Tips on buying a health insurance policy for parents in the time of Covid

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Covid-19 has been an eye-opener, especially when it comes to exposing one's health vulnerabilities. Realising that they aren't adequately covered against medical emergencies, many people are now rushing to buy health plans. Says S P Prakash, Managing Director, Star Health and Allied Insurance: "Right from young people in their 30s to senior citizens above 65 are buying policies this season. Usually, with these two extreme categories, insurance buying is not popular." People who have lost jobs or fear losing one, want not only to cover themselves but also their parents against Covid, alongside other ailments. 

Says Melvin Joseph, a Sebi-registered investment adviser and founder of Finvin Financial Planners: "Many in their 20s and 30s assumed they would work till 60, and parents are old, will live only next 10-15 years, and the corporate cover is more than enough. They were highly mistaken." With actual and potential job losses, buying health insurance has become an urgent need. 

Insurance or corpus: Buying an insurance policy for non-senior citizens is much easier than for the elderly. Experts definitely recommend buying health insurance for your parents. Only and only if they are unable to get a health insurance policy, you should rely on a corpus. Joseph says, "In such a case you need to set aside money in a liquid fund. And, every other member of the family who can get health insurance should buy it. So the medical corpus built can be kept aside only for the seniors who can't get insured." 

Regular or dedicated: There are several comprehensive insurance plans in the market that can be bought for senior citizens. Some insurers also offer dedicated senior citizen policies. Unlike regular policies. These are provided to those over the age of 65, so a senior citizen policy is much more expensive higher than a regular plan, as the insurer has taken the age-risk into account. Some dedicated policies don't even have a medical check-up for buying. The issue is that specific policies could come with a higher co-pay, and some also have a disease-wise cap. So look for regular covers as well. Joseph of Finvin Financial Planners says, "If they are healthy, then go for a normal policy, but if they have any health issues, then they have to think of only senior citizen-specific policies. It is better to buy separate policies for father and mother." You will have to check out a few regular as well as dedicated policies to see what fits your need. A plan that works for one may not work for another. One strategy is to consider buying defined benefit critical illness policies. Here a lump-sum is handed out in the event of diagnosis of listed ailments; this will supplement the co-pay ratios or disease-wise capping if any. 

Key Selection Criteria: 

Co-pay amount: Simply put, co-pay amount is the percentage of the claimable hospital bill that you will have to pay. Higher the co-pay, higher you will have to shell out of your pocket. Naval Goel, chief executive officer, says, "Usually senior citizen policies come with co-payment, as after a certain age there is a higher chance of a claim. At the same time, policies with co-pay usually have a lower premium." For senior citizen plans, the percentage of co-payment is between 10 per cent and 30 per cent. Go for plans with reasonable co-pay amount if you need to keep premiums low.

Claim ratio: This is a ratio of the number of claims paid to customers by the insurance company to the total number of claims. You should purchase health insurance from insurers that have a 90 per cent claim settlement ratio. You can get this information from the insurer's websites. 

Pre-existing diseases (PED): This is an important parameter to check. If your parents are currently suffering from an illness, the policy may either exclude it permanently or cover it only after a waiting period. The waiting period is usually between two and four years. Certain diseases are named in the policy wordings to be covered after a waiting period of two years. For instance, conditions such as hernia, cataract, and sinusitis may be covered. Says Prakash: "Look for a policy where the PED wait period is lower. Lower the waiting period the better it is." Many insurance companies have, however, brought down the waiting period to as low as one year for senior citizens. 

Exclusions: Every insurance comes with some exclusions. Read the fine print of the policy to understand exclusions.  

Close-by network hospitals:  Goel says, "Look for policies that allow you a cashless facility and has a network hospital in your home vicinity." 

Covid Cover: Don't look for health insurance that only covers Covid. Says Sanjay Datta, Chief-Underwriting & Claims at ICICI Lombard General Insurance: "Buy insurance that covers other diseases as well. Only if you simply cannot afford to buy an all-inclusive health insurance policy, should you buy at least buy a Covid cover right now. Sometimes, seniors may not be able to get insurance due to PED, in such a case don't ignore the Covid cover; it is easier to get."

Top-ups and super top-ups: If your parents are covered under office insurance, and you simply can't afford another policy, can you consider a top-up or super top-up? Some experts say a top-up and super top-up is a good idea for senior citizens, others don't agree. Ajay Shah, Director and Head-Retail business, Religare Health Insurance says, "Top-up and super top-up are good generally, but affordability should not be the basis of that decision. If a person can afford health insurance now but doesn't buy, it will be a big problem in future if a health situation arises. Go bottoms up, get the base cover first." 

Full disclosure: Prakash says, "We don't have pre-acceptance screening. You have to fill a self-declaration proposal form. If you hide your medical condition, you will not have a good experience when the claim arises later." Always refrain from hiding past and existing medical conditions from your insurer.

Table: Health plans for seniors

Plan Features Co-Pay Premium (Rs)
Star Health Mediclassic Individual Gold
  • Cover room, boarding and nursing expenses: 2% of sum insured
  • pre- & post-hospitalisation expenses are covered.
  • Cost of health check-up once after a block of every four claim-free years. 
  • Cataract is payable up to the limits,  No-claim Bonus, auto restoration by 200%
10% of claim 36,429
Activ Care Standard Plan
  • Restoration up to Rs 10 lakh, Organ donor expenses covered under Classic and Premier coverage variants
  • Home treatment cover available for up to a specified limit
  • Value-added benefits of health assessment, health coach, health returns 
  • Second medical opinion if insured suffers from critical illness
20% of claim 30,888
HDFC ERGO: Health Suraksha Gold Smart
  • Restoration sum insured rebound
  • Multiple sum insured options ranging from Rs 3 lakh to Rs 75 lakh available under this policy
  • Any age entry option with lifetime renewal
  • Exclusive covers like air ambulance cover, recovery benefit, infertility cover, wellness features like fitness, discount @ renewal, health incentives for maintenance of health, flexi benefits like choosing room rent capping, co-pay in order to avail discounts on premium.
10% of claim 43,857 
Royal Sundaram Lifeline Supreme
  • Restoration up to Rs 10 lakh, in-patient hospitalisation expenses up to sum Insured.
  • Pre and post-hospitalisation expenses repayment up to the amount of sum insured for 60 and 90 days, respectively.
  • All day-care procedures up to the sum insured amount.
  • Ambulance cover of up to Rs 5,000.
  • Coverage for the treatment of organ donor up to amount of sum insured
0% of claim 35,337
Manipal Cigna Pro Health Protect Policy
  • Restoration-unlimited, value-added and optional covers, like deductible, critical illness, cumulative bonus, 
  • Expenses for domiciliary treatment are covered up to full sum insured
  • In-patient care is provided up to the sum insured amount
  • 500 full day-care procedures covered under Pro-Health Insurance Plan
  • The plan covers donor expenses, worldwide cover, maternity, newborn, first-year vaccinations
  • Pre- and post hospitalisation expenses provided for 60 and 90 days respectively
10% of claim 37,255

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