Ageing is an inevitable part of the human experience. With age comes the deterioration of health. And one of the biggest factors that contribute to this decline is co-morbidities. Co-morbidities, also classified as pre-existing conditions by insurers, can enter a person’s life at any age. But they are especially dangerous for geriatric patients. While health insurance can offer protection from the unavoidable consequences of pre-existing conditions, policyholders need to understand how insurers treat claims related to these conditions in the context of senior citizens. Here’s everything you need to know about how to deal with claims for seniors with co-morbidities.
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What are co-morbidities and how they impact claims for senior citizens?
Co-morbidities are usually two or more chronic health issues that exist together in an individual. These conditions often share the same risk factors and sometimes contribute to the development of other comorbidities. Some can be detected with regular health checks-ups but others may show up out of the blue with little to no warning. They can interact with each other or exist independently of each other. A person can have multiple co-morbidities at the same time, which can affect both their physical and mental health. While co-morbidities can be developed at any age, the older one gets, the greater the chances of developing them. Lifestyle habits, genetics, and environmental factors play a huge role in developing these chronic conditions.
Seniors are considered to be a high-risk group for co-morbidities. Here are some of the most common chronic conditions found among those who are 60 and above:
Choosing age-appropriate health insurance plans can lead to better outcomes. While it is always better to start investing in health insurance at an earlier age, those who are 60 and above are not without options if they missed their window earlier in life. Health insurance companies offer customised plans for senior citizens. They can be effective in tackling the complications arising from pre-existing conditions. These policies are designed with seniors and their health issues in mind, including co-morbidities.
Senior citizens with co-morbidities are classified as high risk by insurers. The higher your medical risks and your age, the higher your premium will be. So seniors with pre-existing conditions will have to pay a higher premium for their health insurance plan.
Every health insurance provider has a waiting period in place for pre-existing conditions. It can range anywhere between 1 and 4 years. Some insurers have specialised plans in place for senior citizens, which may have a shorter waiting period or none at all. This is to ensure that senior citizens get access to health care in a timely manner.
Claims for seniors with pre-existing conditions have a more stringent approval process. Claims to treat pre-existing conditions that are under a waiting period will be denied. All pre-existing conditions must be accurately disclosed at the time of policy purchase. If they are not disclosed, any claims related to them will be rejected, and your policy itself may be cancelled depending on the insurer.
Co-pay is when the policyholder pays a certain percentage of the claim out of their pocket. The rest will be settled by the insurance company. Co-pay percentages vary from insurer to insurer and depend on the type of policy as well. Senior citizens with pre-existing conditions may have to pay a higher percentage of co-payment.
Your claim can be rejected if you don’t disclose all your pre-existing conditions. Be sure to list all of them, as failure to do so is considered to be unethical and will get your policy cancelled. The insurer may also blacklist you, and you will not be able to purchase another policy with them in the future.
If your hospitalisation is pre-planned, be sure to get pre-authorisation from your insurer. This will help you to avoid any unnecessary complications related to claims in advance.
Save all the medical reports, consultation notes, diagnostic test results, and medical bills related to hospitalisation. You will need to submit them to the insurer to get your claims approved.
Waiting period has become a standard when it comes to health insurance. If you know that your parents are suffering from co-morbidities and are heading towards becoming senior citizens, it's better to get them their health insurance as soon as possible. It should buy you enough time to ride out the waiting period, as pre-existing conditions only get worse with age. This can facilitate smoother and more successful claims for co-morbidities.
Look for health insurance policies that have a shorter waiting period or, better yet, no waiting period for pre-existing diseases. Health insurance that is geared towards senior citizens may offer one of these features at a higher premium.
Insurers may exclude certain treatments and surgeries for coverage in their policy. Read and review the policy document carefully to see how this impacts co-morbidities.
Cashless claims are the more efficient way to deal with treatments related to co-morbidities. And a more financially viable option too, as you will have spent only a minimum amount of money out of pocket. Check if the insurance provider has a wide range of network hospitals under them that offer cashless claims for pre-existing conditions for seniors. If pre-authorisation is required, keep all the related documents ready. Also find out if the hospital levies any hidden charges for the treatment of pre-existing conditions, as these will not be covered by your insurer.
Pre-existing diseases add an additional layer of complications when it comes to the health of senior citizens. Becoming familiar with their health insurance policy and the claims process can bring down the rate of rejection.
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Reviewed by Dr. Harshita Dahiya 
Acko Technology & Services Private Limited
#36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Bengaluru, Karnataka 560102
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