Senior Citizen Health Insurance : No Medical Test Plans.
While many seniors today focus on living healthy lifestyles, it is no surprise that their health keeps deteriorating. As their medical needs and healthcare costs increase by the year, it only becomes increasingly difficult to find and buy a policy that covers them sufficiently. Many popular health insurance plans cannot be bought once you cross the age of 65. In fact, the recently popular Corona Kavach and Rakshak too are unavailable to this vulnerable population.
To add, the pandemic continues to make things worse. Hospital rates continue to skyrocket, and individuals over the age of 65 are statistically becoming more vulnerable to falling sick and needing extensive hospitalization, especially if they are already suffering from a chronic illness like diabetes or a heart condition.
Generally, insurers request a detailed medical check before issuing policies to senior citizens - this is because they find it risky to evaluate the risk and the price of insuring older people while ensuring that they do not lose money.
On the other hand, elders are usually hesitant to take the mandatory medical tests owing to their fear of discovering an underlying condition. In fact, it is not recommended that senior citizens expose themselves to the dreaded COVID19 disease by taking medical tests at the diagnostic center or at home.
How do you get the best possible cover for your parents, when getting medical tests is tricky?
Here's our attempt to help you with some step by step strategies that aim to extract the best possible cover for your parents in their existing health conditions.
Establish Ground Zero: A quick self-assessment of your parents’ health
Get your magnifying glasses out. You are a detective on a mission. You will need to gather a detailed account of your parents’ medical history. Do not guess anything.
- You: Begin with what you know. Make a list of all ailments and diseases that you know they have
- Parents: Second, speak to them and fill in any blanks you might have left.
- Documents: Next, get your hands on their medical file, and make a note of anything they might have missed telling you.
- Look at all the medication they take and check why these are required.
- It is important to look for conditions that they might not consider ‘diseases’, and might skip. For instance, most parents feel hypertension (BP) is not a disease/health condition 🙂 (but, insurers do)
- Lastly, make a list of all the surgeries, hospitalizations in the past
- Family Doctor: Next, contact your family doctor to get any further missing details.
This will give you deep insights into their health status, and help you cover their health better. It also makes sure you do everything right, so you do not have disputes in claims when you need it.
Choosing the right policy: A step-by-step approach.
Option 1: The best possible option: Comprehensive plans where medical tests are temporarily waived
If you’ve got aging parents, there’s one aspect that is working in your favor during this time of crisis. Given the highly infectious nature of COVID 19, several insurers have relaxed their requirement of medical tests for everyone - including senior citizens for their flagship plans - their best plan with the best benefits and lowest limits and conditions.
This means that it is now possible that some senior citizens may get comprehensive health insurance covers without medical tests.
Important Note: It doesn’t mean that insurers do not need medical tests, only that they are not asking every single proposer to get them done. And, this is a temporary facility because of COVID restrictions.
We spoke to many insurers and a few web aggregators. We realized that the waiver is more or less applicable for senior citizens who are healthy or have a controlled level of pre-existing conditions.
If your parents are relatively healthy, here are some plans that you can attempt to check with. We found plans with the lowest limits or copays in the market, that were open to covering senior citizens. While these policies can be expensive - they can offer the comprehensive cover you are looking for, and are definitely worth it.
Note: All the premiums shown below are subject to premium loading that will be calculated once you have declared the medical history for your parents.
Remember, your parents may not be eligible for these plans if they have multiple health conditions, lifestyle issues (like overweight, etc.), and habits (excessive smoking/drinking/tobacco consumption) - In such cases, you will have to jump to the next best long term option.
Note: This table is not an exhaustive list. If you know of any plan that can offer better or equal options, please share them with us at firstname.lastname@example.org or tweet to us at @beshakIN, and we’ll update the table.
Option two (Second best option): Senior Citizen Plans that never required medical tests.
If one or both of your parents do not get cover without medical tests in the earlier option you can check senior citizen plans that do not have a medical test requirement.
Insurers find it very difficult to balance no medical tests, the significantly higher risk of covering senior citizens, and keeping the premiums affordable. One of the ways to counteract this is by implementing financial limits in the policy. These are conditions you should be well aware of before you sign up.
Necessary conditions you should understand well under this option are as follows:
- Copays: Most of these plans will have copays. Copay is the share in the claim that you would be required to pay each time there is a claim.
- Room Rent Limits: Insurers apply limits on room rent, which cap not only the room charges but also the associated medical expenses like surgeon fees, diagnostic tests, etc. Room rent limits can severely restrict your access to quality healthcare. You need to be well aware of these financial limits. This will help you be aware of eligibility and choose the room closest to what you are eligible for, avoiding significant deductions in your health insurance claim.
- Sub-limits on treatments for specific diseases: Insurers apply sub-limits on surgeries for frequent and major lifestyle diseases to ensure the claims are under control. For instance, insurers usually implement financial limits on Cardiac treatments, breakage of long bones, and even standardize their payments for smaller high-frequency surgeries like cataract and hysterectomy. For instance, Religare has a limit of Rs. 30000 under its Senior Care plan for cataract. All costs above this amount for the treatment of cataract will have to be borne by you.
