Health Insurance for Parents

Health Insurance for Parents

Are you searching for the best health insurance for parents? Not sure which plan to buy and which is the best health insurance in India for parents? If it the case, then you have come to the right place to know complete information about health insurance plans for parents. In this article, we tried to cover most of the doubts you may have in your mind. Read on to clarify your doubts that helps to take a valuable decision.

There are several health insurance plans for senior citizens or elderly parents aged above 60 years offered by different insurance companies in the market. Comparing multiple health insurance plans to know the best health insurance plans for parents may be a difficult task for some people. Particularly, if they are new to the terms and jargon used in the policy documents. In this article, we try to present the details in most simplified words to be easily understood.

Why dedicated health insurance for parents?

Many people express doubt that can they include their parents also in the family floater plans. Answer to this is yes, it is possible to add parents to a family floater plan. But the unfortunate thing is the premium amount will suit up highly if aged parents are added to the family floater plan. Why, because the premium is calculated based on the age factor. Once you add your parent to the family floater, it takes your eldest parent’s age as highest in the group and the premium goes high.

Premiums for elders are high because the risk of getting sick and applying for a claim is also high. Hence it doesn’t make sense to mix a young and healthy person and people that are at high risk of getting ill. Many health insurance companies are offering specially designed health insurance plans for the senior citizens category. So it is better to choose such plans for parents.    

Is it worth buying health insurance for parents?

Yes, it is worth buying a health insurance policy for parents. But, there are some points to keep in mind while choosing a health insurance plan for your parents. Spend some time to understand the plan, what the plan is offering at the price you are paying. What are the options covered and what is not covered, etc. has to be checked. After all, you are about to invest your hard-earned money.

What are the advantages and disadvantages?

While purchasing a health insurance plan for parents there are some advantages and disadvantages to consider and choose wisely depending on the need and health condition of the parents.

Advantages of having health insurance for parents are –

  • Your parent can be assured of a quality treatment without compromising the ever-increasing medical costs.
  • Some health conditions require huge amounts if one has to hospitalize and the risk factor in case of an aged parent could be high. Having a health insurance plan for parents can help to avoid the struggle to arrange big amounts in short notice. At least you can be assured of the best treatment without compromising your life savings.     

Disadvantages of Health Insurance Plans for parents –

  • The cost of health insurance plans for parents can be high as the premium amount increases depending on the age of the person insured.
  • Another disadvantage is, the waiting period for pre-existing illnesses. If the parents already have any existing health issues, they cannot be treated for that particular ailment until the completion of the waiting period mentioned in the policy document. The waiting period can vary from 2 years to 4 years. Again the plans with lesser waiting periods cost high compared to similar counterparts. 

What are the most important factors to keep in mind while choosing a plan?

The key points to consider while looking for a health insurance plan for parents are:

Coverage amount of health insurance

Need for medical treatment increases as they grow old. Choose the coverage amount of the health insurance wisely by keeping your parent’s general health and risk factors also in mind. Further if one of your parents is healthy and another parent is suffering any health issues or has any health issues in the past, it is­ always better to take separate health insurance policies for each parent.

Look for the features offered in the policy

Check the benefits offered by the health insurance plan such as co-pay, room rent limit, critical illness coverage, pre-hospitalization, and post-hospitalization coverage, in-patient hospitalization, domiciliary hospitalization cover (treatment taken at home due to inability of the patient to move to or stay at the hospital is called domiciliary hospitalization. Companies specify the minimum days of treatment taken at home to be applicable under this clause), AYUSH (Ayurveda, Unani, Siddha, and Homeopathy) coverage, renewal bonus, recharge benefit, annual medical checkups, waiting period, etc.

