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Tips for Comparing Senior Citizen Health Insurance Policies

Amid an ample of senior citizen health insurance policy options in India, choosing the right one may not be easy if there is no clarity on how to compare health insurance policies for the elderly.

While taking a health insurance policy for someone who is above 60 years of age, the type of policy to avail depends on certain factors. Here you go:

  • Fixed Income Amount of the Person

 This income is largely guaranteed. It allows the person to plan to pay the premiums using this income. Fixed income is different from regular/irregular income. The latter is the frequency of income influx for the person. The former is the amount of income a person can generate annually, regardless of it is regular or irregular.

  • The Financial Status of the Person

 If the person has lots of financial obligations and the payment of insurance premium is uncertain, then the person has to consider stabilizing their financial status.

  • The Number of Dependents

A senior citizen could have dependents. The number of dependents can have an impact on the sum insured chosen. The more the number of dependents, the more will be the sum insured amount.

  • Health of the Dependents

 Even if the number of dependents can influence the amount of sum insured availed, the health of dependents can further influence the sum insured amount too. If one or many dependents have pre-existing medical conditions, then the sum insured should cover the pre-existing diseases of dependents too. This means that the sum insured will be higher, and so will be the premium.

Senior Citizen Health Insurance Policy: IRDAI Guidelines

In the recent past, IRDAI has stipulated certain guidelines that also include senior people:

  • Implemented a max upper limit to the sum insured.
  • Formed a committee to oversee senior citizen health insurance scheme formulation to benefit senior citizens as well as insurance companies.
  • IRDAI has mandated that insurance companies not reject a renewal of a health insurance scheme by a senior citizen. Even if the rejection has to be made, it has to be made on proven and documented grounds of false misappropriation of one's personal information such as age, pre-existing diseases, etc.
  • All features of IRDAI stipulated guidelines are also applicable for government-sponsored or backed senior citizen health insurance policies.
  • During pre-acceptance medical tests, a minimum of 50% of the cost incurred is to be borne by the insurer, in case the insurer accepts the results of the pre-acceptance tests. However, there are still some insurance companies not following this. They are laying the responsibility of pre-acceptance medical tests on the proposer. So it always a good idea to compare health insurance based on this aspect

How to Compare Senior Citizen Health Insurance Policies?

While comparing a senior citizen plan, the factors should be considered:


Compare the entry age criteria. If the entry age criteria is a minimum of 60, then the insurance policy can be taken. Most public sector health insurance companies have an entry age criterion in the age ranging from 60 to 80 years. It is advisable for senior citizens to take a senior citizen's health plan at the earliest, instead of delaying. Ideally, when a person reaches 60, it is the right time to take an elderly person's health insurance scheme. Because earlier the health insurance policy is taken, better it is in terms of waiting period, especially, in case the person has pre-existing diseases.

Sum Insured

This amount can range from as low as Rs 1 lakh to as high as Rs 1 crore. After taking into account one's pre-existing medical conditions, assess the cost of hospitalization and treatment that can arise. Assess if pre-hospitalization and post-hospitalization support is required based on the nature of the disease. Talk with a medical practitioner to gain more information on senior citizen health insurance. After getting a complete understanding of the possible expenses that might arise, calculate a sum insured amount. Choose a senior citizen health coverage scheme that provides not only the coverage for hospitalisation expenses, but all other benefits such as pre and post hospitalization cover, domiciliary cover etc.


The amount of premium paid is generally directly proportional to the amount of sum insured availed. But there are insurance companies that provide high sum insured with low premiums too. So this can be a good means to compare health insurance. However, there are trade-offs – as these insurance policies may not provide some of the common benefits such as pre and post hospitalisation. If these common benefits are not required, then going for such low-premium high sum-insured insurance plans can be a good idea.

