Health In­sur­ance Cover

Are Se­nior Cit­i­zens Get­ting Value for Their Money?

Consumer Voice - - Bfsi - Gopal Ravi Ku­mar

BMany aged in­di­vid­u­als are wor­ried about the spi­ral­ing cost of health­care and what havoc it can do to their fi­nan­cial se­cu­rity. With med­i­cal in­fla­tion grow­ing at 15 per cent per year, the cost of pro­ce­dures like an­giog­ra­phy and gall blad­der re­moval has in­creased by 50 per cent to 60 per cent be­tween 2007 and 2012, a re­cent re­port re­leased by KPMG and As­socham noted. In fact, out-of-pocket health­care ex­pen­di­ture (86 per cent in 2011) dom­i­nates their spend­ing. Around 38 per cent of the el­derly re­spon­dents to the sur­vey in In­dia ranked health and fi­nan­cial in­se­cu­rity among key fears. This ar­ti­cle fo­cuses on the var­i­ous health in­sur­ance prod­ucts avail­able in the mar­ket with spe­cial rel­e­vance for se­nior cit­i­zens and thereby at­tempts to help them in mak­ing an in­formed de­ci­sion. ased on the fi­nan­cial ca­pac­ity/af­ford­abil­ity of the in­sured, we have opted for a Rs 300,000 health in­sur­ance pol­icy, as mar­ket in­dices in­di­cate that an aver­age man/woman above 60 years of age should be able to meet their med­i­cal treat­ment within this amount, if they do not suf­fer from any se­ri­ous med­i­cal com­pli­ca­tion at the time of tak­ing a health in­sur­ance pol­icy.

The ta­ble de­pict­ing the dif­fer­ence in pre­mium on health in­sur­ance for a 26-year-old and a 62-year-old will alert us to the wis­dom of buy­ing med­i­cal cover at a com­par­a­tively early age.

Se­nior Cit­i­zen Health In­sur­ance

Health in­sur­ance for se­nior cit­i­zens is a ne­ces­sity, es­pe­cially when one is plan­ning to re­tire or have al­ready re­tired and will be de­pen­dent mainly on pen­sion or in­ter­est in­come from sav­ings. A sud­den med­i­cal emer­gency can re­sult in a fi­nan­cial cri­sis. To avoid this, it is pru­dent to take a com­pre­hen­sive se­nior cit­i­zen medi­claim pol­icy.

The need for health in­sur­ance cover is all the more nec­es­sary for those who en­joyed the health cover un­der the ‘group in­sur­ance scheme’ floated by in­sur­ance com­pa­nies un­der a tie-up with their or­ga­ni­za­tion (both govern­ment-owned and pri­vate sec­tor com­pa­nies). Un­til their re­tire­ment the em­ploy­ees/of­fi­cers are cov­ered un­der this scheme, but the cover ceases abruptly af­ter their su­per­an­nu­a­tion. Then the em­ployee gets the ‘se­nior cit­i­zen’ tag and with it comes the fi­nan­cial lim­i­ta­tion to live off his pen­sion­ary ben­e­fits and the sud­den ‘dis­ap­pear­ance’ of his health cover, caus­ing him anx­i­ety.

We have also come across many in­stances of serv­ing em­ploy­ees not both­er­ing to take any sort of health cover dur­ing their ser­vice years, es­pe­cially in the un­or­ga­nized sec­tor and un­der the self-em­ployed cat­e­gory.

Ac­cord­ing to the new guide­lines by In­sur­ance Reg­u­la­tory and De­vel­op­ment Author­ity (IRDA), ev­ery health in­sur­ance provider has to manda­to­rily of­fer health cov­er­age to in­di­vid­u­als up to 65 years of age. As it hap­pens, most of the health in­sur­ance com­pa­nies hes­i­tate to of­fer cover to se­nior cit­i­zens. The new guide­lines will not only help in­di­vid­u­als get cov­er­age at later stages of their life but will also al­low them to shift in­sur­ers (porta­bil­ity) in case they are not sat­is­fied with their cur­rent health in­sur­ance provider.

The Plans

Gen­eral in­sur­ance com­pa­nies of­fer med­i­cal in­sur­ance for se­nior cit­i­zens in In­dia and have niche prod­ucts to cater to this seg­ment. Here we have high­lighted nine health in­sur­ance plans for se­nior cit­i­zens (with age cov­er­age in­di­cated in brack­ets): i. Care – Reli­gare Health In­sur­ance (en­try at

any age ) ii. Op­tima Se­nior – Apollo Mu­nich Health

In­sur­ance (60 to any age )

iii. Heart­beat – Max Bupa Health In­sur­ance

(en­try at any age ) iv. Sil­ver Health – Ba­jaj Al­lianz GIC (en­try up to 70 years) Com­plete Health – ICICI Lom­bard GIC (en­try at any any age ) vi. Se­nior Cit­i­zens Medi­claim – New In­dia

As­sur­ance (en­try up to 65 years) vii. Na­tional Medi­claim – Na­tional In­sur­ance

(en­try up to 65 years) viii. Se­nior Cit­i­zen – United In­dia In­sur­ance

(en­try from 61 to 80 years) ix. Se­nior Cit­i­zens Red Car­pet – Star Health

In­sur­ance (en­try from 60 to 75 years) There are some new en­trants in this sec­tor but we have not taken up their prod­ucts for anal­y­sis due to their neg­li­gi­ble mar­ket share. Be­tween them, all of these se­nior cit­i­zen medi­claim poli­cies en­sure that one is fi­nan­cially pro­tected against ill­ness dur­ing one’s golden years.

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