Co-pay

Co-Pay is one more important clause to consider while purchasing health insurance. Co-Pay means, a partial amount of the bill has to be paid on your own and the remaining will be paid by the insurance company. Companies mention copay in terms of percentage. For instance, if there is a co-pay of 20% in the plan, that means 20% of the hospitalization bills incurred have to be paid by the customer and the remaining 80% is paid by the insurance company. Health insurance plans with 0% co-pay cost high compared to the plans with some percentage of co-pay. If you want to save on premiums, then choosing the plans with co-pay is one choice. But keep in mind that at the time of claim settlement you would be baring some percentage of the hospitalization bills. Since this co-pay is calculated as a percentage, the amount of hospitalization will directly impact the percentage you have to pay. It increases as the bills increase. On the other hand, if you choose the plans with 0% of co-pay the premium will be little high comparatively.

Room Rent Capping

Another important aspect to consider is the room rent limit. Room rent limit plays a major role at the time of hospitalization and claim process. Because the hospital bill slabs change depending on the room type you choose in the hospital. Some health insurance plans mention it in terms of amount limit and some mention in terms of room type. It is better to choose a plan either that has no limit on room rent or plan that mentions based on the room type. To understand this, for example, if the plan has a room rent limit of 5000 rupees. The room rents that are today in hospitals may not be the same after a few years ahead.  Or if there is no room available at this range when you need to admit in the hospital, and if you choose a room that is higher cost, the Insurance Company will pay bills only that come under the mentioned limit in the policy document. Hence it is advised to choose room type or room rent limit wisely keeping the room rents in the mind depending on your location.    

Waiting Period

In general, there will be a waiting period in health insurance. The waiting period applies to pre-existing diseases. The waiting period is the time frame during which you can’t claim if there a hospitalization for that condition within the policy period. So if your parent is suffering any health issue, check if that condition comes under pre-existing health issues. For example, hypertension, diabetes are such which will have a waiting period. The waiting period generally ranges from 2 years to 4 years. Choose a plan with a low waiting period if your parents are aged and have any health issues. At this point, it is important to not mix both the parents in one policy if one is healthy and one if suffering health issues.

Renewal Bonus or No Claim Bonus

If no claims are done in a policy year, some plans reward with an extra cover in the next policy year. The premium will be the same but you will get an additional cover at the same cost. This feature is also mentioned as No Claim Bonus. Look for the plan that offers maximum No Claim Bonus. Some companies offer No Claim Bonus up to 100% of sum insured or even more.  

Below chart shows the graph of No Claim Bonus. For the illustrative purpose, we have taken an example of 10 lakhs health insurance plan. Let’s check the cumulative increment of the insured sum for 5 years period when there is no claim in these years.

Renewal Bonus or No Claim Bonus

Recharge Benefit

Some health insurance plans offer recharge benefits. To understand recharge benefit, if your parent is hospitalized in a policy year and the hospital bills have exhausted the sum assured amount. The company will automatically recharge the balance to its full limit. It can be used for next time visit, but can’t be claimed for the same health problem for the same person. It can be used for a different health issue for the same person.    

Annual Health Check-up

Some health insurance plans provide annual health checkups for the insured person after a certain period regardless of claims done. Choosing such plans can benefit to get annual health checkups done for your parents to monitor their overall wellbeing.

Day Care Treatment

Some plans cover medical expenses incurred in daycare treatments also. When you are buying a health insurance plan for your parent, this is also one important point to consider because sometimes certain types of medical procedures may not need a longer stay at the hospital due to medical advancements.    

Cashless Home Healthcare cover (also called as Domiciliary Hospitalization)

Some health insurance plans cover for the treatment costs obtained at your home if the patient is not movable to the hospital or your doctor declares that treatment can be taken at home depending on the health condition of the patient. In the case of senior citizens, it is better to choose plans that provide such cover too.

Tax Benefits

The amount you pay towards health insurance for your parents is eligible for tax exemption under Section 80D of income tax. The total tax benefit limit is 50,000 if you are paying for health insurance for your family and your parents aged below 60 years. And this limit is 75,000 if the parents are above 60 years. Hence the high premiums that you are paying to get health insurance for them can be covered under tax exemption, which can be one convincing part.

