What is the Limit of Health Insurance for Parents?

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As one grows older, the need for healthcare services tends to increase. According to the WHO report, old age is associated with a variety of diseases like diabetes, osteoarthritis, joint pain, COPD (chronic obstructive pulmonary disease), cataracts, etc. Thus, elderly parents need to have a good health insurance policy to cover them for diseases that can be very costly in terms of treatment.


However, it is important to note that there are several applicable caps in health insurance for parents, and each cap differs from one insurer to another. Therefore, it is important to review them before buying any policy to avoid any last-minute surprises.


Continue reading to find out more!


Major Limits in Health Insurance For Parents


The major limits in health insurance for parents or elderly persons can be grouped into the following categories:


1. Age Restrictions


Insurers used to limit the maximum entry age for health insurance to 65 years. However, from April 1, 2024, the IRDAI has issued a directive to the insurance companies to get rid of the maximum age limit entry clause. It has also instructed them to develop new products or alter their existing policies to make them accessible to all age segments.


2. Limits on Waiting Periods


If parents have any pre-existing conditions such as diabetes, high blood pressure, heart disease, or thyroid, which are common in most older people, then the insurers may impose a waiting period of up to 4 years before they will cover medical expenses for those conditions.


Some insurers have a waiting period clause for certain illnesses, where they do not cover medical expenses regarding certain surgeries, like hernia or joint replacement, for a specified period. These conditions may have a separate waiting period of 2 years.


3. Financial Limits on Claims


Parents' health insurance premiums may initially be lower because certain expenses have financial limits, which means the insured must bear out-of-pocket costs. Check them out below:



  • Deductible:It is the first amount that the policyholder has to bear before the insurer provides coverage. Preventive care services may be paid for by the insurer before the deductible is paid. A higher deductible will consequently lead to a lower premium amount.



  • Co-Payment Clause:The policyholder under this clause pays the fixed charge for certain services after the deductible has been paid. It generally ranges from ₹200 to ₹500 for doctor visits or medications.



  • Co-Insurance Clause:If a co-insurance clause is mentioned in the policy, the policyholder will have to pay a fixed percentage of the medical bills even after the deductible amount has been paid. For example, if the policy has co-insurance of 20%, the insured will pay 20% of the bill after paying the deductible, and the rest will be covered by the insurance company.



  • Sub-limits:Insurance companies put a cap on specific medical expenses, which are usually a fixed percentage of the sum insured amount, in the form of sub-limits.


These three types of sub-limits are most often seen in health insurance policies for parents:



  1. Room Rent Sub-limit:Under this sub-limit, the insurer only pays the room rent up to a specific amount. Sometimes the type of room that is covered is also specified, as the medical costs can be different depending on the room you are in.

  2. Sub-limit on Particular Treatments:Under this limit, the insurer can limit the amount it will pay for certain treatments and procedures. For example, if the insurance policy provides for only 50% of the sum insured to be spent on cancer treatment and the total sum insured is ₹10 lakhs, then the maximum amount that will be paid for cancer treatment is ₹5 lakhs.

  3. Sub-limit Post-Hospitalisation:After discharge, the patient will need a few consultations with the doctor, take medications, and use outpatient services. The insurance company under this limit can set lower annual limits for these services, such as ₹5,000 or ₹10,000.


When purchasing health insurance for parents, it is necessary to ensure they have sufficient coverage, minimal out-of-pocket costs, and high-quality health protection. Go for policies that offer a shorter waiting period for pre-existing diseases, a higher sum insured, free yearly health check-ups, no co-payment, and lifetime renewability.