No Age Limit For Health Insurance, But Premiums Remain A Concern

YN Mathur, a 59-year-old New Delhi resident, recalls the difficulties his family encountered in obtaining health insurance for his ageing parents. Two decades ago, when his father, RN Mathur, needed insurance coverage the most, the family struggled to find any company willing to offer a policy due to his advanced age. At the time, Star Health was the only company providing insurance for senior citizens without stringent conditions.

Now, as Mathur himself approaches his 60s, he reflects on the recent decision by the Insurance Regulatory and Development Authority of India (IRDAI) to remove the age bar for senior citizens' health insurance. "It's a great decision," Yuvraj said with a sense of relief. "This change would have made a significant difference for my father back then, and it's reassuring to know that other families won't have to go through the same struggle."

Expensive medical care is a concern for many, and the situation has become more tense after multiple heart attack cases were reported last year. To address this urgent need and provide relief from health expenses, the Insurance Regulatory and Development Authority of India (IRDAI) has issued guidelines asking health insurance companies to eliminate the age bar for senior citizens from 1 April 2024, and to develop health insurance products accordingly.

The Bharatiya Janata Party, in its election manifesto, mentioned that "everyone over the age of 70 years" would be included in the government Ayushman Bharat health insurance scheme, which supports the IRDAI’s ‘no age bar’ guidelines.

"Government schemes like Pradhan Mantri Jan Arogya Yojana under Ayushman Bharat have provided health insurance coverage to economically vulnerable families, including cardiac care. This initiative has significantly increased access to healthcare services for heart patients. In line with its mission of 'Insurance for All by 2047,' IRDAI has been reforming its guidelines to increase insurance penetration and promote products catering to all age groups and risk categories," said Pooja Yadav, Chief Product Officer at Zuno GI.

It is said that things happen for a reason. Such initiatives are the expansion of those reasons. Data from the Indian Heart Association shows that 50 per cent of all heart attacks in India occur under 50 years of age, and 25 per cent occur under 40 years of age. When such data is alarming, health insurance proves essential to managing the financial burden of heart disease, as cardiac treatments are high in cost, despite government controls on stent prices and other measures. Every year, the cost of treating heart ailments increases by 15 to 20 per cent due to medical inflation.

To ensure health insurance remains affordable for seniors while providing comprehensive coverage, insurers have introduced more modular plans, allowing customers to decide the premium they want to pay. One can opt out of certain features, such as higher room rent categories, or choose a plan with a preferred partner network, which can offer up to a 15 per cent discount if services are used within the insurer's preferred hospitals.

However, Mathur is also realistic about the challenges that remain. "The premiums for new policies at an advanced age will still be high," he added. "For instance, someone at 60 might face annual premiums of Rs 60,000-70,000 or more, which can be a burden for retirees."

Policybazaar's business head, Siddharth Singhal, added, "Additionally, one can opt for a deductible in their policy. A deductible is a fixed amount you need to pay whenever a claim arises. For example, if you choose a modest deductible of Rs 25,000, it means that for any claim, such as one for Rs 10 lakh, you need to pay the first Rs 25,000 from your pocket. This can result in a premium discount of up to 25 per cent. There are multiple discounts now built into health insurance plans, which can be considered when purchasing a policy."

Discussing premium payment options, Singhal noted that earlier plans often imposed a mandatory co-payment of 20 per cent for individuals entering at 60 years and beyond. However, now co-payment has become optional. Policyholders can choose to remove the co-payment by paying an extra premium or increasing it to receive discounts on their premiums. Flexibility in payment options, such as monthly or quarterly EMIs, enhances the accessibility and affordability of healthcare for seniors.

The incidence of heart disease is rising in India, with an annual increase of over 10 per cent. Unhealthy lifestyles, smoking, drinking, stress, obesity, and decreased sleep contribute to this rise. Additionally, the growing prevalence of diabetes and hypertension significantly impacts the increase in heart disease cases. Post-Covid-19, there has also been a notable uptick in heart disease.

Previously, health insurance coverage for heart patients was unavailable. However, today many general insurance companies offer coverage for heart patients across age groups, including senior citizens, where the incidence is higher. "As a result, the scope of insurance available for heart patients in the last two to three years has expanded significantly," said Star Health Insurance COO, Amitabh Jain.