The importance of health insurance is something that Indians realized during the pandemic. While the government was providing free treatment for the Covid-19 patients, many issues were faced across the two waves. Shortage of beds, ICUs, ventilators, etc., led to a lot of chaos and loss of lives. Also, many people were unwilling to opt for the government hospitals, and the cost of treatment in private hospitals was high depending on complications, despite the government capping it.
In the first wave, another unique problem faced by many who had health insurance was that Covid-19 was not covered under the insurance scheme. But the government and the insurance companies quickly acted upon it. The one thing that most of us realized that was health insurance is a must for the future. Many variants of Coronavirus are expected to come, and there is no guarantee about the mildness or mortality rates. Also, there is no comprehensive information available still on the long-term effects of Covid.
Therefore, as they say, it is better to be prepared as seniors belong to the vulnerable category, and many also have co-morbidities. Having peace of mind that any issues cropping up can be addressed with a health insurance backup means a lot. Therefore, let’s try to see the basic points to be checked while taking out health insurance.
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Age
Some insurance companies do not offer health insurance to senior citizens, while a few others provide it at slightly high premium. Some have specific plans for the 60-80 years age group. Some companies do not provide health insurance cover beyond 80 years. Hence, depending on your age, it is important to check up to what age your policy can be renewed. Try to opt for a company that can provide maximum age benefits.
Sum Insured
It is well and good to consider a plan that can cover at least five to six lakhs, if not more. In this age category, heart issues, cancer treatments, knee cap surgeries, etc., are more common. Hence, if the insurance cannot cover the cost of such treatments, it may not be worthwhile.
Illness coverage
Kindly check the illnesses covered and check if it includes dental and eye surgeries as well; critical illness coverage is a must. If you have existing health conditions like diabetes, blood pressure, arthritis, etc., it is also better to check if your insurance can cover OPD costs. A thorough review of the fine letters like exceptions can ensure that you are well covered for the premium you pay.
Pre-existing conditions
This is a critical factor to be considered in this age, as there is a possibility that many in this age group have health issues or the other. From critical illnesses like cancer to diabetes, any disease that you have already been diagnosed with or treated for can be considered a pre-existing medical condition. This is provided the medical condition has had long-term effects on your health. If you keep needing treatment for those, you will be a high-risk customer, and hence they may refuse you a policy.
The terms and conditions on this differ from insurer to insurer. Hence, while it is challenging, it is not impossible to find a suitable insurance policy. However, it is also not good to hide any pre-existing conditions and take up a policy. There is every chance that your claim may get rejected in the worst-case scenario of you getting admitted due to any complications of pre-existing conditions. Some insurance providers are offering a wait-period-based policy for such instances. This means you may have to wait for x years after taking up the policy before you can claim benefits related to that illness. Some others offer a minimal wait period for high premiums. In any case, this is one clause that needs to be thoroughly understood and evaluated before taking up a health insurance policy.
Homecare
Another aspect that is being considered now is the homecare expenses (domiciliary care). Whether a home Covid-19 treatment or regular homecare for some specific health conditions, this, if it can be included, is very good. It is possible to get a reasonably good insurance policy for a slightly higher premium. But, perhaps, at this age, it is a good investment to make as you never know you may have to otherwise dig into your savings.
Network and payment options
Choose a provider with good hospital coverage across the regions you are likely to avail of the treatment. Also, it is better to have a cashless facility rather than a reimbursement option. This will save time and stress and also ensure that you don’t have to immediately arrange to pay for the bill and then wait for the money to come back.
Claim process
Instead of blindly going by the claims of the representatives or the website selling a policy, kindly check how easy or difficult the claims process is. Also, check their claim settlement ratios to know whether they have been rejecting claims on flimsy grounds, etc.
Other little things
We are now openly talking about mental health issues. At times, people get admitted to hospitals due to such issues too. This coverage is also being considered by many health insurance providers now and can be explored. Some seniors prefer to get alternate treatments like Ayurveda, Homeopathy, etc., which also may require hospitalization.
While taking out a policy, you can check this out to see if AYUSH treatments are covered under the policy. Some treatments may require less than 24 hours of hospitalization. It may be good to see if such daycare treatments are also covered. Explore co-payment options to see if you are willing to pay part of the treatment costs. Check if the insurer is providing a claimless bonus when you renew the policy. Last but not least, you/ or someone paying on your behalf can claim IT benefits for health insurance premiums under Section 80D of the Income Tax Act 1961 up to Rs. 50,000.
