Tips for Caregivers to Manage Seniors’ Health Insurance

1. Know What the Policy Covers and Excludes

Carefully read the senior's health insurance policy document. Take note of:

• Hospitalisation cover: Whether it includes pre- and post-hospitalisation expenses.
• Daycare procedures: Whether shorter treatments or surgeries are included or not.
• OPD benefits: Useful for regular doctor consultations.
• Pre-existing conditions: Know which illnesses are covered by the policy after the waiting period.
• Co-payment clause: Many senior policies require the insured to pay a share of the costs.

Maintaining a quick-reference summary, either digitally or on paper, with key inclusions and exclusions, can be beneficial. It can help avoid confusion during claims and save you time.

2. Keep Policy Documents and ID Proofs Handy

In an emergency, the last thing you would want to spend your time on is looking for insurance documents. Keeping everything organised and in one place offers you peace of mind:

• Policy bond or PDF copy
• Health card issued by the insurer or TPA
• Aadhaar card, PAN card, and other ID proofs
• Hospital list under the cashless network

Maintaining digital copies of the documents can be helpful too. Besides these, keeping track of renewal dates and paying premiums on time are also very important. A lapse could mean losing coverage or waiting periods starting over again.

3. Choose the Right Add-ons and Riders

Some plans offer additional benefits for a nominal extra premium that you might want to consider.

• OPD rider: Useful if the senior often visits specialists.
• Domiciliary care: Covers in-home treatment when hospitalisation is not possible.
• Critical illness cover: Provides a lump sum in case of diseases like cancer or stroke.

The riders must match the senior family member's current health condition and future risks, not just the budget. You can also look into preventive care benefits, such as annual health check-ups, teleconsultations, or wellness tracking apps.

4. Understand the Claim Process in Advance

Many caregivers often struggle with claims simply because they are unaware of the procedure. There are two types of claims:

• Type of Claim
• What It Means
• What You Need to Do
• Cashless
• Hospital bill is directly settled by the insurer
• Use a network hospital, show the health card
• Reimbursement
• You pay first, the insurer reimburses later
• Submit bills, reports, and claim form

Always inform the insurer or TPA within 24 hours of admission, even for emergencies.

5. Create an Emergency Care Checklist

For seniors with chronic illnesses or mobility issues, preparing an emergency plan is a good practice. You can include:

• Nearest network hospitals
• Contact details of the insurer or TPA
• Medication list and health records
• An authorisation letter if someone else is making the claim

6. Reassess the Policy as Health Needs Change

Every few years, it is important to review whether the policy still fits your loved one's current requirements. Watch out for:

• Rising treatment costs
• New exclusions, illnesses or diagnosis added in policy terms
• Better plans with higher cover or fewer restrictions

If you plan to port the policy to another insurer, make sure it's done before renewal to avoid losing benefits, such as waiting period credits.

7. Build a Support System and Share Responsibilities

Caring for ageing parents can be overwhelming, especially when you are balancing work and family. If you are the primary caregiver, it can help to involve your siblings, extended family, or even close neighbours. Share insurance details, documents, access to digital copies, claim instructions, and emergency contacts so others can step in if needed.

If you live in a different city, consider arranging for a local point of contact, such as a friend, relative, or professional caregiver, who can help with hospital visits or claims. Having a trusted support system and backup can make a big difference during emergencies.