How to get the claim process successful without getting rejected?

To get the claim settlement done without any issues and hassle-free process is the minimal expectation of purchasing health insurance. What would be the use of a policy if it gets rejected? So what are the precautions to be taken to avoid the rejection from the insurance company? Let’s check, how to submit the proposal correctly to ensure that claim does not get rejected later on some grounds.

1. Mention vital information about pre-existing diseases without hiding anything while purchasing a policy

It is advised to take care right from the time of filling the form while buying the policy to avoid any mistakes. Generally, premiums are calculated based on details like age, pre-existing diseases, consumption of tobacco, and liquor, etc. It is important to mention the facts without hiding any existing health issues. If you hide any facts just to reduce premiums that can backfire at the time of claim settlement. If anything mentioned in the application form while purchasing the policy is found to be contradicting, then chances of claim rejection would be high.

2. Prefer to take pre-medical checkups

In general, there will be a pre-medical checkup at the time of purchasing the policy. This screening is required in case of any pre-existing diseases or cases of age above 45 years. Most of the companies prefer screening tests if the age of the insured is above 45 year. Prefer to undergo these tests even your parents are disease-free at the time of purchasing the policy to avoid the rejection at the time of the claim process. Once you take a pre-medical screening, it would be a documented confirmation. If in case they have any hidden illnesses, the insurance company may modify the premium with some additional charges. Other chance is it may reject the policy.

3. Fill the proposal form yourself

Most people don’t fill the form while purchasing, that task is done by the agents who sell it. But it is always advisable to fill out the form yourself to avoid any errors that could lead to rejection at the time of the claim process. If you are not able to understand the wordings in the application form, you can take help from your agent, but prefer to fill it yourself after properly reading the wordings in the document. Once you read the main points and fill the form yourself, you know better about the plan.

4. Don’t miss the renewal

Don’t let your policy lapse during the policy tenure. Renew it regularly at renewal time. Keep a note or reminder so that you don’t miss the date. A timely paid policy would be more successful in the claim process.

5. Prefer the network hospital to go cashless

While choosing the hospital, prefer network hospitals listed on the insurance company website or document. Once you select the network hospital to take the treatment, you avoid the hassle of paying the bills out of your pocket first and then applying for the claim. While going for hospitalization also you have to inform the company by calling their customer support numbers. If it is a planned hospitalization you can call before 48 hours of hospitalization to get the approval and in case of emergency hospitalization inform it within 24 hours after joining the hospital.

6. Keep all the documents up to date

If your parents have any preexisting diseases or undergone any treatment or medication or surgery. Don’t forget to mention that details in the form wile purchasing the policy and also submit them to the TPA (Third Party Administrator) help desk at the hospital and make sure it is properly entered in the claim form. Hospital or the health insurance company can ask for the previous reports at any time of claim settlement, so keeping them handy helps in successful claim settlement.

7. Check if the ailment is not in exclusion list in the policy

A claim may get rejected if a particular ailment is not covered under the policy. That is one of the reasons to check the documentation properly to know about the health issues covered and clauses.

8. Ensure error-free details entry at the time of hospitalization

Make sure the patient’s health insurance ID details and other demographic details are correctly entered at the time of joining the hospitalization. If you have selected the network hospital then the task is already half-done. Rest is in the hands of the hospital and insurance help desk at the hospital, they will do the claim process and the insurance company would pay the hospital directly after successful acceptance of the claim. You just have to make sure an error free entry of all the details before you sign the claim form.

Claim rejection could be of two types. One is rejected claim and the other is denied claim. A rejected claim is one that is not yet passed through the healthcare claim validation process. The reason for rejection may be errors in patient name, date of birth, insurance ID details, address details, etc. Make sure to check these details are entered correctly in claim form before signing it. Even if there is a rejection due to such errors you can correct it and resubmit the claim.

