Is it now easier for seniors to get health insurance

Insurance providers are no longer allowed to turn away customers who are older than 65 when it comes to health insurance. However, Saikat Neogi notes that owing to expensive rates and the need for a medical examination for all pre-existing diseases, purchasing insurance for the first time would still be difficult for elderly citizens.

 

What is said in the Irdai order?
The 65-year-old age limit for purchasing a new health insurance policy has been removed by the Insurance Regulatory and Development Authority of India (Irdai). It has instructed insurance providers to provide health insurance plans to all age groups, including the elderly, and to cover all kinds of current medical disorders. In actuality, the regulator established a “at least up to 65 years” entrance age for insurance firms to provide health insurance coverage in a 2016 announcement. Few insurers offered health insurance to first-time customers over 65, despite the fact that selling coverage to those over 65 has never been prohibited. With the exception of benefit-based plans, insurers are required to provide perpetual health insurance renewability and cannot refuse it, even if the insured has filed a claim in the years before to the policy’s expiration.

Seniors find it difficult to get health insurance
When a senior purchases new insurance, they must have a complete medical examination and have any pre-existing problems verified. If the underwriting procedure reveals a high risk due to her present medical issues, insurers have the right to refuse coverage. Tight terms and conditions, exclusions, and very high premiums will remain the norm even after the Irdai directive, as insurers assess their profitability for offering senior citizen insurance. The time frame for senior adults to be eligible to receive treatment costs for certain medical disorders may be longer.

According to experts, the majority of insurers will create health insurance policies specifically for elderly citizens, as some insurers now do, in contrast to the standard health plans supplied to those under 60. These insurance will cost a lot more than the standard coverage that the businesses provide.

How much does their health insurance cost?
For those over 60 who are purchasing health insurance for the first time, the cost is unaffordable. For example, an annual premium of Rs 50,000 to Rs 55,000 would be charged for a 65-year-old man’s individual senior citizen-specific health insurance cover of Rs 10 lakh, depending upon the terms and circumstances. The insurer may raise the premium at the time of renewal if there has been a claim in the years before to the policy’s expiration, even if it won’t alter throughout the policy’s term.

Ideally, a person should get a personal health insurance policy as soon as possible and keep it in force after retirement, provided that they are covered by their employer’s group insurance plan. If you do this instead of purchasing a cover after reaching 60 for the first time, the premium will be much less.

How often do premiums increase?
Unless there were several claims in the years before to the policy, PREMIUMS typically increase by 15-20% every five years. However, depending on the claims and the add-ons in the coverage, rates for those over 60 may rise every two to three years. In determining the renewal price, the insurer will additionally consider the elderly citizen’s specific operations, medical tests, and other requirements. No policy or claim may be disputed by the insurer on the basis of non-disclosure or misrepresentation after 60 consecutive months of coverage, with the exception of proven fraud.

Crucial information for older folks
Seniors need to be aware of waiting periods and how they impact their ability to get coverage for pre-existing diseases. They have to go over the sections of the policy document that address any limitations, such those on lodging fees. In order to lower their rates, they have to consider deductibles and co-payments. A co-payment is a portion of the treatment expenses that you share, while plans with deductibles demand payment of a predetermined sum before the insurer would approve the remaining portion of the claim.

Covered lives, claims, and premiums
Health plan premium revenue increased by 22% to 89,492 crore in FY23 from 73,052 crore the previous year. Group insurance accounted for half of the premium (46, 246 crore), individual business for 34,766 crore, and government business for Rs 8,480 crore. In FY23, there were 52.9 million lives insured by individual insurance, a 2.5% increase over FY21 levels. The health category had the highest incurred claims ratio (claims paid as a proportion of total premiums) in general insurance in FY23, at 87.3%.