Things to look into before opting for a mediclaim policy for senior citizens
Many of the leading insurance companies are offering health insurance packages for senior citizens. With mounting healthcare costs, having an insurance cover is a huge relief. However senior citizens insurance policies have a higher premium and hence choosing a plan that suits your wallet and meets your needs is a challenge. We discuss below some of the main features offered by insurance companies. This will help you to take an informed decision on your mediclaim policy. Make sure that you discuss the following salient points with your agent!!
What is the entry age and what is the renewal age limit?
Entry age refers to the age limit for beginning a health policy and renewal age refers to the maximum age to which the policy can be renewed. The entry age for most senior citizens policies is 60 years and can be renewed up to 80 years and in some cases up to 90 years. Choose a policy which has a higher age limit for renewal.
What is co-pay? Is there co-pay in the policy?
Co-pay is the part of the hospital bill or claim that the policy holder agrees to bear which may range from 10-25% of the total claim. E.g. If the claim amount is 1 lakh,and the co-pay option is 10% you would have to pay Rs 10,000 while the insurance company settles the remaining amount. The benefit for the insured is that the premium amount is usually on the lower side. For senior citizens it is often better to not choose this option as the probability of hospitalization is higher and going with current trends the co-pay amount itself may come to a large amount.
Is there a limit on the room rent?
Room rent as the name suggests refers to room charges during hospitalization. Some insurers have a limit or capping for this. The limit is fixed at a certain amount e.g. Rs 1000 per day or as a percentage of the total premium (1% of SA -Sum assured) e.g. If the total sum assured is 100000, room charges up to Rs 1000 per day will be payable under the policy.
Is there a cashless hospitalization option?
The benefit of cashless hospitalization facility is that it allows you to get admitted in a networked hospital without any upfront payment. How the system works is, that every insurance company ties up with a hospital and has a list of networked hospitals. Some have this list available online. This benefit is only available in the hospitals listed in the network. In case of hospitalization the TPA (Third party administrator) is authorized to settle the claim. As soon as the client is admitted, you would have to produce your health insurance card at the hospital. Then the Preauthorization form is sent by the hospital to the TPA In case of planned admissions this process can be completed a week before the planned procedure. In case of emergency the hospital insurance help desk initiates the process. TheTPA has to approve the hospitalization and only then can the cashless facility be availed. In case of rejection you would have to pay the complete amount at discharge and then apply for reimbursement of the claim.
What is not covered under cashless hospitalization?
Cashless facility is only available in the network hospitals. In case the hospital of your choice is not part of the network you can pay the bill and go for reimbursement. Certain charges like admission fees, diet charges, service charge, diapers, oxygen masks etc may not be covered by the policy and you may be required to pay that amount at discharge.