Coverage for Pre-existing Diseases

There have been cases where senior citizens have taken health insurance schemes and later found out that their pre-existing diseases are not part of the coverage list of the insurer. So, always choose a health insurance plan that covers one's pre-existing diseases. Some insurers classify certain pre-existing diseases as special cases, and levy higher waiting periods on them. So, choose a health insurance scheme that has lower waiting periods on pre-existing diseases. If a health insurance scheme does not have coverage for critical illnesses but provides add-on riders, then consider this option too.

Network of Hospitals

It is not ideal for taking senior citizen health insurance policy that has a low or limited hospital network. Senior citizens need access to hospitalization facilities that are close-by, within at least a 10 km radius. So, look for an insurance provider who can provide a good network hospital list that is spread across the country. Not just that, the hospitals have to be renowned hospitals or registered hospitals as well. Do not choose an insurance provider that has a network of hospitals that are actually day-care centers or small clinics.

Benefits of Senior Citizen Health Insurance

These plans come with a considerable number of benefits that make the plan worth your money. Some of them are mentioned below:

  • The insured can avail higher sum insured than other types of health insurance policies.
  • Premium payments made towards the insurance policy can be exempt from tax deduction.
  • Most senior citizen health insurance schemes offer higher duration pre and post hospitalisation support. This is a good criterion to use to compare health insurance.
  • Most health insurance schemes for the elderly have coverage for day-care treatments and usage of high-tech medical equipment.
  • Most health insurance schemes for people above 60 include annual health checkups that help senior citizens assess or track their health regularly.
  • There is no aged person health insurance scheme that does not provide cashless hospitalization, medical practitioner's fee coverage, and room rent coverage in case the hospitalization exceeds 24 hours.
  • Health insurance schemes for senior citizens are generally renewable for their entire lifetime. There are only a few health insurance schemes that have maximum age criteria. Generally, taking a health insurance policy from such insurers is discouraged.
  • Ambulance charges are an important aspect to consider for senior citizens. During emergencies, the ambulance services have to be availed. There could be multiple instances in a year where a senior citizen may be hospitalised, each instance requiring ambulance usage. Therefore, senior citizen health insurance schemes cover ambulance charges and miscellaneous expenses, whereas most other types of health insurance policies may not have this coverage.

Considering the above factors, it is always recommended to have a senior citizen health insurance plan in place if there is an elderly person in the family. And online comparison always comes as a boon in providing the right type of health insurance.


  • Q. Are premiums for senior citizen health insurance schemes more expensive than standard health insurance schemes?

    Ans: In general, the premiums are costlier. As a rule of thumb, insurance policies apply premiums based on the age of the proposer. Higher the age, more is the susceptibility of becoming unwell or have pre-existing medical conditions. In theory, this is the understanding. But in practice, there are millions of senior citizens who do not have any pre-existing conditions. Therefore, currently, health insurance schemes for elderly people have higher priced premiums than other types of insurance policies.

  • Q. How to calculate the premium for a senior citizen health insurance policy?

    Ans: To calculate the premium for a senior citizen health insurance policy, some of the considerations to make are age, the sum insured, and pre-existing conditions. However, insurers can apply other criteria too, such as medical history, family medical history, ethnicity, race, lifestyle habits, etc.

  • Q. What is this phrase 'pre-acceptance medical screening'?

    Ans: Many people do not show symptoms of an underlying medical condition. For example, in the case of those with border-level diabetes, don't show symptoms until at a later stage. Pre-acceptance tests check if a person can develop any disease, even though the person might not be showing symptoms. A few health insurance schemes have this type of screening – especially if the sum insured is high. For the proposer, it is a good idea to undergo pre-acceptance medical screening, because it helps them identify any potential threat to their health, and take corrective action at the earliest.

  • Q. Is showing proof of income mandatory to avail senior citizen health insurance?

    Ans: In general, the answer to this is – No. Most insurers only require documents supporting the existence of a regular income stream. Most insurers understand that senior citizens are retired people who may not be actively employed. But the documents that the insurer insists upon are related to age proof, previous medical history, medical receipts, etc. It is advisable to check the fine print of senior citizen health insurance schemes to understand their documentation process as it varies by insurer.

Written By: Paisawiki - Updated: 11 February 2021

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