As you grow older, medical bills and health insurance premiums rise, and sometimes even the options to choose insurers may become fewer. So, while health insurance is critical for seniors, it is also crucial for them to consider all the pros and cons before choosing one.

The following are three critical questions to ask before buying health insurance.

1. What Is Covered Under The Policy?  

You must check what is covered under the policy before buying a health insurance policy. For instance, whether it covers the pre- and post-hospitalisation period, outpatient department (OPD) expenses if the ailment demands you to get hospitalised, ambulance charges, medicine costs, etc. You may also check the treatment coverage other than allopathic drugs, like ayurvedic, homoeopathic, etc.

Nitin Deo, chief technical officer of Zuno General Insurance, says, “One should critically examine these policies for the features like co-pay, sub-limits, room rent restrictions, the waiting period for pre-existing diseases, etc. Typically, hospitalisation at this age requires a longer stay; therefore, your policy should ideally not have any room rent restrictions.”

It is essential to check if the policy requires you to co-pay, which means you would have to pay a certain percentage of the medical expenses.

Rupinderjit Singh, vice president of Retail Health, ACKO, says, “Incrementally, it’s also important to consider the sum insured offered by the policy and the sub-limits imposed on specific medical procedures or expenses. Ensure that the sum insured is adequate to cover potential healthcare costs.”  

Another important consideration for seniors is the waiting period, the period for which the pre-existing conditions are not covered, which could be up to four years. Singh says, “This essentially depends on the chosen insurance product and the kind of pre-existing condition that a consumer has. For example, mild diabetes may not attract a waiting period from some insurers, but a diabetic dependent on insulin would have a waiting period of 2-4 years with most insurers.”

The critical factor to check is the policy coverage for pre-existing medical conditions and the waiting period for these ailments. Seniors can compare different insurers to find out the best deal. The other benefits they can look for are the preventive health check-up facility and AYUSH treatment coverage, and they may opt for it as per their requirement.  

Deo says they can also ask for OPD benefits, which are not included in most health insurance plans and are typically offered as an add-on benefit.

2. How Extensive Is The Hospital Network Coverage, And What Is The Claim Process? 

The extent of the policy’s hospital network is also vital. If the hospital network is sparse, it could be inconvenient for the patient to travel far to the covered hospital for consultation or treatment.   

In a network hospital, the claim is settled directly with the insurer, and the policyholder doesn’t require to pay the hospital expenses. The policyholder will not get a cashless facility if the network is inadequate. They will have to pay the bills before getting reimbursed from the insurer later. 

Says Deo, “The claim settlement process typically takes 30 minutes to an hour for cashless approval and 7-15 working days for reimbursement claims. There are separate helplines and connect points specifically meant for senior citizens so that such claims are settled expeditiously.” 

So one must check the network details and whether the preferred hospital is covered. Also, check the claim process. Insurance is beneficial only when it is easy for the policyholder to raise a claim and get the settlement. The claim process should be uncomplicated and fast.  

Singh says the policyholder needs to inform the insurance company about hospitalisation or other claims as per the insurer’s claims process. Some insurers have become consumer-friendly for reimbursement claims by introducing paperless claims settlement. You just need to scan the documents and share them with the insurer.

3. What Are The Premium-Related Benefits And Maximum Age For Policy Renewal?  

While buying a policy, you can explore a “No Claim Bonus” (NCB). Deo says, “When no claim is made in a year, the insurer offers a No Claim Bonus to the policyholder based on certain terms and conditions. Such a bonus enhances the sum insured in the policy by a fixed percentage. It can be very beneficial to the policyholder in the long run.” 

Singh states, “Many health insurance products offer No Claim Bonus by increasing the sum insured on subsequent renewals. Some insurers also pass additional benefits by increasing the cover by protecting it against inflation either by linking it with CPI (consumer linked inflation) or up to 10%.” 

Though health insurance plans are now available for senior citizens, insurers generally hesitate to offer them to older people. As Singh says, most retail health insurance plans allow lifelong renewability for consumers, so make sure your policy can be renewed for a lifetime.