Policy brochures can seem long and dull because they include much text and fine print. But this does not mean you should not read them carefully. These documents contain the policy terms, including what’s covered, what’s not, and how the claims will be handled. A survey found that only 60% of Indians understand their health insurance policy. Even those who understood the policy had limited knowledge of cash treatment, accident coverage, and 100% bill payment. While it doesn’t seem like a big deal, carefully reading, understanding, and comparing health insurance brochures can get you insurance policy information that is essential to select the right coverage.
Plans start at just ₹21/day*.
We pay 100% of your hospital bills
From syringes to surgeries
No limit on hospital room rent
No compromises on recovery
A Complete Guide to Understanding Senior Health Policy Brochures
Senior health insurance plans include much information that isn’t always obvious in the headlines or ads. Relying only on ads or marketing brochures can make you miss out on these details. This can lead to surprises. For Instance, you should know that a policy may have some pre-existing conditions or co-pay clauses. If you know how to read an insurance policy, you can have more control over it, which helps you compare insurance policies better.
Here are some key sections included in a senior health policy brochure:
You can understand medical jargon in insurance brochures by connecting with the insurer’s agents. Alternatively, you can look for definitions within the brochure or online glossaries. The following are the simple definitions of the medical terms that you will see in an insurance policy for senior citizens:
The amount you pay to keep the health insurance policy active. You may pay a monthly, quarterly, or annual premium based on the policy’s terms.
A medical condition you already have before buying the policy. Insurers ask these conditions to apply a waiting period before covering their expenses.
The amount of time open to obtaining the benefits. This will apply to pre-existing conditions, specific surgeries, or the policy itself. Let’s say you have osteoporosis and have chosen health insurance that covers it after a 2-year waiting period. In this case, your osteoporosis-related expenses will not be included in the benefits for the first two years.
This is the total amount you can claim within a policy year. Since you are more likely to get an infection or disease due to ageing, you should opt for a high sum insured.
It is the date when the policy became active.
Treatments or surgeries that don’t often require a 24-hour hospitalisation stay are called daycare procedures. Some examples of daycare procedures are cataract surgery, dialysis, colonoscopy, and some minor surgeries.
A co-payment is a fixed percentage of the total expense that the policyholder must pay. Suppose your policy’s co-pay clause says you must pay 20%, and the insurer will pay 80%. In the present case, an insured amount of ₹1 lakh is ideal, and you pay 20% of medical expenses, that is ₹20,000, and the rest of ₹80,000 to the insurance company.
This refers to treatment or care done at home instead of a hospital. Not all health insurance policies for senior citizens have this feature, so you should confirm it before taking one. Additionally, you will need a certificate from your physician stating that domiciliary hospitalisation is necessary to be eligible for this benefit.
This is a network of hospitals tied up with an insurer to offer cashless benefits. It is advised to choose an insurer with a larger network, as it offers the convenience of getting treatment at multiple hospitals without paying upfront.
A cashless facility is a type of reimbursement procedure in which the insured can get treated at a network hospital without paying upfront.
This is the other type of reimbursement procedure, where you must pay the bills upfront and raise a claim to get the money back.
A sub-limit refers to restrictions on the total amount claimed for certain procedures. For instance, consider that your policy has a sub-limit on heart surgery. Now, suppose heart surgery costs ₹2 lakh, the sub-limit cap on heart surgery in your policy is ₹1.5 lakh, and the sum assured is ₹5 lakh. In this scenario, your coverage for heart surgery will be capped at ₹1.5 lakh. Thus, despite having a sum assured of ₹5 lakh, you will have to pay an additional ₹50,000 for the heart surgery.
These are the medical conditions or treatments not covered by the policy.
This represents the part of the expenditure that is paid out of the pocket. As an illustration, when the stated deductible is ₹50,000, then the insurance company will only cater to expenses incurred above the stated amount. The highest deductible will lower the premium and raise the number of out-of-pocket expenses. Conversely, choosing a lower amount increases premiums.
Room rent capping refers to a limit set on the hospital room rent per day. In simple terms, if you have a room rent cap of ₹3,500 and stay in a hospital where the charges are ₹5,000 per day, you will have to pay the extra ₹1,500.
When you compare health insurance policies for senior citizens side-by-side, you can clearly see the differences between different policies. This lets you choose a plan that fits your needs.
Here’s how to compare insurance policies for senior citizens:
Here are some things you should look out for in policy brochures:
Learning how to read an insurance policy is essential. This is primarily true for senior citizens going through multiple policy brochures to select a health insurance plan that meets their needs. While it may not be exciting, it will help you compare mediclaim policies for senior citizens and make an informed decision.
2.5K Linkedin Followers 
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
Products 
Company
Legal
Support
Car Insurance 
Bike Insurance
Health Insurance
Group Health Insurance
Travel Insurance
Life Insurance
