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New Health Insurance Guidelines to Benefit Senior Citizens

Health insurance for the elderly section of our society is an imperative thing that everyone should consider. In order to live those rains days with ease, a health insurance policy is essential. Considering the importance, the Insurance Regulatory and Development Authority of India (IRDAI) instructed the insurance providers to introduce such plans years back. These plans have gained popularity among the senior citizens and that’s why new guidelines or regulations keep implemented time to time to ensue better services.

What is it All About?

The IRDAI has implemented a slew of measures to make insurance accessible and customer-friendly.

Multiple Installments: One such change is the provision to pay health insurance premiums in multiple installments. Earlier, health insurance providers collected health insurance premiums annually and as one-shot payment.

  • Increase in the Maximum Age: IRDAI has also sent a directive to insurers to increase the maximum age limit to avail insurance. Most insurers have a maximum age limit of 65 years. An increase in the age limit would make the maximum age limit to touch 70 years or even 75 years. This move will significantly benefit senior citizens.
  • Premium Installments: The proposed monthly, quarterly, and yearly senior citizen health insurance premium payment in installments facility will also benefit senior citizens. It is expected that senior citizen insurance premiums will be high. So it might burden senior citizens to pay a high insurance premium in one-shot. Paying in installments will make paying insurance premiums easier.
  • Free-look Period: Another change is the free-look duration. Applicable for premiums paid on a monthly or quarterly basis, it allows the policyholder to terminate a health insurance policy during this free-look period, without paying any penalties for doing so. The duration of the free-look period is generally benchmarked at ten days; however, it could vary depending on the insurer.

IRDAI Rules and Regulations

As per the Government’s Senior Citizen’s Health Insurance Policy, the following rules and regulations have been laid down by IRDAI.

A committee has been constituted by IRDAI to understand the special requirements of senior citizens. Recommendations by the committee are either accepted or vetoed. Accepted recommendations are incorporated into the policy. This committee will also compare health insurance schemes for senior citizens and suggest improvements. Those guidelines say:

  • An individual up to 65 years of age can avail of health insurance.
  • Health insurance providers have to justify their reason for rejecting a senior citizen insurance policy.
  • Senior citizen policy owners have to be given the flexibility to change their third party insurance administrator at any time.
  • Upon acceptance of the risk, the insurer should be able to provide 50% of the sum insured to the insured to cover their pre-insurance checkups or at least be able to reimburse the amount
  • Insurers cannot deny the renewal of a senior citizen health insurance policy unless it is a case of misrepresentation

Introduction of Arogya Sanjeevani Policy & Its Impact

Introduced by the IRDAI, this policy came into effect on April 1st, 2020. It is a Novel Coronavirus standardized health insurance plan. All health insurance providers have been instructed to offer this policy to their customers. The plan offers health insurance coverage ranging from Rs 1 lakh to Rs 5 lakh.

The significance of this policy is that it provides a single point of reference for those who are bogged down by the innumerable number of plans on offer by various insurance providers. Given the extent and number of options available, it becomes an uneasy task to select a policy. Therefore, IRDAI thought it appropriate to bring a single policy that fulfilled all the requirements of a health insurance plan, provided all the features of a regular insurance plan, and is easy to apply for and take.

Being a comprehensive plan, it is appropriate for senior citizens. Not only is it moderately priced, but it offers a whole set of features that makes it an excellent alternative or primary health insurance plan for senior citizens.

Features of Arogya Sanjeevani Plan

Some of the features of the plan are:

