The Complete Guide to

Buying Health Insurance

for your Parents

About the author

Mahavir Chopra
/themahavir
/in/mahavir
Mahavir heads Health, Travel & Life Insurance business at Coverfox.com. He has 10+ years of
experience of running successful Online Insurance e-businesses since its nascent stages in India.
He has been actively commenting on the industry since 2008 and is regularly quoted in places
like Economic Times, Business Standard, Moneycontrol amongst others.
Mahavir is also a qualified chartered accountant.
When not obsessing over the insurance industry and Coverfox, Mahavir likes reading, watching
TV and spending time with his 7 year old son.

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Why are we talking about

Health Insurance for Parents

Healthcare inflation in the recent years has crossed double digits and is around 15% now. Which
means, healthcare is becoming more expensive year on year:
To give you a perspective: a surgery that costs 5 Lakhs today would cost Rs. 10 Lakhs in 6 years.
All of us have heard of at least one horror story about how unplanned medical expenses,
especially the ones that involve hospitalization have shaken up savings and investments of an
entire family.
Look around and you will most definitely find one guy who would have got into the vicious circle
of credit card and personal loan debts thanks to unplanned and unannounced health expenses.

Once you cross 30 and your parents are pushing 60, even though your parents might be adept at
hiding their health problems from you, you will yourself start observing gradual changes in your
parents health. Unless you are really lucky, doctor visits, medications, medical checkups start
becoming a routine part of life for your family. In the back of your mind, subconsciously you start
worrying about worst-case scenario. Now that you/family has insisted your parents take it easy
or retire, you feel additionally responsible for them.

Who doesnt wish for their

parents to get the best of
healthcare (best doctors, best
hospitals, best treatment)
when they need it?

To ensure there is no dearth of resources and no

shortfall in matters of health, most of us start thinking
about hedging the expenses. We begin to evaluate
health insurance as an option. Thats when hundreds of
questions crop up, confusion and myths abound in your
mind.

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Conversations with a few friends on this topic result in the following of the 2 (almost always wrong)
conclusions:

Your parents
cant get
Insurance

-or-

You will get

insurance but will
not get the claim
when required.

All of us understand the importance of getting our parents covered and are ready to invest money
for it. However, with so many apprehensions, horror stories and unanswered questions, most of us
are in a terrible fix, and hence end up not taking a decision for or against insurance!

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2
MYTH 1.

I can depend on my
Company/Employer Group
Health Insurance for Parents?

Predominant myths around

Parents health insurance

Now, many of us have depended or are depending on the

Parents insurance provided by our employers. Working in
the Insurance industry for more than a decade, let me be
brutally honest: This party is going to end sooner than later.
Though it makes sense to cover your Parents in this policy
for any immediate hospitalization you foresee, I would not
recommend you to depend solely on this plan in case you
want to ensure your parents healthcare is managed long
term.

Here are two quick reasons:

Reason 1

Parents Insurance schemes through Employers are fast becoming unviable and
unavailable:
These policies have had a history of covering all Pre-existing diseases of Parents
from Day 1 at a very economical premium.
These policies were either paid by the Employer or have been Voluntary paid
benefits, where employees traditionally got great deals due to economies of scale.
Due to rising claims, premiums rose by at-least 4 times in 3 years. This became
unaffordable for everyone, except for the employees who wanted to make a claim.
Since only employees who wanted to claim purchased the policy it became unviable
and unaffordable for Insurance companies to continue the voluntary coverage.
The realization of unviability is gradual: Employers first introduced restrictions (like
copay, limits etc.), then removed the sponsorship, and now many (including very
large employers) have discontinued the parents health insurance program altogeth-

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Reason 2

You switch to an exciting new job at a hot new startup, or maybe you just switched
jobs for better prospects. Chances are your new employer will not have parents
insurance. Even if they may do, portability of Group Insurance plans is near
impossible and extremely tedious, especially for parents.

MYTH 2.

My Parents are healthy!

MYTH 3.

Since my Parents have an

existing ailment, they cannot
get Health Insurance?

