Senior Citizen Health Insurance
A senior citizen health insurance policy is designed for providing financial aid to individuals above the age of 60 years in the case of healthcare emergencies. Most of the senior citizen mediclaim plans provide critical illness cover, pre-existing illness cover, cashless hospitalization, etc. with a greater sum assured.
As per the latest guidelines of IRDA, all the health insurance providers of India must offer insurance coverage to the senior citizens. Additionally, these guidelines enable senior citizens to port their policy from one insurance provider to another if they aren’t happy with their existing plan.
Key Features of Senior Citizen Health Insurance Plans
The key features that some of the best senior citizens health insurance policies are:
- Cashless Hospitalization: A senior citizen can get cashless hospitalization in the network-listed hospitals of the insurance provider.
- Pre-Existing Disease: Some insurance provider covers pre-existing illness as well.
- Ambulance Cost: In case of an emergency, the incurred cost of an ambulance is covered.
- Daycare expenses: Technological advancements have made some medical procedures less time-consuming. If a medical procedure requires only daycare treatment; the expenses for the same are covered as well.
- Medical Bills and Room Rent: The medical bills and room charges during hospitalization are covered.
- No Medical Tests Needed: No medical checkups are required before buying the health insurance for old-aged people.
- High Sum Insured: Most of the senior citizen mediclaim policies offer higher sum insured than basic health insurance plans.
- Health Checkup: Some health insurance providers offer the facility of health checkups at designated diagnostic centres.
- Tax Benefit: As per Section80 D of the Income Tax Act, 1961, tax benefit on premiums.
Best Health Insurance Plans for Senior Citizens in India
The health insurance policies for the old-aged people help them to wear off the financial worries related to healthcare. Below mentioned are some of the best senior citizen mediclaim policies:
|Insurance Provider –Name of the policy
||Pre and Post Hospitalization Expenses
|Bajaj Allianz – Silver Health Plans for Senior Citizens
||46 years to 70 years
||After the age of 46 years below mentioned medical tests are required –Urine R, SGPT, SGOT, EGC, Fasting BSL, Lipid Profile, CBC, Serum Creatinine.
||Coverage offered from the 2ndpolicy year
||Up to 3% of hospitalization expenses
||Rs 50, 000 –Rs 5,00,000
|Star Health –Senior Citizen Red Carpet Health Insurance Policy
||60 years to 75 years
||Coverage offered from the 2nd year of the policy
||Post-hospitalization expenses are covered up to 5,000 Rs. but diagnostic charges are excluded, nursing charges are not considered, consultation fees, and cost of medicine are also not covered.
||Rs1,00,000 – Rs10,00,000
|ICICI Lombard – Complete Health insurance
||46 years and above
||Medical tests are required for anyone who is above the age of 46 years and only at specified diagnostic centres
||Coverage offered from the 3rd policy year.
||30 and 60 days respectively
||Up to Rs 10,00,000
|National Insurance – VARISHTHA Mediclaim Policy for Senior Citizens
||60 years to 80 years
||Not needed if the insured has been covered by the health insurance policy for 3 years, otherwise, it is required
||Coverage offered 1st year when no claim has been filed while the policy is in force.
||For 30 and 60 days respectively
||Mediclaim of- Rs.1, 00,000 and Critical illness cover- Rs.2, 00,000
|United India Health –Senior Citizen Mediclaim Policy
||61 years to 80 years
||Needed, and reimburses only 50 % of the incurred tests expenses, but only after the acceptance of the insurance policy
||Coverage offered after 4 years of regular renewal.
