Health cover for seniors

K. VENKATASUBRAMANIAN | Updated on March 12, 2018 Published on July 07, 2012

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In sickness and in health: A look at key insurance aspects to keep in mind in order to maximise benefits.

Having slogged all through your work life, you may have accumulated a nice pile of money that you believe will take care of your retired life. But have you thought of how quickly that pile can be wiped out by medical emergencies?

If you haven’t considered this important aspect, this is the right time to take a health insurance policy to protect yourself and your spouse.

Here we discuss the key aspects of a health insurance policy for senior citizens. We look at the options available, premiums that need to be paid and important policy aspects that you must be aware of, in order to reap the maximum benefit.

Key points pertaining to pre-existing illnesses, sub-limits to each aspect of treatment and concepts such as co-payment and loading of premiums are also discussed.

schemes on offer

Though health insurers offer a plethora of schemes targeted at the young and middle-aged who may be in the pink of health, there are surprisingly few policies focussed on the elderly.

Sifting through options, we could come up with five health insurance policies that are exclusive to senior citizens. These include United India Insurance – Senior Citizens, National Insurance – Varistha, New India Assurance – Senior Citizen, all from the public sector space.

Among the private sector insurers, Bajaj Allianz – Silver Health, and Star Health Insurance – Senior Citizen Red Carpet, are the only ones offering health cover dedicated to the elderly.

Basic features

Features of health policies for the elderly may be quite different from those for younger people.

These schemes allow you to take health cover at an entry age of 70-80 years.

The sum assured ranges from Rs 1 lakh to Rs 3 lakh in most cases, with Star Health offering up to Rs 5 lakh.

But before the insurance company approves your application, you will have to compulsorily undergo a medical check-up.

The expenses for the tests would have to borne by you. The tests include checking for blood/urine sugar, lipid profile, haemoglobin, blood pressure, ECG and eye-related ailments. These tests, done at any company-approved clinic, would cost you about Rs 1,500.

What is different

Higher premiums: For the same sum assured, premiums are much higher for senior citizens compared with those who are middle-aged.

The annual premium for Rs 1 lakh sum assured at age 60 is in the Rs 4,200-6,200 range. If there is a pre-existing illness such as hypertension and diabetes, the premium could go up by 10 per cent per ailment.

If you delay taking a policy, for every block of five years from 60, the premium would go up by over 20 per cent. At 65, for the same Rs 1 lakh cover, you would end up paying Rs 5,500-7,800.

So take a policy as early as possible. The public sector insurers charge lower premiums, but enhance them in case of ailments, while Bajaj Allianz quotes higher rates at the outset itself.

In case you also insure your spouse, you can get a discount of 5-10 per cent on the premiums.

Renewal of policy is allowed till as late as 90 years of age in the case of National Insurance and New India Assurance. Bajaj Allianz allows renewals only till 75.

Rising premiums: Every time there is a substantial claim amounting to more than 25 per cent of your sum assured, there could be loading or enhancement of premium rates for the same sum assured.

Existing ailments: Most of these insurance companies cover pre-existing illness as well for seniors, subject to some conditions.

The standard waiting period in case of prior ailments is 1-4 years, with the lower limit being offered by both the private insurers.

Treatment of common age-related ailments such as cataract, hernia and gall bladder stone removal, among others, will not be covered for the first two years of the policy.

Sub-limits: The other key aspect that you should be aware of is the sub-limits for various aspects of hospitalisation.

So, there are upper limits for how much you may claim as ambulance fee, room rents, ICU costs, anaesthesia, doctor fee, x-rays, etc.

Also, for many surgeries and ailments, the total sum that can be disbursed by the company is fixed. Even if the cost turns out higher but is within your sum assured, you will still not be paid more than the limit.

You must be aware of these limits — to be prepared with adequate funds — in case you exceed them.

Co-payment: Another very important aspect to be noted about health cover for senior citizens is the co-payment clause. Co-payment simply means that you must pay a portion of the costs in some cases.

In case of pre-existing illness at the time of taking the policy, almost all insurance companies would ask you to co-pay 50 per cent of the charges for the treatment.

Star Health insists on co-payment of 30 per cent on all illness claims, irrespective of whether it is pre-existing or not.

Co-payment must also be done if you take treatment in a hospital that is not empanelled by your insurance company. This can be to the tune of 20 per cent of the sum assured. Also, in a non-network hospital you will not receive cashless service and will get a reimbursement upon submission of relevant bills.

Being prudent

Despite the many difficult clauses embedded in a medical cover, you must take one in your best interests.

In case you feel that the sum assured is not enough, we suggest that you take more than one policy so that it can cover you adequately. This will be especially useful in covering ailments that have a ceiling in disbursable levels.

Another point to note in case you are still in service is that you will do well to take a health cover four years prior to retirement so that all pre-existing ailments are covered once you retire.

Even if you are covered by your employer post retirement, there is a possibility that the sum assured may be reduced. So you must enhance it by taking another health cover yourself.

Given the insurance schemes available at the moment, there is not much to choose from as to which is the best one.

But our suggestion is to take United India Insurance’s Senior Citizen policy as the sub-limits, co-payment clauses and premiums are more benign compared with other insurers.

READ ALSO: >Health cover: All under one umbrella


Published on July 07, 2012

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