I have personal health insurance (including the family). I want to extend this to my uncle and aunt, who are my dependents. But the insurance company has said that is not possible. How can I get insurance protection for my uncle and aunt? Please advise.

Pravesh Jain

It is commendable that you and your family have health insurance coverage and now you are thinking of extending it to your uncle and aunt who are your dependents. However, as per the guidelines, you can indeed only have your immediate family members covered under a family floater plan and won’t be able to add your uncle and aunt.

But that shouldn’t stop you from getting them protection. You must opt for separate health insurance plans for them, where they will be the proposers. Considering their age, it is recommended to buy the policy as early as possible.

Recent IRDAI guidelines have made health insurance more inclusive for senior citizens. Earlier, most insurance companies could provide health cover to people aged 65 years or below, and the plans for senior citizens were limited. The new update has introduced the no-age cap on buying health insurance, which primarily benefits the senior citizens and makes health insurance accessible up to 99 years of age.

Secondly, the new guidelines have also lowered the pre-existing disease (PED) waiting period, from four to three years, which ensures timely coverage for conditions common to senior citizens, such as diabetes and hypertension. In fact, now many insurance plans offer the option of reducing the waiting period to Day 1 for such illnesses.

The moratorium period also has been reduced, from eight years to five, which prohibits the insurer from declining any claim based on non-disclosure of PED after five years of continuous coverage, except for fraudulent cases. The 20 per cent mandatory co-payment is also optional now. Lastly, it will allow policyholders to avail of cashless treatment at any hospital of their choice. The feature has made it easier for all, especially senior citizens who might not have a continuous flow of income to avail of cashless treatment at hospitals that come beyond one’s insurer network.

Given the age bracket of your uncle and aunt, it’s important to have sufficient sum insured to cover age-related medical risks. If they reside in a metro city, a floater plan for both of them with₹50 lakh to ₹1 crore sum insured would be ideal.

Health insurance plans are extremely modular in nature now. In addition to a comprehensive health insurance plan, you can enhance the overall coverage.

Consumables cover: The small cost of consumables (needles, syringes, gloves, etc) adds up to a significant amount in the medical bills. If you don’t have a consumable cover then you have to bear the expenses from your own pocket. To cater to this customer need, insurers offer coverage of consumables as a rider that can be added in the base plan.

OPD cover: This helps cover the cost of the outpatient treatment. It helps make sure that the health insurance provider covers the expenses of the insured that occur outside hospitalisation. OPD covers the routine doctor visits that are usually not covered in a traditional health insurance plan — the treatment that does not require hospitalisation. Any minor surgeries, wound dressings, etc, may be included under OPD benefit.

PED: People often could not take cover for PED because of the prolonged waiting period. With PED cover, you can reduce the waiting period for the pre-existing diseases from three years as mentioned in the IRDAI guidelines to even Day 1 for certain common illnesses such as diabetes and hypertension, while for others you can reduce to as low as 90 days. This means faster coverage for pre-existing conditions for customers.

The writer is Joint Group CEO, PB Fintech

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