||For 30 & 60 days (maximum 10% of the hospital bills, whichever is lesser)
||Rs 1, 00,000 to Rs 3, 00, 000
|New India –Senior Citizen Mediclaim Policy
||60 years – 80 years
||Coverage offered after 18 months of the policy inception
||30 days of pre-hospitalization (5% of the bills of the hospital), whereas 60 days after hospitalization (which can be 10% of the bills of the hospital)
||Rs 1, 00, 000 to Rs 1, 50, 000
|Apollo Munich – Optima Senior
||61 years onwards
||Needed and reimbursed 50% of the incurred tests expenses only but only after the acceptance of the proposal
||Coverage offered after three years of regular policy renewal
||For 30 days and 60 days respectively
||Rs 2, 00, 000 to Rs 5, 00, 000
|SBI – Arogya Top Up Policy
||65 years and above
||Not required up to 55 years, if there is no medical history
||Coverage offered after 4 years of regular renewal
||For 60 days and 90 days respectively
||Sum of Rs. 1,00,000 to Rs.5,00,000 ; and Rs. 1,00,000 to Rs. 10,00,000 (including the deductibles)
|Oriental – Senior Citizen HOPE Health Insurance
||60 years and above
||Required to submit the reports of some medical tests issued by the specified diagnostic centre
||Coverage offered after 2 years of regular policy renewal
||For 30 and 60 days respectively
||Rs 1,00,000 and Rs 5,00, 000
|TATA AIG – MediSenior Health Insurance
||61 years and above
||Needed and 50% of the incurred tests expenses is reimbursed but only after the acceptance of the proposal
||Coverage offered to renew the policy for 4 years
||For 30 and 60 days respectively
||Rs 2, 00, 000 – Rs 5, 00, 000
Eligibility to Buy Health Insurance Policy for Senior Citizens
Here are eligibility criteria to buy senior citizen health insurance plans
- Anyone who is above the age of 60 years can buy this plan.
- Some insurance policies provide a plan for both husband and wife whereas some provide individual policies. One can take a plan as per the requirement.
Senior Citizen Health Insurance: Inclusions
The common inclusions for most of the health insurance plans in India for senior citizens are:
- Hospital Expenses: A policyholder can avail the benefits of cashless hospitalization. Most of the policies cover doctor’s consultation fees, room rent, cost of medicines, nursing fees under this plan.
- Day Care Expenses: Thanks to the medical advancement, some treatments like chemotherapy, dialysis, etc. do not require For such cases, daycare treatment coverage is offered. However, a good health insurance plan for senior citizens covers incurred daycare expenses as well.
- Pre and Post-Hospitalization Expenses: Most of the health insurance plans for senior citizens cover pre and post hospitalization expenses. Usually, the majority of plans cover pre-hospitalization expenses for 30 days and post-hospitalization expenses for 90 days.
- Pre-Existing Diseases: Some plans also offer coverage for pre-existing illnesses. Generally, pre-existing illness is not covered by basic health insurance plans.
- Ambulance Expenses: When an ambulance is required for transporting the policyholder to the hospital, some plans also cover the expenses for the same.
- Annual Health Checkups: Some insurance plans also provide coverage for annual health check-ups.
Senior Citizen Health Insurance: Exclusions
Even though different plans have a different set of exclusions depending upon their terms and conditions, there are common exclusions that are applicable for most of the mediclaim policies for senior citizens:
The common exclusions:
- Incurred treatment expenses for pre-existing illnesses.
- Expenses arising out of the treatment for drug abuse.
- Non-allopathic treatment expenses.
- Incurred treatment expenses due to self-inflicted injuries.
- Any medical condition diagnosed within 30 days of purchasing the senior citizen health insurance policy.
- Cosmetic surgery expenses.
- HIV/AIDS treatment.
- Cost of contact lenses and spectacles.
- Dental treatment expenses.
Benefits of Buying Senior Citizen Mediclaim Policies
Apart from cashless hospitalization, pre-existing disease cover, pre and post hospitalization cover, these plans also provide some other benefits such as:
- Cumulative Bonus: An insured gets a cumulative bonus of a fixed percentage (generally it is 5%) for every claim-free year provided the policy is renewed continuously.
- Portability: Like every other health insurance plan, an insured can port his/her senior citizen health insurance policy at the time of renewal as well.
How to Choose the Best Senior Citizen Health Insurance Plan?
When it comes to health insurance for the old people, it is a must-have. Anyone above the age of 60 years can opt for a senior citizen policy. One must keep the below-mentioned points in mind while buying health insurance for senior citizens.
- Medical History: Before purchasing a health insurance plan for old aged people, it is recommended to know their medical history. The best way to do so is to get their medical checkup done.
- Comparison is the Key: It is a must to compare these plans and then select the best. The comparison can be made on the basis of sum assured, waiting period, coverage, exclusions, and maximum renewability age of the policy.
