Health Insurance

With increasing years comes the need for increased medical care and attention. Yet, HEALTH INSURANCE is an often neglected product, especially in our country. As per available data, less than 10% of the country’s population has life insurance, and health and medical insurance are generally taken when an employer is offering them. Having health insurance is very important because unexpected health emergencies and surgeries can dry up your financial resources very quickly. Health insurance schemes are available for people of all age groups, including senior citizens. Keep in mind that health insurance can be a life-saver when huge medical emergency strikes. Smaller, regular medical needs can always be planned for and attended to. In an emergency, access to funds and hassle-free processes become key.

How to choose a good health insurance plan

1 Premium amount should not act as a deterrent, because as you age, your premium amount increases, but this is a necessary expense that can save you from spending six figures when you need medical aid.

2 It is not true that people over a certain age can not get medical insurance. The only thing as you age, the number of tests you need to undergo can increase significantly, for getting insurance. This is a one-time effort.

3 Check for a network of hospitals covered in your city/town. The more in number they are, and the more convenient they are for you to visit, the better the plan for you.

4 It is estimated that healthcare costs go up each year by 10 to 15%.

5 Consider this inflation before deciding on the sum assures. A larger sum assured will not always increase the premium exponentially.

6 Whenever possible, opt for a lifelong plan that covers you for the rest of your life. Senior citizen plans are designed to cover pre-existing illnesses as well. Check the details before you sign up.

Some benefits to look for

As per norms set by the Insurance Regulatory and Development Authority (IRDA), health insurance is to be provided to all people who want to apply and enroll in the scheme/plan, until they are 65 years old, and for as long as they wish to continue in such plan. The are some additional benefits that some health insurance plan offers:

1 A list of pre-defined critical illnesses can be covered for an extra premium.

2 For pre-existing illnesses, there is usually a waiting period ranging from one to four years, depending on the insurance service provider.

3 For daycare surgeries such as cataracts, you can choose to set a limit on how much the insurance company will pay. You can then allocate the rest of the amount to emergencies.

4 If you agree to co-pay some of the amount and expenses, you may be able to get a lower premium.

5 Some insurance providers’ policies offer complementary medical checkups every year at network hospitals and diagnostic centres.

There are certain things senior citizens should keep in mind:

• Get insured as early as possible. Once you get a disease, the coverage for that pre-existing condition will become more expensive and in some cases may not be available at all.
• Make sure that you declare your medical condition as explicitly as possible at the time of buying a policy. Any attempt or mistake to hide a pre-existing condition will give the insurance company a reason to deny the claim.
• Consider co-pay and deductible options which tend to reduce the insurer’s risk, and thus, the premium, but will give you coverage for any big expenses-which is when most people really need a helping hand.
• Consider critical illness covers which are available for most major conditions. If you do not have those conditions already, then you may be eligible for the cover. Since the critical illness covers are usually paid only one time by the insurer, immediately when the illness is detected, the premium tends not to be too high.

In a country as vast as India, insurance is often a matter of signing on few papers. No one cares to explain the minute details of policy unless we ask them. So you must read the fine print before signing and accepting the policy. Be aware of some bogus companies offering good-to-believe benefits. Remember that no insurance company is exempt from IRDA norms, and if some insurance providers say they are not bound by IRDA norms as they do not have to register with IRDA, then it is a scam.

There are some insurance jargon that may seem confusing, so it is good to be aware of what they mean:

Co-pay – When you agree to co-pay, you and the insurance provider will split the medical bills at an agreed ratio. So if you agree on a 70:30 ratio, and the bill comes to 100,000 then you will pay 30,000 and the balance will be paid by the insuring company.

Exclusions– This is a list of diseases, conditions, surgeries, and procedures that the policy does not cover. Advanced eye surgery for cataracts and cosmetic procedures are some examples.

Lifelong plans– Most insurance plans have an entry age limit, however, you can choose a plan that has an entry limit but also covers you for as long as you live. Premiums are usually higher for such policies.

Pre-existing illness– This is an illness or condition that you already have at the time of taking the policy. Premium amount is decided based on the severity of this illness.

Pre-defined illness– This is a disease or disability that is often critical and included in a policy.

Lastly, group health insurance is often offered by organizations that have certain number of members. This is most commonly seen in the case of organizations that cover all their employees and sometimes, their dependent family members also.

Waiting for your feedback on this blog.

Anil Malik

Mumbai, India

20^th February 2024