MYTH 4.

Since Pre-existing ailments

arent covered, its no point
buying Health Insurance for
parents? Not worth the effort.

I would be safe to assume you arent a teenager reading this!

I have nothing much to say to my 25+ year old readers. At
the risk of sounding rude, you are just being lazy and
careless. You are well aware that health for all of us is
unpredictable and even the healthiest of us can get ill even
at a young age. And eventually, however careful, fit or
disciplined our parents may be, age does catch up.

This is not true. In my experience of more than a decade I

have seen more applications or proposals approved than
denied. At Coverfox we see more than 45-50% of such
proposals approved every month. While, no one can
guarantee coverage, we recommend you go through the
options
available in this book.

In standard health insurance policies, pre-existing diseases

get covered from Year 5. They are not permanently excluded,
unless an explicit acceptance of such exclusion is taken from
you.
Apart from Pre-existing diseases (PeD), a specific list of
ailments like Cataract, Joint Replacement etc. are not
covered for 2-4 years depending on the Insurance plan you
have chosen.
Apart from the other 2: all diseases that require
hospitalization are covered from Day 31. Accidents are
covered from Day 1.

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For simplicity, you may assume that you have restricted coverage up to Year 3. From Year 3
onwards, your health insurance cover keeps expanding, and widens completely by Year 5. This
is the rule of the game for all lifetime health insurance policies. You must be patient and you
are guaranteed to reap benefits in the long run. For more on this you can view this quick video
here.

MYTH 5.

Getting Claims for Parents

Insurance is very difficult.

Making Claims and getting them is not difficult as it looks,

provided:
Your Insurance advisor has ensured that you have
understood the entire terms, conditions and exclusions of
the policy correctly.
You have filled the proposal form accurately to the best of
your knowledge (more about this later in the book)

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Medical History
Check-in

99.99% of the complications with regards to getting coverage under a health insurance plan, as
well as with regards to claims that arise will be related to the medical history of your parents.
Medical History would mean any history of an ongoing health issue, including diseases not
diagnosed. Things like common cold, common fever are not included here.

In case your parents have no health complaints, no medical history,

PLEASE STOP READING AND GET AN INSURANCE COVER IMMEDIATELY! BELIEVE ME,
THIS IS THE BEST TIME TO GET YOUR PARENTS COVERED.
For the remaining who are not sure or whose parents have some kind of medical history or are
in doubt, please read on.

How to know and be certain about your Parents Medical History?

Do not go solely go by your knowledge or your parents knowledge. Most tend to forget
mentioning one or the other disease/condition. It is important, (especially if you stay away
from them), that you take stock of their current health condition, the diseases your parents are
currently suffering and getting treated for. The easy way to start would be:

To find out what

are the medications
your parents are on,
and then infer the
disease for which
they are taking each
medicine.

Next, go through the

medical papers/file
of your parents. Find
latest prescriptions,
and lab reports.

Another foolproof
way is to accompany
your parents on
their routine health
checkups.

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What if you or your parents are unaware of an existing disease?

In spite of all the effort above, there are chances that your parents may not be aware of a
disease that they are suffering from.
Insurance laws are clear that only customers are supposed to declare ailments/history that
they are aware of off. Customers cannot be held responsible of not declaring an unknown
ailment.

What if you dont mention those existing conditions in the form?

Let me clarify: before the start of any treatment or hospitalization, doctors record the
existing medical history. That includes defining the medication and time since when the
patient has been suffering with the specific ailment. Insurers check this document before they
begin with any claim settlement.

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Choosing the
Right Plan

One needs to evaluate health insurance plans on the following key paramaters:
Room Eligibility
Day Care Procedures
Organ Donor
Co-pay
Surgery wise Limits applicable.
Network of Cashless Hospitals
Premiums at various age-bands.
Apart from choosing the plan, you need to zero in on the plan type as well as the Sum Insured.

What are the plan types available?

