A few years away from your retirement, as health insurance benefits offered by your company cease to exist, you might be wondering if you should buy health insurance. But is getting health insurance after 55 years of age going to be convenient or inconvenient? Let’s read the blog further to figure out.
Here’s what the IRDAI regulation says:
IRDAI, or the Insurance Regulatory and Development Authority of India, has mandated that every insurer in India offers coverage up to 65 years of age. This has been done to benefit senior citizens.
Health Insurance companies have combined the benefits offered to senior citizens and clubbed them under senior citizens health insurance plans.
But what are these benefits? Let’s figure out what they are and aspects to consider to get maximum benefits:
Medical insurance for senior citizens is differentiated from other health insurance plans based on:
Entry age
For most senior citizens’ health insurance plans, the entry age of eligibility age while buying a policy is 60 years or above. Some of these plans also have no upper age limit to be more accommodative.
Coverage of Pre-Existing Conditions
Ailments or conditions that you had before being covered by the policy are called pre-existing conditions. So, for example, if you have diabetes while buying the blood pressure policy, diabetes can be pre-existing.
A pre-existing condition or existing health issues are covered by senior citizen health insurance subject to terms and conditions.
Some policies may not cover pre-existing conditions at all. Some policies may charge a higher premium for covering pre-existing conditions. A policy may cover some conditions, and some may not be covered.
Please pay attention to this aspect of a senior citizen health insurance policy.
Day Care Treatment Cover
A treatment that requires hospitalisation for less than 24 hours is called a daycare treatment. Dialysis, chemotherapy etc., are examples of daycare treatments. Most senior citizen health insurance policies cover daycare treatments.
Pre-hospitalisation Expenses
A health insurance policy will cover the expenses incurred for a hospitalisation before the hospitalisation. These are called pre-hospitalisation expenses. Medical tests, doctor’s consulting fees, medicines and diagnostic kits are all examples of pre-hospitalisation expenses. You can collect the bills for these and claim the expenses along with your hospitalisation claim.
Hospitalisation Expenses
The expenses incurred by the insured person during hospitalisation are called hospitalisation expenses. Health insurance covers hospitalisation expenses.
Post-hospitalisation Expenses
Expenses related to the hospitalisation that are incurred after the hospitalisation are called post-hospitalisation expenses. These can be doctor’s consulting fees, medical tests, medicines, diagnostic kits etc. Health insurance covers these expenses.
Critical Illness Cover
Illnesses like cancer, cardiac diseases, kidney-related illnesses etc., fall under the category of critical illness. Senior citizen health insurance plans offer critical illness cover.
Exclusions
Exclusions are conditions or ailments that are not covered under the policy. Look at all the exclusions of a policy carefully. Here are a few common exclusions from senior citizen health insurance policies.
- Certain pre-existing conditions as per terms and conditions of the policy
- Certain injuries as per terms and conditions of the policy
- Expenses from self-inflicted injuries
- Expenses for treatment of drug abuse
- Medical conditions diagnosed within 30 days from the date of purchase of the policy
- Cost of non-allopathic treatments
- Cost of treatment for injuries inflicted by foreign armies or in a civil war
- Expenses for cosmetic surgeries
- Cost of treatment for dental conditions as per the terms and conditions of the policy
- Expenses for treatment of AIDS
COVID-19 Cover
Most senior citizen health insurance policies cover expenses related to treatment after contracting COVID-19 or coronavirus. This cover is up to a limit specified in the policy.
Organ Donor Expenses
The amount paid to the donor for an organ transplant is called organ donor expense. Most senior citizen health insurance policies cover organ donor expenses.
Ambulance Charges
Most senior citizen health insurance policies cover ambulance charges. These charges are subject to limits specified in the policy.
Oxygen Charges
Most senior citizens health insurance policies cover oxygen charges. These charges are subject to limits specified in the policy.
Ayush Treatment Cost
Some senior citizens’ health insurance policies cover Ayush treatment in a government recognised hospital or institute.
Domiciliary Hospitalization Cover
In some cases, the doctor may suggest home treatment. This is called domiciliary hospitalisation. Some senior citizens’ health insurance policies cover domiciliary hospitalisation expenses.
Annual Health Checkup
Annual health check-ups can screen for several conditions and minimise expenses for treatment. Most senior citizen health insurance policies cover these.
Pre-Medical Screening
Most senior citizen health insurance policies mandate a pre-medical screening. This is performed for the insurance company to assess your health. The insurer can then make a risk assessment and offer you an appropriate premium.
You should consider these aspects too:
Cashless Hospitalisation
A lot of health insurance schemes offer cashless hospitalisation at network hospitals. All you need to carry at the time of hospitalisation is your health insurer’s cashless card.
Claim Settlement Ratio
This is the ratio of the number of claims settled to the number of claims received. Going for an insurer with a higher claims settlement ratio is a very good idea.
Network Hospitals in your Area of Residence
Look at the list of network hospitals. Is the quality of the hospitals good? Are there enough hospitals in your area of residence?
No Claims Bonus
Most insurers would issue a no claims bonus if no claims were made in the previous year. This is called the no claims bonus. It may be issued as a reduced premium, or increased sum insured. Look for a policy that provides the most no claims bonus.
Health Insurance after 55 is very much possible and a great idea. The insurance market is full of senior citizen health insurance products. Examine all the aspects mentioned above very carefully to pick the right policy for you.
Read about Best Health Insurance for Parents here.