- Provide Correct Information: In order to buy the senior citizen health insurance plan, it is recommended to provide the correct information in the proposal form. Providing incorrect information can lead to rejection from the insurance
- Medical Checkup: The insured senior citizen may need to undergo medical checkups after submitting the proposal form. The panel of doctors of the insurance provider will verify all the information related to the health condition of the senior citizen. Depending upon the health condition of the senior citizen, the health insurance provider may ask the applicant to undergo few medical tests at the specified diagnostic labs. However, there are various health insurance providers who do not conduct preliminary medical screening.
Let us take an example to understand this.
Shashank is a private banker who earns approximately Rs. 60,000 per month. He is married and has one kid. His wife is a homemaker and he is the only earning member of his family. His parents are over 60 years of age and are dependent on him.
To avoid any medical crisis, Shanshank purchased a senior citizen health insurance plan for his parents. He searched on the internet and found a plan for them. The preliminary tests results were normal, so they got covered in the plan without any issue. He needs to pay a nominal health insurance premium.
Factors to Compare Senior Citizen Health Insurance Policies
Since there are various health insurance plans for senior citizens available online, it can be difficult for anyone to select the best plan. However, comparing health insurance plans on the basis of below parameters can help you to come across the most suitable policy for senior citizens:
- Cover: Generally public health insurance companies offer lesser cover in comparison to private insurance providers. However, the premiums are also higher for private companies. Therefore, if you can afford to pay higher premiums, then it is wise to take insurance from public health insurance providers who offer higher cover.
- Waiting Period: Another deciding factor while comparing different health insurance plans is the waiting period. Since the senior citizen plans are purchased for older people, so it is required to factor in the waiting period as well. It is suggested to opt for a plan that comes with a shorter waiting period.
- Pre-Existing Illness Cover: If the senior citizen is suffering from any pre-existing illness, such as diabetes or high blood pressure, it is suggested to opt for a plan that covers pre-existing illnesses.
- Maximum Renewal Age: Most health policies cover senior citizens falling in the age bracket of 60 to 80 years. However, there are some plans that do not cover a person older than 69 years. After 69 years, it may become difficult to renew the policy. Therefore, it is essential to check and compare different health insurance plans for senior citizens on the basis of the maximum renewal age.
- The option of Co-Payment: In the co-payment option, a percentage of the medical expenses are borne by the policyholder whereas the rest is settled by the insurance company. Despite the fact that an insured has to pay comparatively lesser premiums, the policy coverage is lesser as well in the co-payments plans. So, select a plan accordingly.
- Free-look Period: It is a period during which a policyholder can terminate the policy without being penalized for the same. Generally, health plans for senior citizens offer 15 days of the free-look period, but if some have more, so consider accordingly.
Key Points to Know Before Purchasing a Health Insurance Policy for Senior Citizens:
- Select a senior citizen health insurance plan that provides maximum coverage at an affordable premium by comparing various plans online.
- Select a policy that comes with the maximum age of
- Select a policy that covers pre-existing illness and comes with a shorter waiting period.
- Go for a plan that comes with a minimum co-payment.
What to Do If the Proposal for Senior Citizen Health Insurance is declined?
One can do two things if the insurance provider rejects the health insurance proposal for the senior citizen:
- Try approaching another health insurance provider. However, if the proposer is applying for the policy within 30 days of the rejection from the first insurer, then it is required to present all documents of the medical checkup obtained from the first insurance provider.
- If there is some issue with the medical checkup reports, one can go for another checkup conducted by another doctor and then can submit the reports to the insurance provider. If the insurance provider is satisfied with the health checkup reports, it can reconsider the application for a medical insurance policy.
How to Port a Senior Citizen Health Insurance Plan?
Sometimes the policy buyer isn’t satisfied with the coverage and services provided by the opted senior citizen health insurance plan. In that case, he/she can port the policy from one provider to another. However, this feature is available for the same type of insurance policies. It means a health insurance plan for senior citizens cannot be ported to a family floater health insurance plan/individual health plan of another insurance provider.