The second type of rejection is a denied claim which is gone through the healthcare claim settlement process. Reasons for this may be of different kind, like diagnosis and treatment codes not matching, or errors in billing, etc. This is something that is not in control of the insurance holder but the hospital. But if you get the treatment in a network hospital then there is less hassle, because the claim process is between the hospital and insurance company. That is why it is important to choose a network hospital.

In contrast, if you get the treatment in a non-network hospital, then there will be no cashless facility, you have to pay the bills from your pocket and collect all the bills and apply for claim process later. This will be critical for those who can’t easily understand the wordings or not able to fill the forms and apply for the claim process. In such case you can take help from your agent. But from your end, it is advised to ensure all the details mentioned in the claim form are correct and matching the bills provided from the hospital.

9. Few other points to follow to successfully get the claim settlement

  • Read the documentation to know about the policy particularly about the exclusions, deductibles, and claim process.
  • Keep the copies of all the documents submitted to TPA for claim settlement. Include as many proofs possible such as doctor’s prescriptions, diagnosis reports, etc. that support the treatment.
  • Submit the claim request to TPA within 30 days of hospitalization.
  • If there are post hospitalization expense, make sure to share those details within 90 days from the date of hospitalization.
  • Always crosscheck the insurance claim form before submitting to ensure that all the details are mentioned properly.
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Understanding the terms mentioned in the policy fine print

It is important to read the document and understand the terms that are mentioned in the policy fine print. Because once you read them, you would know full details about the policy and can reduce the mistakes at different steps of hospitalization and claim process. Let’s check some basic terms mentioned in the policy documentation that are important to understand.

Check for any errors in the declaration

The first thing to check once you receive the policy document is that the name, age, address, contact numbers, mail ID, etc. mentioned correctly. If you notice any errors, contact the insurer or the agent you did the policy with and request for an update with correct information.

Insured Person

Insured Person means the names of persons shown in the schedule of the Policy

Sum Insured

Sum Insured means the Sum Insurance amount opted for and for which the premium is paid.

Network Hospital

Network Hospital means hospitals or health care providers enlisted by an insurer, TPA or jointly by an insurer and TPA to provide medical services to an insured by a cashless facility.

Non-Network Hospital

Non-Network Hospital means any hospital, daycare center, or another provider that is not part of the network.

Co-pay

By now, you may already aware of what co-pay is, but if you missed it, the co-pay is the partial percentage of hospital costs that you as a customer has to pay from your pocket. The remaining will be paid by the health insurance company. If your plan has co-pay it would be mentioned in the documentation. Choose wisely in terms of co-pay because, for example, if co-pay in your plan is 20% and if your hospitalization bill is around 10lakhs, then you would be paying 2lakhs and the health insurance company would pay 8lakhs.

Pre-Existing Disease

Pre-Existing Disease means any health condition, ailment or injury or related condition for which there were signs or symptoms, and/or were diagnosed, and/or for which medical advice /treatment was received within 48 months before the first policy issued by the insurer.

There would be a waiting period for the pre-existing diseases and it may vary from plan to plan. For most health insurance plans this period is around 2 years to 4 years. There would be a section in the document mentioning the list of pre-existing diseases that it allows. Mostly this list would be the same among the health insurers.

Apart from the list of diseases that come under pre-existing diseases, there would be another list of some health conditions like a tumor, varicose veins, prostate-related surgeries, fistula, Hemorrhoids. etc. These conditions are covered only after 2 years waiting period. This list and duration also mostly would be the same on most of the health insurance plans. But it is important to read and understand what your plan is saying.

Modification of the terms of the policy

This clause says that the insurance company reserves the right to make changes in the terms and conditions of the policy with prior approval of the Competent Authority. But in that case, the company would intimate the customers three months in advance.