  • Hospitalization expenses covered – All pre and post hospitalization expenses are covered in this senior citizen health insurance. It could be related to a medical condition or an accident. Even hospitalization due to illness caused due to a pandemic is covered as well.
  • AYUSH – Senior citizens will benefit most from this policy as they have a penchant for seeking alternative treatments such as Ayurveda. Under the Arogya Sanjeevani policy, any treatment sought and experienced in a licensed Ayurvedic hospital is eligible for coverage.
  • Cumulative Bonus – A claim-free year is awarded a 5% bonus. Two claim-free years elicit a 10% bonus and so on.
  • Room Rent – Offered as a percentage of the total sum insured. The limit is 2% of the sum insured or Rs 5000 per day, whichever is higher.
  • ICU – Expenses related to ICU are covered. Up to 5% of the sum insured or Rs 10,000 per day, whichever is higher.
  • Ambulance Services – Ambulance charges are covered in this senior citizen health insurance. The cap being Rs 2000 per travel related to hospitalization.
  • Plastic Surgery/Dental Surgery – Plastic surgery or dental surgery expenses due to an injury or a medical condition are covered.
  • Cataract Surgery – Often, senior citizens do not get this benefit being dependents from existing policyholders, as some cataract surgeries in certain medical establishments are conducted as outpatient procedures. In this policy, 25% of the sum insured or Rs 40000, whichever is higher, can be availed as coverage amount for cataract surgical procedures
  • New-age Treatments – Immunotherapy, balloon sinuplasty, and stem cell therapy are some of the modern treatments that are eligible for coverage. Up to 50% of the sum insured can be availed as expenses.

Benefits of the Arogya Sanjeevani Policy

The benefits of this policy on senior citizens are innumerable. It is especially helpful for senior citizens given the affordability of this policy, which reduces financial stress on senior citizens.

  • Renewable Lifelong – The policy currently covers people in the age group of 18 to 65 years. As long as the policy is renewed annually before its expiry date, it can be renewed lifelong.
  • Nominal Premium – IRDAI has accorded this policy as a basic, standard insurance plan that is accessible for people from all walks of life and most income groups. Therefore, the insurance premium for this policy is affordable. It is much lower comparatively than some of the prevailing health insurance policies in the market.
  • Low Copayment – Some senior citizen health insurance companies have no copayment. Some do – but they have higher copayments – of up to 10% - 20%. This policy does have a copayment – but it is really low at 5%. When claiming insurance, only 5% needs to be paid from the insurance policyholder’s pocket.
  • Individual Floater and Family Floater – There are two plans available under this policy. One is Individual Health Policy that provides a policy each for a member of the family. The other is the Family Floater Health Insurance that provides one policy for the whole family

Popular Govt.-owned Senior Citizen Health Insurance Schemes

The four main insurance companies in the public sector offer government-backed health insurance schemes. They are namely:

Varistha Mediclaim Policy

This policy is open for senior citizens in the age bracket of 60 to 80 years. The policy is renewed yearly and covers a range of medical conditions and diseases and also covers pre and post-hospitalization expense coverage. The policy provides coverage for organ transplantation as well.

HOPE (Health of Privileged Elders)

This is a comprehensive senior citizen health insurance policy that can be availed by anyone above 60 years of age. There is no upper age limit. Also included are optional coverages ranging from Rs 1 lakh to Rs 5 lakh. The insurance policy only covers specific ailments and also has a compulsory copayment clause of up to 20%. HOPE gives cent percent coverage for injuries caused due to accidents. Given that the policy covers all major illnesses, and also the fact that there is no upper age limit, it is a very beneficial policy for senior citizens.

Ayushman Bharat – National Health Protection Scheme

This is the planet’s largest government-funded healthcare plan for citizens in the urban poor and rural poor classification. The plan intends to reach more than ten crore people in the country. Active from September 2018, the scheme is accorded to those families or individuals who are classified in the deprived charts prepared as per SECC stats. The rural poor are classified as such based on their housing standard and living conditions. The urban poor is classified based on the nature of their occupation.

The plan is open for people of all age groups, and that includes senior citizens as well. All government and non-government empanelled hospitals can accept this plan. An Ayushman Mitra representative or personnel is the point of contact at accepting hospitals, where this person will coordinate with the hospital on behalf of the Ayushman Bharat policyholder.

Currently, the scheme has been renamed or called as PM – Jan Arogya Yojana.

World Elderly Day Celebration

Not just India, but the world is recognizing the value of elderly citizens, not only with affordable senior citizen health insurance policies but also with dedicated days recognizing their importance. October 1st has been identified as the World Elderly Day by the United Nations. The intent of having such a day is to increase awareness of the problems confronted by senior citizens and how the younger generation should help them help themselves.

To Conclude!

Given the numerous health insurance schemes available, it will be a good idea to compare health insurance from public sector health insurance companies and also government-funded health insurance schemes to make an informed decision on the policy to take. Senior citizen health insurance is becoming more robust and solidified, given the fact that they are a priceless asset to the world. 

Written By: Paisawiki - Updated: 11 February 2021

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