Family Floater: With age, as mentioned earlier, there are high risks of increased ailments. As

selfish as it may sound, having parents with pre-existing illness in your policy could eat into the
cover amount which would be healthy amount for your family, otherwise. This could, of course,
work the other way around too where your family can use up the coverage amount and yours
parents are rendered helpless. Moreover the premium may be bumped up too as you increase
older people in the plan, as it is decided by the age of the oldest member of the plan.

Individual Policies: Individual policies are ideal, as there is clear predictability. This is an

option that allows one peace of mind and is a much more practical long term solution.

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How do you choose the coverage/Sum Insured?

You need to keep in mind that most Insurance companies do not allow upgrades for Parents
Health Insurance without a fresh medical check. Also, if there is a claim in the policy, they may
just reject any upgrade requests. It is therefore sensible to take a great cover assuming you
may not get a chance to upgrade your policy.
If you must buy a family floater that covers you, your spouse, kids and your parents, ensure you buy
a high coverage closer or higher than Rs. 10 Lakhs.
In case of a floater that covers only your parents you may look at around 7-10 Lakhs of coverage.
In case of individual plans for both parents you must look at a Rs. 5 of coverage individually.

The top plans to consider for this are:

Religare Care

MAXIMUM
ENTRY AGE

L&T Medisure
Classic

Oriental Happy
Family Floater

Star Red
Carpet

No age bar

No age bar

45 and/or when sum

assured is 15 lakhs or
more

50 years

60 years

No Medical Check up
required

4 years

3 years

4 years

PED - 12 months/
24 months for the
specified illnesses

Available

Available

Available

Available

RESTORE /
RECHARGE

Available (recharge)

Available if
hospitilization is due
to accident

Not Available

Not Available

CO-PAY

20% when over 60

years

10% when over 80

years

10% in Silver plans

50% - Claims due to

Pre-existing illness
30% - Other claims

MEDICAL CHECKUP COMPULSORY

FROM
PRE-EXISTING
DISEASES WAITING
PERIOD
DAY CARE
PROCEDURES

No age bar (but

proposer should be
within 55 years)

60 - 75 years

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Process of buying
HEALTH INSURANCE

Heres what it takes to buy a lifelong insurance on hospitalization expenses for your parents.
Filling the Proposal Form

You will have to declare your parents health status and history in the application form.
Doctor Interview:
The panel of doctors of the Insurance Company may call in to understand more about the
medical information you provided.
Medical Checkup:
Your parents in most cases will be required to go through medical checkup.
Depending on the above the Insurer will take one of the following decisions:

Insurer may approve your proposal.

Insurer may approve your proposal subject to payment of additional premium.

Insurer may approve your proposal subject to acceptance of additional terms.

Insurer may decline the proposal.

What are the medical tests generally carried out?

Medical tests carried out would depend on the Insurance company and plan you have
selected. Usually the medical tests generally will include some of the following:

Blood Routine
Lipid Profile
Fasting Blood Sugar
Urine Routine
Glycated Hemoglobin
Liver Function Test

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Kidney Function Test.

Serum Creatinine,
PSA (Males)
Sonography (Females),
X-ray Chest and Knees,
Tread Mill Test (Stress Test),
General Physical Examination.
Additional tests could be demanded depending on declarations made

What are the key things one must take care on the day of the medical tests?
Test results could go wrong due to any reason! But there is no reason to get worked up over it.
Now that you have managed to convince your parents about getting insured, theres no point
letting fear of medical tests get in the way of this practical investment.
If tests get in the way of buying health insurance, make sure to check-off these things ahead of
the test day so that nothing out-of-the-ordinary messes this deal up for you and your parents.
Ensure that they are regularly taking their usual medication.
Ensure, to your best effort, that they dont fall ill on the day of the tests.
Ensure that they reach reasonably before time to avoid any kind of last minute anxiety! (We all
know how things turn out when that happens, dont we?)

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Insurance proposal
acceptance probability
for various types of diseases

Declarations/Findings

No Ailments
MINOR CURABLE

Proposal Acceptance
Instant Coverage

History of infectious Ailments like

Malaria, Jaundice,Typhoid etc.
History of minor curable ailments like Kidney
stone, Hernia, Piles, Cataract.