Moreover, portability waives off the waiting period for pre-existing diseases with the new insurance provider, if the policyholder has served the waiting period with the previous insurance provider.
Below mentioned are steps for porting senior citizen health insurance plan:
- The application for porting the senior citizen health insurance plan must reach to the new health insurance provider at least 45 days before the renewal of the current policy.
- Upon receiving the request, the new insurance provider will provide the portability form with details of the senior citizen health insurance plans.
The applicant must select the health insurance plan for senior citizens as per the requirements and fill up the portability form. As per the requirement, the applicant must attach all required documents and submit the form.
- IRDA has developed a common platform for sharing the data of the applicant. The current health insurance company will share all the relevant and required information of the applicant to the new insurance provider within 7 working days on the common platform.
- As soon as the new insurance company has all the information, within 15 days it will underwrite the policy. If the company fails to do the same within this time, it will have to accept the application for portability.
Senior Citizen Health Insurance FAQs
Q: What is the need for a standalone senior citizen health insurance plan?
Ans: For most of the people in the golden age (more than 60 years), the cost of medical expenses increases with time. Additionally, the older one gets, the difficult it gets to take a health insurance plan. Therefore, it is advised to buy a health insurance plan for senior citizens to safeguard the financial safety.
Q: Do I need to pay more to get a health insurance plan for senior citizens?
Ans: Yes, you need to pay slightly more premium for your senior citizen health insurance plan in comparison to basic health insurance policy. One obvious reason for the same is the old age of the insured. Since increased age leads to more medical issues hence the insured has to pay a higher premium.
Q: Will I be able to enrol my spouse in my existing senior citizen health insurance plan?
Ans: Generally, most of the health insurance providers offer a joint plan for senior citizens so that both the insured and his/her spouse are covered under one policy.
Q: Is there any limit on the number of claims that one can make in his/her Senior Health Insurance Plan?
Ans: Until and unless the sum assured is exhausted, you can file claims as per the applicable terms and conditions. If an insured has exhausted the sum assured, the claim will be rejected and he/she will have to bear all the incurred medical expenses.
Q: How will I be able to differentiate between network hospitals and non-network hospitals?
Ans: The hospitals that are listed in your policy brochure are known as network hospitals and provide added benefits such as cashless hospitalization. However, any other hospital is considered as a non-network hospital and does not provide any such benefits. If you need to undergo treatment in a non-network hospital, you have to pay the bill from your own pocket. After filling out the claim form, you will get the reimbursement.
Q: What tax benefits does a medical insurance policy for senior citizens provide to its customers?
Ans: A policyholder of senior citizen health insurance plan can avail the tax exemption under section 80D of the Income Tax Act, 1961. One can avail the rebate of Rs. 30, 000 if he/she has a mediclaim policy for his/her elderly parents. Additionally, a rebate of Rs.5, 000 can also be availed for preventive health checkups.
Q: What are the documents required for filing reimbursement claim for senior citizen health insurance claim?
Ans: Below mentioned is the list of documents that one needs to provide while filing a claim for reimbursement:
- Doctor’s prescription
- Medical bills
- Original bills from the hospital with the complete breakup
- Discharge summary
- All the reports of the investigations
- Other documents related to hospitalization as well as demanded by the health insurance provider
Q: What are the types of treatment that are covered in my senior citizen plan?
Ans: Most of the times it depends upon your health insurance provider. However, some basic treatments covered in most of the plans are:
- Daycare treatment.
- Expenses during hospitalization excluding the co-pay and other non-medical expenses.
- Charges of the ambulance.
- Pre and post hospitalization expenses.
- Some plans cover the pre-existing diseases as
- Coverage for specific ailments after the completion of the waiting
Q: Is it possible to avail cashless treatment in senior citizen policy?
Ans: Any treatment underwent in the network hospital of the insurance provider is eligible for the cashless facility. However, for the treatment underwent in non-network hospitalization, the policyholder can avail reimbursement facility.
Q: Will I be able to cancel my health insurance policy for senior citizens after purchasing?
Ans: Mostly, all health insurance plans under this category come with a free-look period under which a policyholder can cancel his/her policy and he/she will not have to pay any penalty for the same. Generally, all policies have a free-look period of 15 to 30 days.