Strategies for Increased Coverage
For individuals aged 80 and 78 seeking to increase their health insurance coverage from Rs 7 lakh to Rs 10 lakh each, there are primarily two avenues available.
The first involves 'porting' an existing policy to a new insurer that offers the desired Rs 10 lakh sum insured. This process allows for a change in provider while potentially retaining some benefits. The significant advantage here is the consolidation of coverage into a single policy, which can streamline the claims process and reduce administrative complexity. However, a key risk associated with porting is the meticulous declaration of pre-existing health conditions. Any oversight or omission during this phase can lead to disputes and claim rejections later. The second approach is to acquire a 'top-up' health insurance policy. This plan functions by complementing your current Rs 7 lakh base policy. A top-up policy is purchased with a specific deductible amount, which is the threshold you must meet from your base policy before the top-up kicks in. For instance, one could obtain a Rs 10 lakh top-up with a deductible of Rs 5 lakh. This would effectively provide a total coverage of Rs 17 lakh (Rs 7 lakh base + Rs 10 lakh top-up). For a couple in their late seventies, the annual premium for such a top-up plan is estimated to be under Rs 30,000. While this method keeps your existing policy intact, a potential drawback is the administrative process for claims. Often, you'll need to utilize your base policy for cashless settlements and then seek reimbursement from the top-up policy, which can be more cumbersome than a single unified policy. Despite this, the top-up option offers a substantial increase in accessible coverage and is generally preferred for its simplicity in managing the existing policy.
Underwriting Challenges for Seniors
The possibility of increasing health insurance coverage for elderly individuals, even those with existing policies and a history of disclosed conditions, can be met with underwriting challenges. In one case, an attempt to raise coverage from Rs 10 lakh to Rs 15 lakh for an 87-year-old mother, who had disclosed hypertension and had a single cataract claim in 2020 after 13 years of policy holding, was declined by the insurer. The insurer cited 'underwriting norms' as the reason for refusal. It's crucial to understand that while Indian health insurance policies offer lifelong renewability as mandated by IRDAI regulations, any request for an increase in the sum insured is typically treated as a new underwriting exercise. This means the insurer re-evaluates the applicant's risk profile based on their current age, health status, and the company's internal risk assessment criteria. For individuals in advanced age brackets, insurers often factor in the natural progression of age-related health issues and the statistically higher probability of future claims, even if the individual has a low claim history. While the insurer's decision is within their purview, policyholders can always request a formal reconsideration or seek a detailed clarification on the underwriting decision. If an enhancement remains unavailable through the current insurer, exploring alternative solutions is advisable. These might include obtaining a completely new, separate senior citizen policy or opting for a top-up or super top-up plan, provided the applicant meets the eligibility and underwriting requirements for these products. Such supplementary options can help augment the overall financial protection available for unforeseen medical expenses.
