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Health Insurance options for Senior Citizen
Posted By Rushabh MEMBER 02 Aug, 2021

Hello,


My father currently has the following policies:

1) United India Gold - Sum Insured (Rs. 5,00,000). Domiciliary Hospitalisation Limit (Rs. 50,000). For this we are paying a premium of (Rs. 37,000) yearly. This policy has a limit of claims upto Rs. 3,50,000 when hospitalized for certain diseases.

2) Religare - Care Heart - Sum Insured (Rs. 10,00,000). 20% Copay till 70 years age & 30% Copay for age above 70 years. For this we are paying a premium of (Rs. 59,000) yearly. Pre & Post Hospitalization - Maximium upto 5% of SI. NCB: 10% of Sum Insured for each Claim free year, maximum upto 50% of Sum Insured, reduced by 10% of Sum Insured in case of Claim.

Treatment for each and every Ailment / Procedure mentioned below:- i. Surgery for treatment of all types of Hernia ii. Hysterectomy iii. Surgeries for Benign Prostate Hypertrophy (BPH)

iv. Surgical treatment of stones of renal system - Up to Rs 80,000

Treatment for each and every Ailment / Procedure mentioned below:- i. Treatment of Cerebrovascular disorders ii. Treatments/Surgeries for Cancer iii. Treatment of other renal

complications and Disorders iv. Treatment for breakage of bones - Up to Rs 300,000


He went through a bypass surgery in 2019. His policy renewals are in March every year and we haven't yet used the Religare insurance as of now (2 years since we bought it). He has been offered Star Cardiac Care Insurance Policy which has a premium of Rs. 73,278/- yearly. It has similar T&C's like Religare where specific diseases have a cap.


Now my questions to you:

1) Is this Star policy worth it for the premium we are paying?

2) What are my options for having a cover of 25L with minimal disease caps and no co-pay when I renew these policies next year in March? Are there any super top-up plans that I can opt for?

What happens on frequent admission to hospitals in older age?
Posted By Kautilya Bhardwaj MEMBER 21 Mar, 2021

Hi, please guide us through the real-life examples or IRDAI policy for this case when we or our parents get admitted frequently to the hospital due to worsening health conditions in older age.

My curiosity surrounds the following points (don't limit your answer only to them, though)

  1. Does the insurance company start to find loopholes in the policy claim documentation? So that somehow legally they can prevent disbursal of the claim amount.
  2. Can they decline cashless admission even at their network hospitals?
  3. Many policies now offer restoration benefits as a part of the policy. Can they decline/add complexities in such cases?
  4. Can they disallow the renewal of a policy?
  5. Are there any regulations/protections for policyholders being provided by IRDAI for such cases?
  6. Can insurance companies move them to some risky class of individuals? And increase the premium amount at the time of renewal?
  7. From the insurance provider's perspective - How do they manage this risk associated with their business model?
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