For senior citizens, check health insurance clauses

Age ailments shouldn't have high waiting periods or low sub-limits

Though there are various health insurance products for the elderly, buyers must look at the clauses and restrictions in these policies, experts say.

Bajaj Allianz General Insurance's Silver Health (for those aged up to 70) and Star Health Insurance's Red Carpet Senior Citizen (which can be bought by those between 60 and 75) are two such products. The latest entry into this segment is Tata AIG's MediSenior (for those aged more than 61).

For a 61-year-old and a sum assured of Rs 2 lakh, the premia could be Rs 7,000-14,000.



These policies allow for a co-payment that helps keep premia low, says S Sridharan, head (financial planning), FundsIndia.com. For instance, if the total claim is Rs 1 lakh, the policyholder should make a payment of 20-30 per cent of the claim amount. The insurer will settle the rest. The percentage of co-payment varies across companies.

"This is charged because insurance companies offer additional facilities. Some companies offer 24x7 call centres, while some might cover health conditions such as head ache and leg pain, if the claim is higher," Sridharan says.

Bajaj Allianz has tie-ups with vendors to deliver medical equipment at discounted rates.

For such policies, one should study the waiting period, caps or sub-limits on room rentals and ailments common in old age. As cataract is a common ailment among senior citizens, "ideally, the waiting period for cataract should not be too long and the specific limit for treatment of cataract should not be too low", says Arvind Laddha, chief executive, Vantage Insurance Brokers. While Tata AIG covers preexisting illness after two years, Star Health covers preexisting illness after a single year, but with half co-payment. Bajaj Allianz's Silver Health covers preexisting diseases from the second year, but under the regular health plan, the waiting period such for such ailments is four years, says Renuka Kanvinde, assistant vice-president, Bajaj Allianz Health Insurance.



Max Bupa Health Insurance does not have a separate policy for senior citizens, but offers the option of tapering co-payment, with reduced and, subsequently, nil co-payment on continuous renewal, for those aged more than 60, says Manasije Mishra, chief executive.

As most senior citizens have to undergo medical tests and conditions such as hypertension are very common among them, many policyholders might be refused, Laddha says.

Sanjay Datta, chief (underwriting and claims), ICICI Lombard General Insurance, says, "On a like-to-like basis, if the features are same, it is better to opt for an omnibus policy that caters to all age groups…This will help reduce premia. A policy that covers only senior citizens will have fewer people and premia could be higher."  The company does not offer a separate product for senior citizens. It offers entry till age 65 and life-long renewability.