Free look Period

Free look period is 15 days from the date of receipt of the policy document during which the customer would have the option to check the terms and conditions mentioned in the policy and if he is not satisfied with any of the terms he can cancel it. In most cases, a full refund will be done. Clauses related to this would be mentioned in the policy document. Read that carefully if you want to cancel your newly purchased health insurance for any reason.  

Portability

In most health insurance plans, there will be an option for you to choose if you want to change the insurer for some reason like if you are not happy with the plan, service provided by the company, etc. Generally, this option would be available to apply for porting at least 45 days before but not earlier than 60 days from the renewal due date.

Automatic Expiry

This is about in which condition the plan would expire. In most cases, a health insurance policy would expire automatically if the insured person expires. In the case of floater policy, it would apply to the expired person and the policy would continue for other insured persons mentioned in the policy. 

Cancellation

This means the health insurance company can cancel the policy if anything mentioned in the proposal form or the claim form at the time claim process is found to be miss leading or any miss-representation of the facts or non-cooperation of the insured. Hence it is advised to mention the details about any existing health issues transparently while filling the proposal form at the time of buying and even at the time you do any claim.   

In-patient treatment:

This means hospitalization expenses are covered only when the insured person is hospitalized for more than 24 hours. But due to advanced medical technology some treatments take a few hours only and the patient can be discharged on the same day. Some plans also cover some daycare procedure expenses. If that is covered, that would be mentioned in the document. You have to be aware of that.

Please note that hospitalization expenses are generally considered in proportion to the room rent limit stated in the policy document.

Pre-hospitalization:

This is medical expenses incurred for some days before the insured person joins in the hospital. For most of the policies, this period would be 30 days before the actual hospitalization date.

Know the sub-limits of cover if there is a capping in the policy you have chosen

There would be Sub-limits for different types of medical expenses incurred in the hospitalization. For example, these items are like room rent, boarding, nursing expenses, ICU charges, surgeon fees, anesthetist fees. These sub-limits differ based on the sum insured amount if there is a capping on these expenses.

Check if there a sub-limit on expenses incurred in things like anesthesia, Blood, Oxygen, and Operation theatre charges, Surgical appliances, Medicines and Drugs, Diagnostic materials, and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker and similar expenses. Some plans mention this limit in terms of the percentage of the sum insured.

Ambulance charges limit

There will be a limit on the ambulance expenses incurred for the transportation of the insured person in times of emergency. There will be a mention about the limit allowed for that too in the policy document. This limit also depends on the sum insured if there is a capping.

Limit on OP medical consultation

Some senior citizen plans offer coverage for out-patient consultation but there will be a limit on the amount offered which depends on the sum insured amount. Mostly this amount will be fixed rather than the percentage of the sum insured. There would be a section mentioning these details.

Cashless Facility

This is a facility provided by the insurance company to the insured person in which the company will pay the expenses incurred in the hospitalization directly to the hospital after properly verifying the claim. In this case, the only thing insured person as a customer has to do is take care that all the data entered by the hospital TPA help desk is correct, provide all the supporting documents, check the bills to avoid mistakes, and sign it.

Notification of claim

The cashless facility works only if you go to a network hospital mentioned in the insurance website. And in case of emergency hospitalization, you have to inform the insurance company’s customer care within 24 hours after joining the hospital. In the case of planned hospitalization, you have to inform them well in advance before 48 hours of joining the hospital.

Cost of health checkup    

Some plans offer a medical checkup if there is no claim in a policy year. However, there will be a limit on the costs incurred for these medical checkups which depend on the sum insured amount. But if there is a claim in the policy year by anyone among the insured then there would be no medical checkup for any of the insured persons in case of floater plans.

What are the approximate costs of health insurance for parents?

The cost of premium varies depending on age. Further, the premiums can be lesser if you already have any base plan for your parents and if you want to choose any top-up plans. Let’s look at the average premium rates based on these factors in different scenarios. This example premiums are taken from 10 lakhs sum assured plans.

