• Introduction
• How do you get the best possible cover for your parents, when getting medical tests is tricky?
• Choosing the right policy: A step-by-step approach
  • Option 1 (The best possible option): Comprehensive plans that are available to Senior Citizens.
  • Option 2 (Second best option): Special Senior Citizen Health Insurance Plans that don't required medical tests
  • Option 3 (The last resort): Enrolling into Group Health Insurance from Banks
• Things to check before enrolling under senior citizen health insurance plans

Our need for a health insurance is directly proportionate to our age. Such needs peak once you or your parents hit 60. 

You can see the first signs of degrading health - increased medicine intake, the knee pains, weakness, imbalance (which leads to falls in the bathroom), losing clear vision, hearing problems (all of which they deny, till a certain point), apart from of course health conditions like Hypertension(BP), Diabetes, Vertigo and more. 

An insurer's interest in acquiring you as a customer, covering you, is, however, inversely proportionate to your age. The older you get, the lesser the chances of you getting approved into the top plans in the country (at an affordable cost). 

Also, the plans that you come across as recommendations have massive conditions, and even more mind-boggling premiums.

The question is then how to go about covering your ageing parents? That's what we attempt at answering in this post. 

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Yes, an employer facilitated policy is a good solution >> It may cover existing diseases too and provide seamless cashless service - but remember it is not a long-term solution. 

1. Your cover is linked to your employment. It stops as soon as you leave the organisation.
2. Portability, promised by your insurance broker, or HR is subject to underwriting (medical evaluation) of the case, and insurers may reject your portability application
3. Lastly, an employer facilitated cover is under a group insurance scheme. Remember, group insurance schemes are one year policies, and the policy, the terms of the policy, the benefits, the pricing everything can be withdrawn/changed at the time of renewal. A change in budget by your CFO or hike in premiums by an insurer can change the dynamics. Please realise you have no control or say in this policy.

As mentioned, keep an employer-driven group policy, if it is for free (obviously :)) or for serving short-term hospitalisations you foresee, till you complete your waiting periods in the retail policy.  

In the long run, you need a policy that is not linked to your employment, and where you exercise control over benefits, coverage, etc.  

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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. Guess nothing.

• 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.

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These are mainstream health insurance plans with no entry age limit, and the best possible benefits, lowest limits, exclusions, and financial conditions like Copay. While these plans are expensive, if your parents are relatively healthy, these are some plans that you should first attempt applying to before you choose Senior Citizen specific plans (discussed later below)

COMPARISON OF COMPREHENSIVE HEALTH INSURANCE PLANS WITHOUT ENTRY AGE LIMITS

Please Note:

• This table was created on 23rd February 2022.
• The premiums are calculated for a 66-year-old male, individual policy, 10 Lakhs sum insured, and are inclusive of taxes.
• We have opted for No Room Rent Limit option, wherever applicable.
• These are standard premiums. An additional premium of 10% to 50% may be charged by Insurers depending on adverse health conditions.
• The insurance company may ask for a medical test if your parents have multiple health conditions, lifestyle issues (like overweight, etc.), and habits (excessive smoking/drinking/tobacco consumption).
• This is not an exhaustive list. If you know of any plan that can offer better or equal options, please share them with us at info@beshak.org or tweet to us at @beshakIN, and we’ll update the table.

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If one or both of your parents do not get covered in the earlier options, you can check senior citizen health insurance plans for the remaining parent/s. These are specialised plans for senior citizens that may not require medical tests, but are likely to have many financial limitations in form of room rent limits, copays, limits on treatment carried out. 

Necessary conditions you should understand well under this option are:

1. 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.
2. 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.
3. 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.
4. 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 senior citizen health insurance plans we found. We will keep updating this list as we find more such plans.

COMPARISON OF PLANS SPECIALLY DESIGNED FOR SENIOR CITIZENS (> 60 yrs) 

Here's a comparison of top health insurance for senior citizens above 60 years.

Please Note:

• This table was created on 23rd February 2022.
• The premiums are calculated for a 66-year-old male, individual policy, 10 Lakhs sum insured, and are inclusive of taxes.
• We have opted for No Room Rent Limit option, wherever applicable.
• These are standard premiums. An additional premium of 10% to 50% may be charged by Insurers depending on adverse health conditions.
• The insurance company may ask for a medical test if your parents have multiple health conditions, lifestyle issues (like overweight, etc.), and habits (excessive smoking/drinking/tobacco consumption).
• This is not an exhaustive list. If you know of any plan that can offer better or equal options, please share them with us at info@beshak.org or tweet to us at @BeshakIN, and we’ll update the table.

People who will find it difficult to get mediclaim for Senior Citizens (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

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If you suffer from multiple ailments and don't get any of the above mediclaim for senior citizens 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 banks do not intervene in case of a service issue in a group policy. You are required to address 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 medical insurance for senior citizens

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1. 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?
2. 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.
3. 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.
4. 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.
5. 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 insurance plans would have coverage restrictions.
6. 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.
7. 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

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