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Buying a senior citizen policy

Buying a senior citizen health insurance policy? Look out for these points


A senior citizen policy has come like a blessing for senior citizens who were deprived of health insurance coverage due to their age. Most health insurance plans limit the entry age to 65 years or 70 years. If you have not invested in a health insurance plan till that age, you cannot buy a fresh plan. Senior citizen health insurance plans, however, have changed this. These plans are designed for senior citizens who are above 60 years of age. These plans, thus, allow health insurance coverage for older individuals who are, usually, denied coverage under normal health insurance plans.

While these plans are designed for senior citizens and have various benefits, there are some points which you should check when buying senior citizens health insurance plans. Do you know what these points are? Let's find out:

The entry age

While you might think that senior citizen plans only cover individuals above 60 years of age, you are wrong. There are a few plans which cover individuals above 50 years as well. Moreover, there might be a maximum entry age under senior citizen plans. You might find 75 years or 80 years to be the maximum entry age under these plans. So, when you are looking for senior citizen plans, look for the entry age limits under the plan.

Maximum coverage age

Though there might be restrictions on the maximum entry age, renewability is allowed lifelong, thanks to the directives of IRDA (Insurance Regulatory and Development Authority). However, some senior citizen plans might impose a maximum restriction on the exit age. Be careful to check for lifelong renewability when you are buying a senior citizen health insurance plan.

The Sum Insured

Senior citizen health plans are offered for a limited Sum Insured only. Since these plans cover individuals with a relatively higher health risk, the Sum Insured is restricted. You can find a maximum coverage of up to Rs.5 lakhs or Rs.10 lakhs under most senior citizen health plans. Since medical costs are high, look for a senior citizen plan which offers the maximum level of coverage.

Co-pay clause

Senior citizen health plans have a co-pay clause. This clause states that in the event of any claim, you, the policyholder, would have to pay a portion of the claim from your pockets. This portion is called the co-pay ratio and it ranges from 10% to 25% of each claim. So, for instance, in a claim of Rs.40, 000, if the co-pay ratio is 10%, you would have to bear Rs.4000 from your pockets and the insurance company would pay the remaining Rs.36, 000. You should look at the co-pay ratios of different senior citizen plans and choose a plan which has the lowest ratio.

Pre-policy health check-ups

Due to old age, senior citizen health plans insist on pre-entrance medical screening before the policy is issued. The medical check-ups are, usually, done at company authorized centers and the cost is borne either by you or by the company or partially by both. Keep in mind that the medical test results are valid only for 15 days. When you get the check-up done, follow-up with the insurance company to find out whether the policy has been issued or not. If you delay, you might have to undergo another medical test.

Sub-limits in the plan

You might find restrictions on various coverage features under a senior citizen health plan. These restrictions are due to the fact that the policy is covering high-risk individuals. You would find sub-limits on the room rent, ambulance expenses, expenses incurred in specific treatments, etc. If you have a room rent capping, you should be careful in choosing the hospital for treatments. If you choose a higher room rent, your entire hospitalization expenses would be reduced in proportion to the allowed room rent against the room rent you incurred. This is because the hospital charges are linked to the room rent. Higher the room rent higher is the charges. So, when you choose a room with a higher rent other related expenses also increase. As such, the insurance company does not pay the full amount. The amount is reduced in proportion to the room rent allowed against the room rent availed. Consider this when you buy a senior citizen plan.

So, if you are buying a senior citizen plan, look out for these points. Make your choice only after you compare the available senior citizen plans on the above-mentioned points. Only if you choose a plan after careful consideration can you enjoy the maximum benefits of a senior citizen plan.