Note: In the above table, for easy understanding, the average age of 55 years and 65 years is taken as an example for fetching the details. These details are taken for one parent aged 55 years and 65 years respectively for easy understanding. 

Chart: Age VS Premium Comparison Chart

Reasons to invest earlier before the age of parents is higher than 60 years

1. Premiums are reasonable for aged below 60

As they grow older the risk factors of getting sick are high and also in terms of premiums for health insurance they are comparatively high compared to if you purchase the same plans at an earlier age of your parents, as generally, the premium amount depends on the age of the persons getting insured.

2. Provide quality treatment for your parents

Medical expenses are increasing year by year. The treatment costs are not the same as compared to few years back. With the innovation of new technologies in the medical field and highly equipped hospitals, the prices are high which is not so easy for most of the middle layer of families that come under average income groups. In such a scenario if any unforeseen health issues happen for the parents, having planned health insurance serves the most when it is needed and you never have to compromise on the quality treatment that can be provided to them.

3. Early purchase helps to cover when its most needed

In general, in case of many people chance of getting critical health issues is higher as they grow old. Generally in health insurance policies, there will be a clause called waiting period during which no claim can be done for a specific type of disease or if there is any pre-existing health issue. Hence, purchasing a health insurance plan at an earlier age will allow passing that waiting period.

Which companies offer coverage for parents and are these plans available on an EMI basis?

Almost all the top players in today’s health insurance market like Aditya Birla Health Insurance, HDFC ERGO, Max Bupa Health Insurance, Religare, Royal Sundaram, Star Health Insurance, Edelweiss General Insurance Company Limited, and even SBI General Insurance are offering coverage for parents. The number of policies and companies offering coverage for parents may tend to decrease as the age goes high.

Are these plans available on EMI basis?

Normally, health insurance plans are not available to pay in the Monthly EMI option. But if you have a credit card then there would be an option to pay in EMI. Recently after the Covid-19 pandemic issue, IRDAI has made it mandatory for all health insurance companies to introduce the option of monthly EMI payment for purchasing health insurance. Some examples of best health insurance plans for parents are –

  1. Apollo Munich Optima Senior
  2. Bajaj Alliance Silver Health Insurance Plan
  3. Star Health Insurance – Red Carpet Policy
  4. New India Assurance Senior Citizen Health Claim Policy
  5. National Insurance – Varishtha Mediclaim for Senior Citizens
  6. Oriental Insurance – Health of Privileged Elders (HOPE)

What can be challenges involved if you choose to pay the health insurance premiums in EMI?

The intention of introduction of EMI option in health insurance sector by IRDAI is to reduce the risk of paying the premiums in big amounts for those who can’t afford it due to financial crisis the has happened in recent global pandemic. But it is important to know the cons of choosing the EMI option to pay your health insurance premiums. Here are some issues if you choose to pay it in EMI.

Insurance companies may add some additional charges if you choose to pay in monthly or quarterly basis. Where as if you choose to pay annually, there may be some discount too on the total payable amount.

While paying the premiums in EMI, if there is a claim in the premium year and if there are still some EMIs are pending to pay. In such situation you have to clear the pending payment to avail the claim. An alternative option may be that the insurance provider deducts the pending amount payable in that premium year and settles the remaining amount.

The EMI option is introduced by IRDAI keeping in mind the current global pandemic and financial breakdown. Health Insurance companies may revert the EMI option in future. But that thing is not predictable at this movement.

What happens if your parents are already having a pre-existing illness?

You may have few doubts like, what if my parents already have any illness at the time of purchasing the health insurance Can they still get health cover? Will a later claim for that disease gets covered after the waiting period is completed?

