5 Lesser-known Restrictions in Senior Citizens Health Insurance Policies

Senior citizen health policies are designed for 60+ people. These plans provide coverage for certain medical expenses, such as hospitalisation costs. Buying health insurance for the elderly is essential because the people of this age have higher chances of diseases and frequent hospitalisation due to age factor. Ignoring health insurance during this age can burn their savings.

A senior citizen health insurance policy can let you enjoy tax benefits as well as provide health benefits to the elderly ones. If you want to buy health insurance for your elderly parents, you should be aware of certain restrictive features that come with the policy.

Restrictions

Below are some of the most common restrictions that usually come with senior citizen health insurance policies:

Sub-limits

A sub-limit is one of the critical features to evaluate. It is not just available in senior citizen health insurance policies, but in an individual or the family floater plan as well. It’s a pre-decided cap on a particular disease/treatment costs, surgery/operation fees, nursing expenses, doctor’s consultation fees, medicine's costs or room rent. Or it comes as a percentage of the total sum insured.

A health insurance policy with sub-limits, restricts the claim for any incurred expenses regardless of the amount insured. A plan with no sub-limits is available at higher premiums.

Co-payment:  

Co-payment is a compulsory feature that comes with every senior citizen health insurance policy. This feature compels you to pay a pre-decided amount of the total bill when clearing hospitalisation bills. Also called co-pay, the co-payment feature applies to three things: Treatment, Specified ailments and Specified hospital expenses.

Before you opt for any senior citizen health insurance plan, understand the criteria of co-payment. Discuss with your insurance provider whether the co-payment can be waived off by paying an additional premium.

Waiting Period

Buying a health insurance policy doesn't mean you’ll get cover from day one of the policy. Other than accidental hospitalisation, no ailments are covered during the first 30 days of the policy start date. This applies to the senior citizen health policy as well. Every policy buyer should be aware of the waiting period.

Different Types of Waiting Periods

• Initial Waiting Period: This period may range between 30 and 90 days.
• Disease-specific Waiting Period:  This may be for one or two years. Some of the diseases that come under this period are ENT, tumour, hernia, etc.

• Pre-existing Disease Waiting Period: A special waiting period applies to some diseases that you have suffered from before purchasing the policy. You need to inform the insurer about these diseases at the time of purchasing the policy. The waiting period for pre-existing diseases generally varies from 1 year to 4 years of continuous policy coverage.

• Maternity Waiting Period: The waiting period for maternity expenses may range from 9 months to 4 years, depending on your policy.

Medical Tests

It’s good to know that health insurance companies usually offer free medical check-ups when it comes to health insurance policies for senior citizens. They don’t charge even a single penny for the pre-policy health check-up, especially if the tests are done in their network hospitals.

Before opting for a senior citizen plan, make sure the nearest network hospital for the health check-up. And also make sure from the insurer if the expenses incurred on medical tests will be borne by the insurer.

Additional Features

There are some other features you must be aware of when choosing a health insurance policy for senior citizens. You can avail certain benefits by paying an extra premium.

Domiciliary Treatment: A few policies for elderly people come with the domiciliary treatment benefit. This is a type of treatment which is done at home otherwise would require hospitalisation. If you pay extra, the insurance company will bear the pre-decided expense of such treatment.

Organ Donation Transplant: On the payment of extra premiums, the insurer bears the costs of organ donation at the time of organ transplant.

Ambulance Services: Usually, ambulance service expenses are covered by the insurance company. Before choosing the policy, ask the insurer about this benefit or you will have to pay extra for this service.

Second Opinion: A second opinion or e-opinion from a doctor is another feature of health insurance policies. Discuss with the insurance provider about this benefit.

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Conclusion

In India, medical inflation is rising at a higher pace, almost more than the double of the total inflation. That’s why, health insurance is super important not only for adults, but for children, and senior people too. Before choosing a plan for your elderly parents, consider all the restrictive features of the policy to let them enjoy the full benefits of the policy.