Why securing a separate comprehensive health insurance plan is crucial, especially considering the unique healthcare needs that arise with age
Iam a retired person from a PSU (age ~ 63) and have health insurance provided by the company, for me and my wife limited to₹25 lakh. In addition, there are some specified diseases for which the insurance cover by the company is unlimited.
My concerns are that over the years the real value of this cover will continue to decrease due to inflation, and there are hassles in getting the reimbursement.
Can I have a specific insurance policy that comes into effect once the limit of ₹25 lakh is exhausted? Additionally, can this policy cover medical expenses that were not reimbursed under the primary policy due to various office rules? Can the admissible medical expenditure be claimed through this new additional medical insurance?
Anil Kumar Rana
For a retired individual like yourself, securing a separate comprehensive health insurance plan is crucial, especially considering the unique healthcare needs that arise with age. While your existing employer-provided coverage of ₹25 lakh offers a solid foundation, exploring additional options ensures better preparedness for unforeseen medical expenses.
Comprehensive health insurance plan
To ensure inflation-resistant and comprehensive medical coverage, consider a standalone health insurance policy with a high sum insured. Such a plan complements your current policy, simplifies claim processes, and provides financial security. Many insurers offer plan with no upper-limit age, tailored to cover hospitalisation, pre and post-hospitalisation expenses, and domiciliary treatments. Additionally, one can also explore senior citizen plans offered by health insurers. Senior citizen health insurance plans are designed to cater to the unique healthcare needs and financial constraints of individuals aged 56 and above. Key features include comprehensive coverage for medical expenses including PED from 91st Day onwards, higher sum insured options, guaranteed bonus, tax benefits, premium waiver benefit, lifetime renewability, restoration of SI, tele consultation and domestic second opinion, unique organ donor cover, modern and advanced treatments, cover for mental illnesses, and quick & easy claim settlement process. A comprehensive plan often includes valuable benefits like annual health check-ups, catering to the healthcare needs of retirees while mitigating inflation’s impact through substantial coverage limits.
Super top-up health insurance plan
A super top-up health insurance plan is another effective way to enhance your coverage. This plan comes into effect once the deductible amount — ₹25 lakh in your case — is exhausted. It is a cost-efficient option for extending coverage without duplicating benefits. Super top-up plans typically cover medical expenses exceeding the primary policy’s limits, including hospital bills and treatment costs.
To address expenses not reimbursed under your primary policy due to specific exclusions or office rules, carefully review the terms of the super top-up plan. Some plans allow for a removable deductible, which can be adjusted if necessary. However, this adjustment is subject to underwriting discretion and may require additional premiums.
Choosing the right option
While super top-up plans are economical, a comprehensive health insurance plan provides greater flexibility and convenience. Unlike super top-ups, comprehensive policies do not depend on exhausting your primary policy’s limits to become effective. This makes them ideal for managing overlapping or non-reimbursed expenses. Additionally, comprehensive plans often offer broader coverage and fewer claim-related hassles.
Claiming admissible medical expenditure
To claim admissible medical expenses through an additional policy, familiarise yourself with the terms of both your primary and supplementary policies. Expenses not covered by your primary plan due to exclusions or limits may still be claimable under the new policy, depending on its terms regarding pre-existing conditions and waiting periods.
In conclusion, supplementing your employer-provided coverage with either a high-sum insured individual plan, or a flexible super top-up plan creates a well-rounded protection strategy. This approach safeguards against the diminishing real value of your current coverage while simplifying the management of medical expenses. Given your concerns about inflation and reimbursement hassles, obtaining a comprehensive health insurance plan with adequate sum insured tailored for senior citizens is advisable. It will provide peace of mind and ensure robust financial protection against rising healthcare costs during your retirement years.
The writer is Head, Products and Operations, ManipalCigna Health Insurance
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