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How to handle medical costs of Senior Citizens?

Health Cover in the Golden years

Insurance is a product which cannot be purchased, when you really need it! Sounds confusing? We will not listen to our insurance agent, when he meets us during our active life. But when we are diagnosed with some health problem, we really wish that we could have taken a policy! At that time, no insurance company will offer insurance to you. Health insurance is all the more fit into the above story, because living without a health cover is going to be almost impossible in advanced ages. Thanks to the ever increasing medical costs and the incidence of lot of life style diseases and the increasing longevity. So, it is in our own interest, to ensure that we are having a health cover, when we are healthy. Go for a policy which offers life time renewals.

But, if you have not bought a health cover and are already into your 60s, or if you are having parents in that age group, you can still go for the limited edition offer – Senior Citizen’s Health Plans. IRDA has mandated insurance companies to keep the entry age upto 65 in health policies. Today, such senior citizen’s policies are offered by National Insurance Company, Oriental Insurance Company, New India, Star Health and Bajaj Allianz General Insurance.

These are similar to the normal health cover but with certain limitations. Entry age is limited to 60 – 70 in most cases and are renewable upto age 75 or 90. Most of them are having a limited sum insured range between 1 lakh and 5 Lakhs.

Another restriction in these policies is the co-payment clause. In simple words, you have to share a portion of the bill, while the balance only will be paid by the insurance company. For example in the case of Star Health’s Red Carpet Policy, 50% co-payment is applicable for pre-existing diseases and 30% for all other claims.

Name of the Company Oriental New India National Bajaj Allianz Star Health
Policy Name HOPE Senior Citizen policy Varistha Mediclaim Silver Health Red Carpet Policy
Entry Age 60 60-80 60 -80 46-70 60-69
Renewal allowed upto lifetime 90 90 75 beyond 69 with loading as per claim
Sum assured 1lakh – 5 Lakhs 1lakh – 1.5 Lakhs 1lakh – 2 lakhs 50000 – 5 Lakhs 1 lakh – 5 lakhs
Co payment 20% NIL 20% Nil 30%
Extra Features Pre existing diseases are not covered. Pre. existing diseases cover after 18th month 50% cover to pre.  existing diseases from 2nd year. Pre. Existing diseases covered from 1st year with 50% Co-pay.

Please study the exclusions before taking the policy. Pre – existing ailments are covered generally from the 2nd year with certain conditions. In most of the health policies, certain ailments are totally excluded and certain ailments fall under the pre existing category. We have to see the fine print to understand which ailments are covered from which year. Most of these policies will not cover cataract, knee replacement etc. in the first 2 years while dental treatments are excluded totally.

Loading on renewal:

Most companies will load the premium based on the claim experience in the policy. Please check the insurance companies loading mechanism before buying the policy. Some companies charge higher premium initially and will have less loadings on renewal. Most of the companies are charging premium based on age bands. When you move from one age band to the next, the premium increases sharply. Look out for premium in your next age band, while analyzing the policy.

Sublimits:

Most policies have sub limits for certain ailments. If your sum insured is 2 lakhs, and if knee replacement surgery is having a Cap of 70%, you will get only 1.4 Lakhs even if you spend more than that for the treatment.  Most policies will have a sublimit of 1% for room rent. Look for policies with less sublimit.

What to do?

Companies like Apollo Munich and Max Bupa offers policies which are having life time renewal facility and without much sub limits. You can go for these policies if you are below 65. The premium will be bit higher compared to the PSU companies. But if you can afford, these policies offer value for money. Don’t just look at premium only while selecting the policies. Look for exclusions and sub limits and lifetime renewal facility.

8 Comments

  • V G Bhat Posted November 1, 2011 2:23 pm

    Hi,

    I have an old Family Mediclaim of National Insurance for my mother (77 yrs now) for Rs. 2 lacs and for me (43 now) for Rs.50K, for present premium Rs. 15,743/- (after no claim bonus and taxes).

    Since this policy covers up to the age of 80 yrs only I need to go for another policy for my mother which covers for at least another 8-10 yrs. Meanwhile I got covered myself for Rs. 3 lacs by another policy by Star Heath Medi-classic, last year for Rs.4026/-

    An agent offering a new policy of United India’s Senior Citizen mediclaim policy to my mother(77) for Rs. 2 lacs at premium of Rs.14,340/- (including taxes) (see attachment)

    The National policy can be continued for another 3 years only and as told by the agent max entry age for the United’s policy is 80 yrs and premium remains same thereafter.

    My mother has no health problems except for knee joints which are replaced 2 years back and has no problems yet and doctor guaranteed for 8-10 years provided no injuries are caused to the joints.

    I request your advise on whether to continue existing National’s policy for another 2 years or discontinue this and go for United’s senior citizen policy or would you suggest any better option after going through the policies of other companies, taking into consideration ifs & buts, if any.

    Regards
    V G Bhat

    • admin Posted November 1, 2011 3:48 pm

      Since the United India policy for 2 lakhs is available at a lesser premium(14,340) than your current cost of Rs.15,743/- you can go for it. Avail the new facility of switching, because there will not be any pre existing clauses also. You can try Star health Red carpet also with 30% copay clause.

  • Neeraj Hasija Posted December 24, 2011 12:10 pm

    Hi

    My parents are 69 years old and turing 70 early next year. I don’t have insurance cover for them. I need to get them insured.

    Can you please advice on the insurance companies which will offer insurance for senior citizens in age group of 69-70 and till what age it can be continued.

    Regards

    Neeraj

    • admin Posted December 26, 2011 12:22 pm

      They require only health insurance and not Life insurance. You can try with Star Health Insurance for the Red Carpet Policy.

  • sallav Posted January 26, 2013 11:38 am

    My parents are 63 years & 54 years old . I don’t have health insurance cover for them. I need to get them Health insured.
    My father suffer from leg problem doctor advice to knee replacement which cost around Rs.140,000 for one knee in mumbai

    Can you please advice on the insurance companies which will offer health insurance for senior citizens which cover the above problems. & also suggest the best hospital with cheap cost.
    Regards

    Sallav

    • Melvin Joseph Posted January 26, 2013 2:59 pm

      No health insurance company will cover such pre existing diseases from the day of taking the policy. If you take a policy for your father clearly mentioning this problem, any treatment for this will be covered after 4 years. So, health policy is to be taken not after having any problem.
      Some companies like Star Health insurance offers policies to senior citizens with certain exemptions. You may check for Red Carpet policy of Star Health.

  • Monika Kapoor Posted February 13, 2013 9:28 am

    My father is of 65 years. I just enquired about health policies. And I got to know that star health red carpet is charging very less against other policies and THAT TOO WITHOUT MEDICAL TESTS.
    I am confused as there is no other company that offers policy without medical tests.

    • Melvin Joseph Posted February 13, 2013 5:51 pm

      Having no medical test should not be the criteria to take a policy. There are lot of limitations in Red Carpet policy. if there is a pre existing diseases, they will reimburse you only 50% of the claim amount and for other diseases, there will be a reduction of 30%. You have to consider all these. But if he is really having some health problems now, other companies will not give policies to him. In that case, Red Carpet is an option to consider.

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