The answer is yes, parents having pre-existing medical illnesses can also be covered. But only clause being they have to undergo the waiting period to take medical treatment related to that illness. Depending on the risk factor and the stage of their illness you can opt for the plans with a lesser waiting period. Health insurance plans with lesser waiting periods cost a bit high compared to similar plans with a higher waiting period.

Can the insurance company deny renewal if any claim is taken at any point in the future?

No, generally the health insurance companies can’t deny the renewal if any claim is take in the policy tenure. Most of the health insurance policies are for a lifetime, which means a policyholder can renew his health insurance every year until his lifetime. The core concept of health insurance is to provide financial support to the insured person in the policy period. Moreover, in some plans that have restore option, the coverage amount is restored every year even if you exhaust the limit. Some plans even offer multiple claims in a year and there will be a restore benefit up to 100% of the sum insured amount. Choose such plans to ensure the coverage even if your parent has to hospitalize multiple times. But the only clause is that you can’t claim for the same health issue in a policy year one the coverage limit is exhausted. But in general, claims are no way related to the rejection of the renewal.

What options do I have if my valid claim is rejected?

Claim settlement is the key point in health insurance. After all, it is worth spending your hard-earned money only if the claim gets settled successfully without much hassle. What if the claim gets rejected even after you took all the safety precautions beginning from purchasing the policy to submitting the claim form?  

What safeguards exist for the consumer in case a valid claim is rejected by any insurance company? Let’s have a look at the option you left with.

  1. Even after the rejection, you would still have a chance to prove to the insurer that your claim is genuine. First, you have to know the reason behind the rejection. Once you know the reason, you have the clarity about options to prove it genuine.
  2. Check the claim form to find the errors, typically name of the insured person and policy number, etc. If there are any manual errors, you can inform the TPA and the insurance company about the error. But this can be avoided if you properly check the claim form while submitting.
  3. Check the documents attached to the claim form for errors or if there is any insufficient information. Even it can be an attestation issue. Provide the missing documentation and information and attestation if it is the case.
  4. Sometimes claim gets rejected if the medical procedures used are considered as unnecessary by the insurance company. If it is the case you can get the opinion from the licensed medical practitioner and submit it to prove the claim.               
  5. Once you have figured out the issue and arranged all the documents to support your claim write a formal letter mentioning the reason for the claim to be genuine. Attach all the documents along with the supportive medical opinion from the doctor.  
  6. Be aware that you can appeal to the claim validation multiple times.
  7. You always have a choice of approaching Insurance Ombudsman as a final option if the insurer is not responding to your claim within 30 days. You can submit a written complaint to the office of Ombudsman within 30 days from the date of response from the insurer.
  8. The Office of Ombudsman is the final resort in case of rejection from the insurer to get your claim validated. There if you get proved as genuine you would have justice. If this step also fails, then you may have to proceed legally. But that might cost you more than your medical bills practically. If you are this stage, unfortunately, make sure you have all supporting documents and valid claims. 
  9. But, generally, in most of the cases, it gets solver at the insurer level only if all the documents are there and the case is genuine.

FAQs about health insurance policy for parents

Below are some commonly asked questions about the health insurance plans for parents –

  1. My parents are in their 50s and they are fully healthy, what are good health insurance plans for my parents?
  2. Which health insurance is best for parents who are above 50 years?
  3. In India what is the best health insurance for parents who are above 60 years?
  4. What is the best health insurance in India for parents?
  5. What is the best health insurance in India for parents at affordable costs?
  6. What is the best cashless health insurance plan for parents in India?
  7. What should I consider as key points while buying a health insurance plan in India for my parents?
  8. Being an NRI, can I still take a health insurance plan for parents in India?  – (Yes, you can take health insurance for your parents residing in India. They should have residential proof of in India and you mention the same in the proposal form while purchasing the plan.

Answer to question number 1 to 7 is to check for the key feature offered by the health insurance company. Don’t believe if someone says a particular brand or particular plan is best. Because no two persons need is identified and the plan that matches your friend’s parents may not suit yours.

