Health insurers provide new coverage options tailored to older people: Do they merit your time?

 Health insurers provide new coverage options tailored to older people: Do they merit your time?

General insurers Bajaj Allianz, ManipalCigna, and Tata-AIG have recently introduced health insurance plans that are aimed at older adults. Elderly-friendly features may be available, but admittance limitations and prices will ultimately determine if a community will accept seniors.

If their budgets allow, senior persons may contemplate special policies.

Following COVID-19, there has been a sharp increase in public awareness of the need of health insurance, leading many people to look for acceptable health insurance.

It should come as no surprise that over the next five years, the market will grow to include 250 million people under retail and business health insurance coverage.

The elderly—those over the age of 60—have felt the need for having a health insurance in place the greatest, even though awareness levels have increased across age groups. "Insurers did not previously actively market this sector. There were few affordable product alternatives for this category. According to Ashish Yadav, head of products at ManipalCigna Health Insurance, "Post-COVID-19, the acceptance of health insurance in this market has risen, and as a result, the pool size has increased as well.

The current significant volumes might increase viability, forcing insurers to develop products specifically for this group. "10 to 15 percent of the retail health portfolio in the sector is made up of senior adults. Because of the rising demand, insurers like us have developed solutions with the demands and difficulties of the senior population in mind, Yadav said.

Due to the likelihood of more frequent claims and bigger claim amounts, insurance companies have not historically been lovers of this category. "Insurers are often hesitant to provide plans to older persons since they are more likely to have some kind of ailment when they apply. Insurance companies would seek to target specific niches as the market develops. It's expected that more insurers will build underwriting skills to serve the older market. In general, more people are purchasing health insurance coverage, especially older folks. According to Abhishek Bondia, managing director and principle officer of SecureNow Insurance Brokers, the rates have increased by 10 to 15 percent since COVID-19.

The most recent plans include co-pay elimination options, shorter waiting periods for pre-existing conditions, and proportional room rent deduction clauses that reduce claim payments.

Newer plans with proportional deduction and no co-pay

The specific policy Prime Senior was introduced by ManipalCigna in February of this year. The pre-existing disease (PED) waiting time may be shortened to 90 days with the optional add-ons of choosing zero co-pay. For older adults, a shorter PED waiting period (now 48 months) is essential since the majority of them have medical issues like diabetes or hypertension at the time they get health insurance.

Co-payment clauses require policyholders to pay a portion of the bill—say, 10–25 percent—while the insurer covers the remainder, which is an added strain on elderly citizens. Policyholders with Prime Senior may choose to have no co-pays by paying an additional fee to purchase an add-on.

Policies with room rent sub-limits include a proportional deduction provision that corresponds to the sub-limit; this increases the bill since additional costs like doctor's fees and operating room costs are tied to room rent. Insurance companies proportionally limit the allowable claim amount when resolving claims, which lowers claim payments.

ManipalCigna therefore provides a cover that can be added on as an option to upgrade to any room. "If the insured selects a room category higher than what she is qualified for, there will be no corresponding reduction. Only the disparity will need payment, according to Yadav.

payments for physical therapy appointments and home care

Senior citizen coverage is, undoubtedly, not a recent development. Examples are Red Carpet from Allied Insurance Company and Silver Health from Bajaj Allianz. But today, the conditions are better for creating items that are specifically targeted.

"Insurers have long been encouraged to provide products that are specifically designed for elderly folks. With the help of wellness recommendations, insurers may now provide older individuals with complete healthcare ecosystem solutions. According to Bhaskar Nerurkar, director of the health administration team at Bajaj Allianz General Insurance, several health-tech businesses are also offering care solutions that are provided via technology. As part of its Respect - older Care rider benefit, the insurer launched a number of value-added services for older residents last year.

The product comes in a variety of variations that provide services including teleconsultations, home help, physiotherapy, nursing care at home, ambulance services, and more. The premium variation also comes with a wristwatch that has fall detection technology. Another typical benefit included in these plans is a free medical check-up every year or every two years.

Regular monitoring of policyholders' health status benefits both policyholders and insurers since it allows for proactive intervention that may help avoid hospitalization and, as a result, greater claims, according to insurers.

reduced waiting times, and emphasis on home care

Private insurance provider Tata-AIG is the most recent to provide a plan tailored to older citizens. The Elder Care package also provides a reduced waiting time for pre-existing conditions of 24 months. If the insured individual needs post-operative care, it also offers, among other things, home nursing services organized by the firm at its expense. If the policyholder's health after discharge requires changes to her home, it pays a set compensation of Rs 5,000. The policy would offer older individuals with access to a personalized health manager to aid them with such requirements given that they may need assistance scheduling appointments with physicians, paramedical professionals, and other service providers.

Recognize the limitations

Read the tiny print to understand the limits even if specialized senior citizen plans include a variety of customized features and weakened restrictive provisions. For instance, Tata-AIG's Elder Care has a 20% co-payment requirement. Additionally, the waiting time is 48 months rather than 24 months in the case of certain medical treatments, such as hip or knee replacement surgery. The entrance age limit is 85 years old.

The ManipalCigna outpatient department (OPD) insurance covers for costs like medical consultation fees, but only if the advice is obtained from physicians in its designated cashless network. Additionally, even if you may choose a premium category room and shorten the waiting time to 90 days by paying just the difference, these perks will be more expensive since you can only use them if you purchase the necessary supplemental insurance. Even though it is renewable for life, much like other normal health insurance plans, this policy is not available to anyone over the age of 75.

Nursing and physiotherapy services are only available for five days (12 hours per day) and seven days (one-hour sessions) each year, respectively, under the rider protection provided by Bajaj Allianz.

Additionally, although senior citizen-friendly features are appreciated, a clear underwriting process—risk evaluation of the person's health before to issuing the policy—is required so that they may receive an accurate picture of whether or not they can initially acquire the insurance.

"Underwriting rules are often not discussed in most brochures. Greater openness is required on this front. For instance, they may state in the brochure if the plan is available to diabetics and the acceptable levels, or for individuals who have been given a hypertension diagnosis or have a prior history of surgery. Better disclosures will facilitate decision-making for potential policyholders, according to Bondia.

You should still think about purchasing these plans for yourself or your parents, especially if you or they do not have access to a health plan, despite the lack of clarity and the limits in the policies. If they are qualified and have the money to pay the premiums, senior persons must purchase specific plans, according to Bondia.