- Pre-existing disease waiting period: Yes, the policy would have a waiting period for existing diseases. While it's natural that you would want to buy health insurance primarily to cover existing diseases. But to get a long term financial coverage, you will have to be patient and continue the coverage through the waiting period.
Here is a list of plans we found. We will keep updating this list as we find more such plans.
You will find that there is a huge difference in the premiums. The reason is the difference in the coverage: Here's ideally how you should try to explore these plans.
- The best plan amongst the above, that balance price and benefits, would be Religare Senior Care.
- The second best would be Religare Care Freedom - this plan is expensive because it is liberal when it comes to covering people with multiple diseases.
- If you don't end up getting any of these two plans, then you can consider Star Star Senior Citizen's Red Carpet
People who will find it difficult to get Senior Citizen plans (indicative list)
- People who suffer from cancer, heart disease, or similar critical illness.
- People on Insulin or with Type 1 Diabetes.
- Three or more negative lifestyle markers - lifestyle diseases like Diabetes, Hypertension, or lifestyle conditions - like heavy smoking, alcohol or overweight
Option 3 (The last resort): Enrolling into Group Health Insurance from Banks
If you suffer from multiple ailments and don't get any of the above or find the premium unaffordable - you need to explore policies offered by banks. You just need to apply for a bank account in one of these banks and then enroll in the group health insurance policy on offer.
These bank policies are group policies that have a very different structure from a retail policy. Here are some key differences you should understand before taking a call.
- Group policies may not be renewed for a lifetime. Even if they do, the terms may not be in your control.
- The benefits and terms of group policies are negotiated by the banks every couple of years. The bank can break ties and move you to a different policy that may have different terms and pricing altogether.
- From our experience, we know that banks do not intervene in case of a service issue in a group policy. You are required to directly communicate with the insurance company or the TPA.
- Since the pricing is tightly negotiated, claims are higher for the insurance company - the service in many cases may not be as good as retail policies.
Summing up all the options you could explore to buy a health insurance cover for your senior citizen parents
Things to check before enrolling under senior citizen health plans
- Go for the highest cover you can afford: If your parents are over 60 years old, an INR 15-20 lakhs individual cover should be good, considering increasing healthcare costs. If you cannot afford that much, buy the maximum protection you can afford. Do not compromise on the coverage as much as possible. You don't want a medical contingency to be hard on your pockets despite having health insurance, do you?
- Share your medical details before you make payment If you have the latest medical reports, papers, try to request your agent or the salesman on the phone to ask for an underwriting evaluation basis submission of a soft copy of the medical papers - before making the payment. This way you can avoid the entire tedious payment and refund process.
- Fill the proposal form yourself: No medical test does not mean there will be disputes at the time of claims. Ensure you fill-up the proposal form yourself correctly, providing accurate and honest information about their medical health. You do not need to worry about anything you and your parents are unaware of. You just need to ensure you declare all that you know. Being negligent or careless about health conditions would jeopardize your claim.
- Make clear declarations on video/telephonic call When the insurer's representatives call your parents, ensure you provide them with a summary of the health assessment you carried out (as mentioned at the beginning of the article). Ensure they provide clear and detailed answers to all the questions the insurer has. The call is recorded and will be used not only for evaluation but also in case there is any dispute at the time of claims.
- Ensure you understand the plan well: Check the pre-existing conditions’ waiting period. If you are afflicted with any pre-existing illness, which, at an old age, is a sure possibility, opt for plans with a low waiting period so that you can get covered at the earliest. You need to accept the fact that senior citizen health plans would have coverage restrictions.
- Do not depend on your employer policy alone: Your employer company might have a health insurance cover for parents, without a waiting period. But, remember that such a policy is controlled by your employer. There are factors you cannot control - like yearly renewals, modifications, or even termination. In the worst case, the premiums might even become unaffordable or unreasonable. Further, you should consider the fact that you might leave this job and move to another company that might not provide a similar cover. So, it is always better to take a health insurance cover for your parents, separately.
- Ensure you invest in a healthcare savings fund: Most insurance plans we saw in this article have some kind of restrictions like copays, limits, etc. It is hence important that you also separately save in a healthcare fund for your parents. This is all the more relevant for people who suffer from multiple diseases and hence aren't able to get any of the policies above.
The attempt here is to initiate a compilation of options and steps for people to consider when they are insuring senior citizen parents. If you would like to contribute with any additional plans or insights as an expert, do share the same in the comments or by tweeting to us at @beshakIN
Mahavir is the Founder at Beshak.org. Since 2005, Mahavir has been building tech-based startups that compare and advise insurance products to individual buyers. In his last role, he was the Chief Business Officer at Coverfox. Mahavir is a recognized professional in the personal insurance field. He has contributed to leading business publications, including The Economic Times, Business Standard, Mint, DNA, and Moneycontrol