How to Claim Health Insurance for Parents?

Sudarshan (32-years-old) works in an advertising agency in Hyderabad. Sudarshan and his wife are covered under Sudarshan’s corporate group health insurance policy. But last year, Sudarshan purchased separate health insurance for the elderly in India to safeguard his parents from this COVID-19 pandemic. These insurance policies are beneficial for senior citizens as they cover miscellaneous healthcare expenses. However, though Sudarshan is an educated guy, he still has scant knowledge regarding the claim procedure in medical insurance for parents in India.

Due to rising healthcare inflation, flagging immunity, and being susceptible to various medical conditions while purchasing health insurance coverage for elderly people, always consider the claim procedure, apart from the affordability. The claim procedure for health insurance policies should be dealt with extra attention for senior citizens as the features may vary from policy to policy. Here we are going to discuss how you claim health insurance for your parents so that people like Sudarshan don’t need to face any problems in the claim settlement process.

10 Points before Initiating a Claim for Parents without Rejection

• Clearly understand the policy
• Improper information
• Co-payment clause
• Waiting period
• Pre-existing illness or disease
• Know your deductibles
• Adequate documents
• Domiciliary hospitalization
• Alternative treatments
• Organ Donor Expenses

• Clearly understand the policy

Before making any commitments, go through the policy documents, i.e., terms and conditions, exceptions, inclusions, and exclusions. Policies that come with low premiums may restrict the coverage significantly. If you go for a low premium policy plan, you should be careful about the features and benefits that you are getting against the plan. Considering all these features, you need to raise a claim. If you select a wide coverage, then ask your insurance company about exceptions.

Always ensure that your purchased policy should offer coverage for most treatments and costs associated with elderly people. The medical requirements of a senior person are different from that of younger people. So, purchase a policy that goes well with all healthcare requirements of your elderly parents. 

• Improper information

You should provide all imperative information like policyholder’s health condition, employment status, right age of the policyholders, complete documentation, etc., to the insurer properly. These are some crucial factors that will help your insurer to decide the premium amount for your policy. If you try to hide any information or mislead the company with incorrect information, you may face a lot of challenges during the claim process.

• Co-payment clause

Co-payment refers to a certain part of hospital expenses that you need to pay as a policyholder from your end. According to the policy terms, you need to pay this percentage. So, before purchasing the policy, you should clearly understand everything. The percentage may vary from 20%-50% of the total claim amount. Therefore, before initiating your claim, you should discuss it with your insurance company so that you can arrange money accordingly.

• Waiting period

The waiting period is not the same for every health insurance policy plan. It may vary from 30 days to two or four years for certain pre-existing conditions. In addition, a policyholder can’t initiate a claim during this waiting period. Generally, corporate group health policies don’t come with a waiting period. So, if your parents are covered under such a policy, then you don’t need to face any waiting period.

• Pre-existing illness or disease

For your elderly parents, you must opt for plans that come with a provision for covering pre-existing diseases. According to the policy terms, many health insurers often deny claims based on pre-existing diseases within a certain tenor. Before purchasing a policy for your parents, check with your insurance company regarding the inclusion of pre-existing ailments coverage, specific waiting periods. For example, a health insurance policy may offer coverage for a certain percentage of particular diseases like a hernia. If you want to raise a claim for a particular treatment, always check with your insurance company.

• Know your deductibles

Some policies embrace customers with deductibles as an option. This means policyholders need to pay a certain amount from their pockets during the claim. While raising a claim, you should be very careful about deductibles.

• Adequate documents

Before pursuing the claim process, don’t forget to carry your complete original documents. If the documents are insufficient or not verified by the hospital authority, then the insurance company has every right to reject your claim. If you want the approval of your claim by the insurance company, then you must submit all relevant documents, reports, etc., to support your claim. Some insurance companies often guide their customers regarding the documents they need to submit during the claim process.

• Domiciliary hospitalization

If you choose a home care treatment option, you must inform the insurance company about the same. Your insurance company will consider the prescriptions of the medical practitioner, and it will follow the guidelines so that you don’t face any problems during the claim process.

• Alternative treatments

Many health insurance policies are now offering coverage for alternative treatments like Unani, homeopathy, Ayurveda. You can raise claims for these treatment methods. But before claiming alternative treatments, you must check with your insurance company regarding the same.

• Organ Donor Expenses

Some of the insurance policies compensate for all medical expenses regarding organ donation. Check with your insurance company whether you can make any claim for medical expenses of this type of treatment.

Health insurance policies are beneficial for your aged parents as they cover a plethora of medical bills. But always pay attention to the claim procedure. Before buying a policy, go through the documents properly to ensure that the insurance company does not deny your claims.