SINGLE CHRONIC

SINGLE chronic manageable and under

Policy is issued but with additional
control diseases - Hypertension, Diabetes,
premium loading.
Asthma, Thyroid, Arthritis, Osteoporosis etc.

MULTIPLE CHRONIC

MULTIPLE chronic manageable and under

control diseases.

CRITICAL

Chronic ailments NOT under control. For

Proposal is declined!
instance, in the insurers guide book, a
condition that requires multiple medications
is an ailment thats not under control!

Proposal is usually declined. But its

worth giving a few other companies
a try.

Critical/Serious ailments like paralysis,

stroke, rheumatoid arthritis, cancer, organ
failure, coma, and neurological disorders like
epilepsy
People with mental disorders

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Your Proposal declined

Next Steps

Evidently, the open-market retail health insurance policies have very stringent medical
evaluation (underwriting) before accepting the case. But heres something positive to observe.
At Coverfox, out of all the policies we issue monthly, about 10% of them are for parents over 50
years. For every 100 cases of parents only about 35 get rejected! Thats still 65% success rate.
This obviously includes cases of additional loading of premium, which would again be 1 in every
5 cases. Thats not so bad!
So, with these real numbers we deal with month on month, it is easy to see how insurance for
parents is not an elusive unicorn it has been believed to be! You could fear rejection less than
you need to, much to your parents satisfaction as well!

Check with your Insurance Broker for alternative options:

He may be able to use the existing medical check-up reports to get insurance from another
equally good Insurance company.
Create a Healthcare fund:
If this does not work, you must create your own healthcare fund. Ensure you take help of your
financial planner to build a healthcare contingency fund that can come to your rescue in case of
a large hospitalization. In fact this should be done irrespective of an insurance policy or not.
Bank Group Insurance:
Though not a recommended option, you can use this as the last resort. Plan B when there is no
other choice. Note, the services in bank group policies are average or below average. You will
have to deal directly with the Insurance company, as Banks will not advise you in case of any

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Have a policy already but

facing problems

Own a policy and feeling stuck with it? Thats not something new but thats not irreversible
either. So if you already own a health policy, and you are facing issues like these, this is what you
can do about it.
If
You had a PeD or even just signs of it and you genuinely forgot to mention it in the proposal
form, you can stop freaking out now. But its imperative that you start process with your broker/
agent for an endorsement of the fact from your side. This is simple you only have to intimate
them about the existence of any PeD. If you dont do it, and its found out later, the policy gets
nullified.
Lets look at these cases:
Case 1:
Say you had an eye infection/problem when you bought a policy, which gets diagnosed later to
be cataract. And cataract has a waiting period of 2 years. Chances are likely that your claim could
get denied even though you did not intentionally hide the fact!
Case 2:
Say you are a heart patient but do not disclose this in your proposal form. And at some point in
the future, you meet with an accident. Youd think that since an accident is not even remotely
connected to your heart issues, there would be no problem making a claim. But, no!
Both these cases stand to be rejected for claims on grounds of misinterpretations and
nondisclosure. In the first case, its still a symptom that you did not communicate to the
cvv insurer. And in the second case, you may not even have been issued a policy if the insurer
knew you were a critical illness (heart) patient! So, they would reject all claims and nullify the
policy!
An endorsement is all it takes, even if you forgot to mention a PeD. Save all the trouble and do
that right away if you are going through this or something similar!

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If...
...you had taken a policy so
cautiously years ago, you were
definitely taking the right decision
then. No doubts about it. But, for
todays rising costs in healthcare,
your previously chosen health
coverage limit will slowly but
surely become smaller and smaller
as days go by.

