"Madam, it is good that you have no pre-existing diseases at the age of 65. But you are overweight and will get one soon. We can't sell you a policy." That was the reply from many insurance agents when they were told a senior citizen needed a medical policy.
While most general insurance companies sell medical insurance policies, it remains on paper for senior citizens. And, despite the fact that the Insurance Regulatory and Development Authority has made it mandatory for companies to sell policies to citizens till (not above) the age of 65.
However, agents, under the garb of inspecting minute details, turn doctors and physicians. Most judge your health condition by weight, height or any other detail.
For instance, Asha Joshi, 69, was denied a health insurance policy (from an agent of a private general insurer) purely because she happens to be over-weight. After taking her basic details like (age, height and weight), the agent told her that she is sure to develop blood pressure or diabetes in the near future, if not today.
Among the agents Business Standard spoke to, only one private sector player was willing to sell a policy to someone over 65. But, only a new policy, the company has launched recently. Also, he insisted that medical cover should be for Rs 10 lakh. The premium: A whopping Rs 50,199. When he was told that the policy is too expensive, the response, "No one will sell a policy to you at this age. This is a new policy so the company is willing to do so." The agent was right. Most others simply said they will get back.
Even switching a policy is difficult. Most agents say it will be too expensive. On insisting, the reply was, "We will check the insured's history with the previous insurer and get back if we have an option."
In case you are looking at a family floater (including parents), the premium goes up depending on the age of the eldest member of the family, in many cases a senior citizen. Often, companies also refuse to insure those who have been treated for ailments like breast or uterine tumour (benign), saying though curable, these ailments might relapse.
When contacted, a senior official from a private sector general insurance company, said, "Even though the entry age has been increased to 65, most insurers will be hesitant to cover someone above 60 under an individual plan as the health risk increases from 55 and onwards."
|PICKING THE RIGHT ONE |
|General Insurer ||Star |
|Name of the plan ||Red Carpet ||Silver Health Plan ||Easy Health ||Rishtey |
|Maximum age |
|69 ||75 (renewable till 80) ||65 ||70 |
|Co-payment ||50% for |
|20.00% ||NA ||NA |
|Exclusions ||4 months for |
|4 years for |
|3 years for |
|4 years for |
Industry players say, general insurers do issue health policies above that age also, but they tend to inspect minute details and pay extra attention while issuing policies to senior citizens. Says another insurer, "Companies make the process of applying for a policy difficult, sometimes for an elderly. They will ask for ten times more tests to be done. If the tests are clear, they may ask for another one for those above 65."
The only solution, it seems, lies with policies in which there are co-payment options. For instance, National Insurance's 'Varishtha Mediclaim' which issues policies to people up to the age of 80 years has a co-payment clause where the insured has to bear 10 per cent of all the admissible claims. This means, for claims worth Rs 100, the insurance company will pay Rs 90 and the insured will have to pay Rs 10. Another option is if the insured agrees to bear 20 per cent of the co-payment, then the company will give 10 per cent discount in premium.
Some private players also give this option. The quantum of co-payment can differ from insurer to insurer. For example, Star Health's Red Carpet product has a 50 per cent co-payment on claims made by the insured on its pre-existing diseases.