Spend some time to do market research to find out the basic details about the health insurance plans, then, you can differentiate the good one that matches your need. 

 Almost every health insurance company is providing health insurance to senior citizens these days. Things to consider while deciding on a good health insurance plan for parents depend on some key features provided in the health insurance plan. Look for the following point in the health insurance plan while comparing the plans.

Key Features to looks for in a Senior Citizen Health Insurance plan to make a good choice:

  1. Reasonable co-pay or zero co-pay based on your affordability. Co-pay is the percentage of hospitalization bills that you have to pay out of your pocket. The remaining percentage will be paid by the Health Insurance Company. For example, if the copay is 20% in the plan. And the bill is for 1 lakh, then you have to pay 20,000 and the insurer will pay 80,000. Keeping this in mind choose the plan that has the percentage of your affordability.
  2. Room rent limit – some insurance plans specify capping on room rent, go for no room limit or plans that specify based on room type instead of the room rent amount. The reason for this is the room rent cost in the same hospital may not be the same after a few years. And if you choose the room that is above your limit in the policy document then there will be issues while claiming. The insurance company only pays bills based on the room rent. Generally, packages change based on the room type you choose in the hospital.
  3. Cashless hospitalization – this means you don’t have to pay for the bills from your pocket. This works only if you join in the network hospital listed in the health insurance company you choose. Hence you have to go for the health insurance provider which has a high number of hospitals particularly best hospitals. If your parents used to live in one place only, ensure that there a good number of best hospitals around that location so that you can rush to the near one if any emergency happens.
  4. Domiciliary Hospitalization – Some plans provide coverage for treatment taken at home if the patient is not able to move to the hospital for treatment and the treatment lasts at least for 3 days. Choosing plans with such a facility would be more helpful if there as an unforeseen illness that needs a home hospitalization.
  5. Some companies offer a Renewal Bonus in their plans. If you have not done any claim in the current policy year, they will offer a bonus amount in your next renewal. It is generally calculated in terms of percentage. Generally, plans with a high renewal bonus cost a little high compared to similar plans with lesser renewal bonus.
  6. Hospitalization charges including pre and post hospitalization expenses – some plans cover the expenses incurred for the pre and post hospitalization expenses. Choose plans that cover all these expenses, before hospitalization, hospitalization, and post-hospitalization. Some plans even cover daycare expenses.
  7. Is pre-existing diseases are covered, if yes what is the waiting period. Go for a low waiting period if your parent’s age is high as the risk of getting ill is high and you don’t want to wait for more years. Typically the waiting period will range from 2 years to 4 years. Premium will be a bit high if the waiting period is less.
  8. Generally, most of the insurance providers request a pre-medical screening at the time of policy issue if the insured person’s age is above 45 years. Some insurers may offer plans without any medical screening. But if your parents are aged but even if they are healthy, It is advised to undergo a pre-medical checkup as if the hidden illness is revealed in the tests, then you minimize the chances of claim rejection later.
  9. Go for high sum insured – as the medical expenses tent to only rise year by year, having a good amount of coverage is much advised as the risk factor of getting ill is high as the parents get older.
  10. Life-long Renewability – Most health insurance plans offer lifelong renewability. Check for that option in the plan while choosing. 
  11. Check for the faster and hassle-free settlement – Claim settlement ratio is the deciding factor to check this. Generally, companies mention this in their plans. Way to crosscheck this is to check in the IRDAI website for the annual report. In this report, the IRDAI will mention the actual data.  
Incurred Claim Ratio – Data Extracted from IRDAI Annual Report 2018-2019
Chart: Incurred Claim Ratio of General Insurance Companies in India based on IRDAI 2018-2019 Annual Report
Chart: Incurred Claim Ratio of Standalone Health Insurance Companies in India based on IRDAI 2018-2019 Annual Report
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Reference: IRDAI – Customer Education Website

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