If and when you ever need to make a claim, you would find out
that the coverage doesnt even make a dent on your
hospitalization expenses. You can work around this in two ways:
a) Increase your Sum Assured limit at your next renewal. You
can do this gradually by a small percentage each year or you
could choose a large cover that you feel is appropriate for
todays financial standards. This option is open to you only at
the time of renewal
b) You can opt to buy a top up policy. Top up policies are a very
good option to take up if youre looking to bump up your
coverage amount or upgrade your policy. They work
exactly like any regular mediclaim policies but have a
deductible amount attached to them. What it means is,
when you claim against a top up policy, you have to pay a
minimum deductible amount before you can claim from this
policy. This deductible amount should be equal to the older
policy amount. The biggest advantage of opting for this is
that a top up policy comes at a much cheaper premium than
a regular policy. To know everything you want to know about
top up policies read this article or watch this video.

...you have just taken a policy less

than a fortnight ago but any/all of
these apply to you as well, dont
worry! Its not a wasted effort.

The free look-up period of 15 days allows you to make changes/

cancel a policy, so that you can choose a better policy making
the desired changes!

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Essential Checklists to make

claims for your parents
health insurance

Now that you have gotten past the obstacles and have successfully insured your folks, what
next? What should you know or let them know about the claims procedure?
The health insurance company issues you a cashless claim health insurance card, which usually
reaches you along with the hard copy of your policy.

Claims are done in 2 ways: Cashless and Reimbursements

In case of hospitalisation first of all, check if your hospital is eligible for Cashless Claim under the
policy.
Then proceed to do the following:
Check your policy or your Cashless Card for the Third Party Administrators (TPA) toll-free no.
Call the TPA and check whether the hospital you are looking for is under the Cashless Network.
If it is - congratulations - your hospital bill will be directly settled by the Insurance company, as
per the insurance terms and conditions - you can just pay for the remaining costs.
If the hospital you have chosen is not part of the cashless network, there is no reason to worry.
Just ensure you follow the procedure below, and you can get claims settled within 30 days.

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Ensure you intimate your TPA/Broker about your claim.

Ensure you collect and store the following in a single file:
Bills, Receipts, Prescriptions, Reports for all payments made related to the hospitalization
including expenses incurred, before hospitalization right from the investigation for the specific
illness started.
Bills, Bar code of any implant or equipment used in the surgery.
Discharge Card of the Hospital.
Indoor Case papers - Apply for this with the hospitals medical record department.
Cancelled Cheque - so that the Insurance company can make an electronic payment of the
claim.

Fill the Claim Form with the help of your insurance advisor/broker.
Submit these documents within 7 days of discharge to your insurance broker/advisor or
insurance company or TPA. Ensure you have acknowledgement as proof of submission.
Remember though its ideal, but you must not wait for all documents to be available for
submission. Its important to meet the 7 day timeline.
Ensure you have your mobile no./email address registered with the TPA/Broker so that you get
regular updates about your claim.
Post Hospitalization: All insurance policies also cover expenses incurred on post hospitalisation
care upto a certain period defined in your policy. Usually this is 60 days. All your bills post
discharge, Bills, Receipts, Prescriptions, Reports - should be collected and submitted within 7
days of completion of your post hospitalisation period defined in your policy.

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10

Smart Elder Care

-the best insurance

While its true that medical advancement has made long life possible, quality of life has become
a rather arguable factor. While you would not want anything but the best for your parents, the
early onset of lifestyle diseases does overwhelm their everyday activities, which in turn leads to
that one thing which becomes extremely and something that everyone wants to shy away from
an expensive healthcare policy!
Medical care is expensive and preventing diseases can avoid a large financial loss.
At the risk of sounding like your parents and their parents, its extremely important to continue
with some of those health habits even if its not easily possible, result-worthy and not-soconvenient.
Dietary needs: Their intake could get minimal as they age. But old habits of untimely meals and
a spicy diet die hard! Its important to insist on a disciplined diet thats comfortable to follow for
them, both with respect to proportion and diet specifics and is a balanced meal.
Regular exercise: If your parents are fitness freaks, good for them! The obsession will help them in
the longer run. But even if they are not, spare some time and take a walk with them. Insist that
they do it, even if you arent around! Walking is easy and making a habit of it could keep them fit
over years!
Medical needs: Keep an alert eye on their medical needs; both physical and psychological. Find
a source of assistance they can seek help from whenever they need help. With years, they are
bound to get more and more fragile, making the need for medical support and good health to
sustain, a necessity.
Regular health checks: Even if they have had no trouble at all, it doesnt matter. Insist that they go
for regular complete health check-up at least twice a year.

