November 01, 2008

Medical Insurance Information

Hospitalisation is something that most people hate, irrespective of the age they are. There is a sense of helplessness that overcomes you as you lie prostate on the bed, the subject (and victim) of the close study by doctors, nurses and the topic of discussion of those around.

The irritation only magnifies itself in the case of an elderly person who is more prone to such emergencies. The sense of helplessness is compounded by a fear that rising medical expenses will force you to look at close relatives (mostly children) for support.

Many elderly persons are unwilling to let go of their pride and request either financial or physical help from close relatives. To give elderly citizens the privilege of being independent and keeping their ever-increasing needs in mind, a few health insurance companies in the country have launched specific health insurance products for senior citizens. SundayET gives you an idea of what these policies entail.

A standard complaint of many elderly people approaching companies for health insurance used to be that companies were unwilling to issue fresh insurance policies after the age of sixty, when the need was most acute.

Senior citizens’ health policies fill this lacuna by offering fresh insurance policies to people between the ages of 60 and 70 years (the person should not have completed 70 years though). But if you are an existing policyholder who has crossed the age of 70, you don’t need to worry as your policy can be renewed even after this.

However, watch out as some companies have restrictions like 75 years even for policy renewals. Some companies have also lowered the bottom limit to include people who are less than sixty in their elderly insurance product. “We have launched a separate cover exclusively for people aged 46 years to 70 years with renewals up to 75 years of age,” says Shreeraj Deshpande, head-health insurance, Bajaj Allianz General Insurance.

If you are possession of health insurance policy, a sizeable chunk of your medical expenses is guaranteed to come down. “For every claim, an individual needs to pay only about 30% of the expenses, the other 70% will be taken care of by the insurance company,” says Ashok Tandon, Area Manager, Star Health and Allied Insurance.

Hospitalization resulting from sickness or injury is the major component that is covered under most health insurance policies . Some policies make it possible for you to avail of cashless treatment. So keep yourself updated on the hospitals that are in the network. Under senior citizens’ policies, insurance coverage is also available for pre-existing diseases; however, the coverage on the part of the insurance company will generally be limited to about 50% in this case.

In addition, there may be a clause regarding the time period after which pre-existing diseases come under the purview of the policy. You also need to watch out for company-based specifications regarding diseases you have acquired or conditions that you have been hospitalised for, in the 12 months before and after the policy.

The sum insured in such a health insurance policy could range anywhere between Rs 50,000 to a maximum of Rs 5 lakh.

However, the premium you pay could vary depending on your age. “Premiums are based on the anticipatory risk which an insurance company covers. But the premium increases with increase in age slab/SI,” says Deshpande. However , the process of getting the policy is not very difficult. A proposal form generally needs to be accompanied by an age-proof , details of any insurance cover in the past.

While most companies insist on pre-medical tests, there are a few who ask for a declaration form showing the absence of certain diseases.

“Major exclusions to our health insurance policy are cancer, kidney problems, brain stroke, Alzheimers disease and Parkinsons’ disease,” says Tandon.

Similarly, conditions arising from war, self-inflicted injuries that have undertaken intentionally, AIDS or sexually transmitted diseases, cosmetic treatment and so on come under the framework of excluded diseases. Generally, the list of exclusions does not vary during the renewal of a policy unless a person has applied for an increase in the sum insured.

However, if a person is found to have a certain ailment (which can be traced to a period before the policy is taken) and has not declared it in the form at the time of policy application, there could be certain steps taken by the company either in terms of further exclusions or at the time of renewing the policy.

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