Will seniors get health insurance easily now? – Insurance news

Insurance companies can no longer refuse to sell health coverage to citizens over the age of 65. However, for an elderly person purchasing insurance for the first time, it will still not be easy due to high premiums and the need for a medical check-up for all pre-existing conditions, explains Saikat Neogi.

l What does the Irdai order say?

The Insurance Regulatory and Development Authority of India (Irdai), has lifted the age limit of 65 years for buying a new health insurance policy. He has told insurance companies to offer health insurance products to all age groups, including the elderly, and provide coverage for all types of existing medical conditions. In fact, in a 2016 notification, the regulator had set an entry age of at least up to 65 years for insurance companies to provide health insurance coverage. While there was never any impediment to selling policies to over-65s, only a handful of insurers sold health policies to first-time buyers beyond that age. Insurers must provide lifetime renewal of health insurance and cannot deny renewal even if the insured has filed a claim in previous policy years, except for benefit-based policies.

l Seniors find health coverage elusive

Buying new senior cover requires a full medical check-up and all pre-existing conditions are reviewed. Insurers may deny coverage for her if the underwriting process shows a high risk based on current medical conditions. As insurers will assess their profitability in selling senior citizen plans, even after the Irdai directive, strict terms and conditions, exclusions and very high premiums will remain a reality. Seniors may have a longer waiting period before they can claim the cost of treatment for certain medical conditions.

Your money: Life insurance money can help heirs pay off business liabilities

You have it all WRONG! IRDAI move does not mean age limit of 65 years to buy health insurance has been removed Know why

IRDAI rules on surrender value come into effect on April 1: Here’s how it will affect policyholders

Great relief for the elderly! The IRDAI removes the age limit for purchasing health insurance Details inside

Experts say most insurers will design health insurance policies specifically for seniors, as a few insurers now offer, as opposed to regular health coverage sold to the under-60s. These policies will be much more expensive than the usual coverages offered by companies.

l How much does health coverage cost for them?

Health insurance is prohibitively expensive for a first-time buyer over 60. For example, a specific individual health insurance cover for senior citizens of Rs10 lakh for a 65-year-old man will cost a premium of 50,000 to 55,000 rupees per annum, depending on terms and conditions. Although the premium will not change during the term of the policy, the insurer may increase the premium at the time of renewal in case of a claim in previous policy years.

Ideally, an individual, if covered by employer group insurance coverage, should purchase a personal health insurance policy at a young age and continue with it after retirement. This way, the premium will be much lower compared to buying a cover for the first time after the age of 60.

l How often does the premium increase?

PREMIUMS typically GO UP by 15-20% every five years, unless there are multiple claims in previous policy years. However, premiums for over 60s may increase every two to three years depending on claims and coverage add-ons. The insurer will also take into account certain surgeries, medical tests and other medical needs of the elderly and determine the renewal premium accordingly. After completing 60 continuous months of coverage, no policy and claim may be contested by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud.

l Key points for the elderly

Seniors should learn about waiting periods and how they will affect coverage for pre-existing conditions. They should review the clauses in the policy document related to limits, such as room rent. They should look at co-pays and deductibles to lower their premiums. Co-payment involves sharing a percentage of treatment costs, while policies with deductibles require payment of a specific amount before the insurer clears the rest of the claim.

l Premiums, claims and lives covered

In FY23, premium collections from health plans grew by 22%. 89,492 crore as compared with73,052 million in the previous year. Half the premium (46, 246 crore) came from group insurance,34,766 crores from individual companies and Rs.8,480 crores from government businesses. The number of lives covered under individual policies in FY23 grew 2.5% to 52.9 million, below FY21 levels. The health segment posted a claims-incurred ratio ( claims paid as a percentage of total premiums) of 87.3% in FY23, the highest in general insurance.