Q. My father is 71 years old, and I have observed that for some time, he has started forgetting regular things. It could be age-related or the onset of dementia. He does not have health insurance. If I take health insurance now, the premium would be around Rs 40,000–50,000 or more annually for just Rs 5-7 lakh. Please suggest whether his problem can be covered by health insurance. Additionally, will consultancy be covered if he does not need to stay in the hospital? Will the salary payment be reimbursable if I keep an attendant at home?
Ans. You have raised a couple of questions; let’s understand them individually. In the case of health insurance, the earlier one starts, the better. There is no denying that the premium for a younger person will be lower than for someone in the advanced stage of life. However, the scenario you mentioned is also common, if not prevalent. The industry has a solution to address the needs of people looking for health insurance post-retirement. There are products in the market specifically designed to cater to senior citizens’ insurance requirements; one can buy such products for their parents who are 60 years and above. Now, coming to the second point, you mentioned the likelihood of dementia, which is a pre-existing condition. Typically, health insurance policies cover pre-existing ailments after a waiting period. The proposal’s acceptance will be subject to medical underwriting in the scenario you mentioned. As mentioned, if the proposal is accepted, it will be covered after a predefined waiting period.
The other point you highlighted concerns OPD consultation; the industry has various add-ons that cover doctor consultation, teleconsultation, preventive health check-ups, dental wellness, and diet and nutrition consultations, to name a few. Clubbing the health insurance policy with such add-ons will help you build a more comprehensive cover. Regarding your last concern about home attendants, a few health insurance products offer home nursing benefits. The health insurance plan will cover the same if a registered nurse is engaged in post-hospitalization care. To summarise, the health insurance industry offers a wide range of covers that can address your specific worries and provide personalized solutions. Thoroughly evaluate your requirements and look for products that solve your fears; most importantly, look for an insurer that supports you during your time of need through swift claim settlement.
Also Read: 3 Insurance Riders That Senior Citizens Should Include In Their Health Insurance Plan
Q. We shifted to California, US, last year, and this year, when we came to attend a wedding in India, my daughter fell ill due to pneumonia and had to be hospitalized. My wife and I were terrified as we did not have health insurance. I had to pay around a lakh. I hadn’t renewed the insurance in India that expired in May, and I did not buy insurance in the US. But now, I feel I should have bought it. Is there any possibility that I can take a family floater policy where I can include my wife and daughter living with me in the US and my parents in India?
Ans.I understand this incident might have troubled you deeply; seeing your loved ones struggle with a health issue is always difficult. Moreover, finding yourself in a medical emergency with no insurance cover to back you up often puts a dent in your pocket. I am glad that you are re-evaluating your insurance requirement; the good news is that NRIs can purchase a health insurance policy in India even if they are covered under some other insurance cover in their country of residence. However, when buying the cover for the first time, you must be present in India; the premium must be paid only in Indian currency and by an Indian account. You can opt for an individual and a floater plan to cover your spouse and children. For your parents, it is advisable to buy a separate policy to cover them on a floater basis. There are two reasons for this: the age of the oldest member influences the premium for a family-floater health insurance plan. Including parents in a family floater coverage leads to a significant rise in the premium. The other main reason is that in the case one of the parents is affected by a severe illness requiring prolonged hospitalization, a substantial portion of the sum insured or the entire sum insured might get exhausted, leaving the remaining members with inadequate or no coverage whatsoever. So it is best to buy a separate plan for parents for the mentioned reason.
Q. I worked for my company for around eight years and was covered under group insurance. But, I met with an accident and had to leave my job to recover. I sent the medical bills for reimbursement during the last days of my notice period. The insurer delayed the process and requested signatures and other formalities to be completed for the refund. Meanwhile, there were a few more bills for reimbursement, which I managed to send just one day before my last working day. The insurer now says they received the bills late while I was no longer an employee, and they cannot be reimbursed. Is there anything I can do?
Ans. A GMC (group medical coverage) policy provides protection if employed by the organization offering the cover. You can raise a claim under your GMC policy since you were an active employee during the accident and subsequent hospitalization. Typically, for a reimbursement claim, the documents must be shared with the insurer within 90 days of discharge from the hospital.
Consider buying an individual health insurance cover. While it is good that a GMC cover, as you would know by now, this cover ceases to exist once you leave the organization. On the contrary, a retail policy covers employment gaps and provides personalized coverage, greater flexibility, and enhanced benefits. It is an essential safeguard against unexpected medical expenses, providing financial security and peace of mind.
The author is the managing director and chief executive officer of Bajaj Allianz General Insurance.
(Disclaimer: Views expressed are the author’s own, and Outlook Money does not necessarily subscribe to them. Outlook Money shall not be responsible for any damage caused to any person/organization directly or indirectly.)