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Finance: Its not about pay-back! Its about being sensitive and understanding that all their lives
their monetary priorities were you. So if and when such a time arises that they need help, who
better to give care than you!
Avoid stress: One of the main things that affect most people who are ageing is the stress. The
stress of having to deal with the ageing, may be even retiring and other such time related
changes in life. Try to keep them as stress free as possible. Never be rude. Patience and
tolerance is the key word. Even if its just small things they need help with, be around for them. A
good mental state of mind has a lot to do with wellness and physical state of being!

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11
Co-pay:

Critical illness:

Pre-existing diseases:

Restore:

Medical check-up:

Definitions made easy:

No more greek and
latin for you

Co-pay is a percentage of the claim you have to pay from

your own pocket. Read more about co-pay here.
Critical illness can be any life-threatening or terminal
condition but strictly defined by the company. It is usually a
lump some benefit given if the policy holder is diagnosed to
be suffering from any critical illness.
Any pre-existing condition/ailment/symptom/sign/disease
that the applicant is suffering from before buying the policy.
Hospitalizations by pre-existing diseases are not covered
by insurance companies and if covered, will be done so only
after 2-4 years of waiting period.
When the sum assured in a policy gets exhausted, the restore option acts as a recharge and refills it up with the same
sum assured amount for use again during the same policy
year, as long as its not for the same reason of
hospitalization. Read more about what restore can do here.
Insurance companies require a mandatory medical check-up
conducted, especially in cases of declared pre-existing
diseases predominantly in people aged 35+.

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Proposal form:

No claims bonus:

Room rent limit:

Pre/post hospitalization:

Domiciliary
hospitalization:

This is the foremost form you fill out with particulars of your
profile, health and declarations of pre-existing disease if any.
No claims bonus(NCB) is a discount offered by insurance
companies if you have not used your insurance policy to
make a claim anytime in the previous year. This discount
would stretch upto a maximum of 50%. NCB could be by
way of a discount on your premium payable at renewal or
in the form of a bonus given on your sum assured limit. This
is a must-know, must-have discount. So read up all you can
about this here!
This is a specific limit defined by the insurance company,
within which your room rent for one day should fall under, if
in case of hospitalization. This can affect all hospital charges
proportionally. You will need more information to
understand this in detail and you can find it here.
Pre- and post-hospitalization is the cost incurred for health
examinations, tests and procedures recommended by
doctors ahead or after a bout of hospitalization; provided
that the ailment for which youre getting admission in the
hospital is covered by the insurance policy.
Treatment taken for a period of time at home owing to
medical reasons or inability to get hospitalized are classified
as domiciliary. These is usually a pretty rare condition. But
here is what you need to know about it!

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Medical under-writing:

Tele-under writing:

This is a binding that the insurance companies require from

you if they do not require you to go through a medical
check-up. This could be owing to the reason of a fairly young
applicant who had a medical check up conducted very
recently, the results of which the insurance company would
need. In the case of a higher age-group, insurance companies
insist on a medical check-up.
This is a stage in the application process when insurance
companies arrange for their doctors panel to call you in
order to collect more information about an pre-existing
ailment mentioned by you in the proposal form.

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How can Coverfox help to cover your parents?

EXPERT TEAM TO GUIDE YOU:

Speak to a team of experts who will guide you in choosing the right product most suitable for your parents from across 10+ top Insurance Cos in
India.

DEDICATED RELATIONSHIP MANAGER:

Get a dedicated relationship manager for your parents. Your parents can
directly call the RMs instead of chasing customer service on contact
centres.
HANDHOLDING THROUGH THE TEDIOUS CLAIMS PROCESS:
Receive complete hand holding at the time of making claims. Coverfox
offers document pick up and submission on your behalf and help you with
the status tracking as well.

To buy health insurance log on to www.coverfox.com

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