
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Introduction:

A majority of households in the country often overlook health insurance. Even
families with active life insurance policies for the family head refuse to
acknowledge the importance of taking health insurance. The rapidly changing
lifestyle of people tags along diseases like obesity, heart disease, diabetes
and stroke. This, in turn, has made hospitalization, treatment and medical
expenses an inevitable part of most people’s lives. Along with the massive
increase in the number of people diagnosed with such diseases, healthcare costs
also multiply. This, coupled with the vulnerability of elderly parents, takes
both emotional and financial toll on the entire family. Health coverage for
senior citizens lets the family breathe easily during the crisis by easing
financial concerns and allowing them to look after their ailing parents.

Health insurance for senior citizens in India:

Health insurance for senior citizens is a specially designed insurance plan to
address the healthcare needs and medical expenses of individuals aged above 60
years. It helps them cover medical treatment and hospitalization costs at the
hospital of their choice. It offers numerous benefits like pre-existing disease
coverage, cashless hospitalization coverage, pre and post-hospitalization
coverage, preventive health check-ups and tax benefits. The insurance is a
safety net that offers financial support when needed, thereby reducing the
anxiety and economic concerns of the ailing person and their family.

Since numerous health insurance policies are offered by about two dozen
insurance companies for senior citizens in the country, it has become vital to
look for a coverage plan that caters to the various needs of the individual.
Below are some of the secrets one must be aware of before choosing a health
insurance policy for senior citizens.

1. Claim settlement ratio:

The claim settlement ratio (CSR) is the ratio of claims settled successfully by
the insurance company against the total number of claims that they have
received. The factor not only tells policy seekers about the financial capacity
of the insurer to pay claims but also gives an insight into their consistency
level in settling claims. Since a high claim settlement ratio indicates the
insurer’s commitment to settle claims, it always plays a vital role in choosing
the policies.

The Insurance Regulatory and Development Authority (IRDA), a statutory body
constituted to regulate and license insurance industries in the country,
releases quarterly reports detailing claims settled by each insurance company.
CSR is believed to be fair if it falls between 75% and 90%, though a higher
ratio is better for the policyholders.

2. Incurred claim ratio:

The incurred claim ratio (ICR) is the total amount of money paid by the company
as claims against the total premium collected from policyholders. It helps
policy seekers understand the insurance company’s financial stability and
reflects its long-term financial credibility. The ratio can be viewed as the
company’s ability to pay equal importance to policyholders’ and their financial
well-being. Just like CSR, it is also published by IRDA in its report. ICR is
believed to be ideal if it falls between 50% and 100%.

3. No-claim bonus:

Abbreviated as NCB, it is a remunerative benefit the insurance company offers to
police holders for a claim-free year. It is one of the significant factors to
consider while choosing a policy since it provides a monetary benefit for every
no-claim year, which will help increase policyholders’ insured amount. The
insurer can either offer a cumulative bonus – under which policy holders’
insured amount will increase by a certain percentage – or a discount on premiums
– under which the premium rate of policies will come down by a certain
percentage.

4. Pre-existing disease coverage:

Pre-existing disease (PED) is a medical condition the policyholder has before
purchasing a policy. As per the guidelines issued by IRDAI, a policyholder is
said to have PED if they were diagnosed with a medical condition up to 48 months
before purchasing the policy, and it includes any long-term condition right from
high blood pressure and diabetes to thyroid and asthma. Since most of the
policies cover PEDs only after a waiting period and no claims raised for PED
treatment will be approved during the waiting period, it is wiser to purchase a
policy with a minimum waiting period. On average, the PED waiting period is
between two and four years, but it varies from one company to another.

5. Extensive network hospitals and cashless hospitalization:

Since senior citizens are vulnerable to diseases and may require frequent
hospitalization, it is always better to purchase health insurance covering many
network hospitals. It will be more convenient for policyholders to find a
hospital nearby if the list of network hospitals included in the policy is
longer.

In network hospitalization, a policyholder can get treatment in one of the
hospitals included in the insurance company’s network and avail of cashless
Mediclaim without submitting any bills or documents and without any waiting
period. The company will bear the expenses covered under the policy. If treated
at a non-network hospitalization, the policyholder must pay the hospital bill
and claim the amount by submitting the documents and invoices. It usually takes
a couple of weeks to get the refund amount.

6. Co-payment:

Co-payment, which is nothing but a fixed sum in the claim that the policyholder
agrees to pay irrespective of the claim amount, is insisted in most of the
health insurance policies for senior citizens. While the policyholder pays the
co-payment amount, the insurance company pays the remaining amount. In most
cases, it varies from 10% to 30%. Most policyholders prefer to purchase a policy
with either no co-payment or less co-payment because a higher co-payment kills
the purpose of buying the insurance policy. So, it is vital to check the clauses
of the policy before purchasing one.

7. Lifetime renewal:

Since most health insurance policies have an age limit for renewal, choosing a
policy with lifetime renewability is wiser. It means a policyholder can renew
their coverage without re-qualifying for a new policy. With this policy, a
policyholder, especially a senior citizen, need not worry about spending from
their pocket for treatment. Since it does not have an age limit, one can
continue receiving health insurance coverage for life, and there is no waiting
period for PEDs.

8. Tax benefits:

As per the section 80D of the Income Tax Act, 1961, a senior citizen or those
who are paying for health insurance for senior citizens can avail of health
insurance tax benefits. It offers tax deductions on insurance premiums up to Rs
50,000 in a financial year for senior citizens. If you are someone who is aged
above 60 years and you have claimed health insurance policies both for yourself
and your parents, then claims can be made up to Rs 1 lakh in a financial year.
However, deductions under the section cannot be claimed if the company made a
group health insurance premium on behalf of the employee.

9. Critical illness plans:

It has become essential to avail of a critical illness plan even if a person
already has a health insurance policy. It provides extensive coverage against
life-threatening conditions like cancer, kidney failure and heart attack. Apart
from easing the financial concern during the emergency by covering medical
expenses, the plan also ensures that their livelihood is not put at stake by
compensating for the lost income.

10. Policy with AYUSH cover:

Due to the rise in number of people opting for AYUSH (Ayurveda, Yoga and
Naturopathy, Unani, Siddha and Homeopathy), an alternative medical treatment,
IRDAI has gone a step ahead and modified its guidelines to let insurance
companies to cover AYUSH treatment. As a result, health insurance companies have
started covering the expenses incurred for the treatment.

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