Health Insurance Coverage at Midlife

When you turn 45 years old and enter your midlife stage, you should invest in health insurance if you haven’t yet. You should consider factors such as premium amount, coverage, co-payment details, waiting period, renewal age limit, and so on.

Midlife, around the age of 45 years, is the time when you would slowly fulfil all your responsibilities. It is the best time for you to start making long-term investments and plan for retirement. With the increase in age and the added stress of today’s lifestyle, health tends to deteriorate. It is crucial for every individual to have a health insurance policy that aids him/her when there are medical expenses. If you don’t have a health insurance plan already, you should consider purchasing one at this stage in life at least. Here’s why:

  • Health insurance plans have a pre-existing condition clause. Generally, age-related problems like severe cardiac disorders, bone issues, etc. might lower your eligibility to purchase the policy.
  • Insurers consider older individuals to have a higher risk to contract critical illnesses. Hence they charge a higher premium for those in the higher age bracket.
  • In a few cases, there are many exclusions with regard to certain medical conditions for individuals of advanced age.

It is, therefore, wise to purchase a medical insurance policy well in advance. The older you get, the more difficult finding an affordable health insurance plan will become. Further, the cost of healthcare has seen a steady rise of late. Paying out of the pocket during an emergency could put you in heavy debts. This is when a medical insurance plan could be beneficial.

How to Narrow Down on the Best Health Insurance Plan at Midlife:

For someone who doesn’t have an inkling as to what a health insurance plan is and which plan to choose from the gamut of plans available in the market, these pointers could come in handy.

  • Find the right coverage amount: The sum insured is the maximum amount payable when the person insured incurs medical expenses. You should choose the sum insured based on your health condition and approximately how much you would end up spending for the treatments. You should also take rising costs and the possibility of contracting diseases into consideration.
  • Look out for the premium: The premium is the amount that should be paid on a regular basis to the insurer to cover your medical expenses. It is calculated based on your age, plan opted for, sum insured chosen, etc. Make sure the amount is affordable and worth paying.
  • Find out what the renewal age limit is: Certain health insurance policies cannot be renewed after the policyholder crosses a certain age limit. You will then have no health insurance cover to aid you in times of need. So, preferably choose a plan with a lifetime renewability.
  • Check what the co-payment option is: Certain medical insurance plans come with a co-payment feature wherein the policyholder will have to share the expenses with the insurer. Try to choose a plan that offers lesser co-payment.
  • Pick the one with shorter waiting periods: Pre-existing conditions have specific waiting periods. Pick the health insurance policy that has shorter waiting periods so that you need not have to wait to get treated for your ailments.
  • Make enquiries about the expenses covered: Read the policy to ensure all services that you require like hospitalisation, daycare facilities, OPD, ambulance charges, etc. are all covered under the policy.
  • Ask for a list of network hospitals: You can avail the benefit of cashless services in hospitals if it is included in the network of hospitals of your insurer. You should ideally pick an insurer which has neighbouring hospitals as empanelled hospitals.
  • Check for bonuses: Certain insurance companies provide a no-claim bonus each time a policyholder completes a policy year without making even a single claim. A few insurers offer discounts for adding family members to the same policy. Find out such details to reap maximum benefits.
  • Research about the insurance company: Find out what the claim settlement ratio (the number of claims settled in a particular year) of the insurer is. This will help you understand the functioning and ranking of the insurance company.

Benefits of Buying a Health Insurance Plan at Midlife:

Health insurance is a necessity and every individual is advised to purchase a policy as early as possible. Each health insurance policy has unique features that are beneficial to the policyholder.

  • The premium paid qualifies for tax benefits under Section 80D of the Income Tax Act.
  • Insurance policies generally have a free-look period. In most cases, 15-30 days are provided to the policyholder to review the terms and conditions of the policy. The policy can be returned if the policyholder is not satisfied with it.
  • Health check-ups are conducted throughout the policy term. The expenses incurred on the same can be reimbursed at a later time.
  • At the end of every policy year, the sum insured can be enhanced to meet the expenses incurred.
  • Additional covers like personal accident covers and critical illness covers can be added to the policy.
  • A few insurers offer top-ups to the basic health insurance plan. If you opt for a top-up, you can make claims beyond the maximum sum insured amount.

Exclusions of Health Insurance Plans:

Health insurance plans do not cover all treatments and conditions. The insurer specifies certain exclusions of the policy.

  • Pre-existing injuries and illnesses are not covered until a specified waiting period is completed.
  • Any injury or disease contracted within 30 days from the date of inception of the policy is not covered.
  • Claims cannot be made for non-allopathic treatments.
  • Injuries that are self-inflicted or caused by drug abuse/alcohol are not covered under the policy.
  • Treatments undergone for a change of life/cosmetic surgeries are excluded from health insurance coverage.
  • The policies will not cover injuries caused by wars, war-like situation, nuclear material or radioactive sources.

Purchasing a health insurance policy will help you make a sound financial plan to manage your medical expenses. It is imperative that you purchase the perfect health insurance policy that will cover your medical expenses and help you lead a stress-free life. The key is to have a medical insurance plan that will help you meet all your medical expenses while you pay only a nominal amount of premium.

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