Senior Citizen Health Insurance

With old age, health-related issues tend to increase. This leads to frequent medical visits and indirectly affect one’s savings. At this point of age, when there is no steady flow of income, these expenses could cost someone a bomb.

Financial instability or burden in old age can be challenging to cope with, although this scenario can be avoided with a simple Health Insurance plan, specifically Health Insurance for Senior Citizens. This Insurance plan can come in handy for those who are old and have financial requirements for medical treatments.

What is the Senior Citizen Health Insurance?

Senior Citizen Health Insurance is medical insurance for senior citizens in the form of a policy or plan. Age groups that are offered medical coverage through a medical insurance policy differ from insurer to insurer.

On average, the medical requirements of individuals within the age group 60 to 85 years are covered through this policy. It is designed such that it covers all categories of healthcare needs and expenses that are to be incurred by a potential policyholder.

Due to a survey that was conducted on people belonging to different age groups in India, it was found that individuals belonging to 22 to 26 age bracket were the least insured. 72% of individuals belonging to 46 to 54 age bracket and 68% of 55 to 60 age category had health insurance.

Thus, it can be concluded that Indians gain awareness or get concerned about their health, as in purchasing a Health Insurance plan late in their lives, which necessitates the availability of Senior Citizen Health Insurance plans

Also, according to the new IRDA (Insurance Regulatory and Development Authority) guidelines, every medical insurance provider has to offer healthcare coverage up to 65 years of age, which is the minimum age limit for the exit age category. This helps individuals to secure healthcare coverage at later stages of their lives.

There are several Insurance agencies and companies that offer Health Insurance for Senior Citizens in India with attractive premium rates, interests, and returns. The new IRDA guidelines allow the policyholder to switch insurance providers if they are not satisfied with the services that they are currently provided.

Why Should You Choose Senior Citizen Health Insurance?

Old age always brings with itself several illnesses and ailments that are often expensive to treat. The older one gets, the more their physical and mental stress over the ability and the required finances to afford quality healthcare in their hour of need.

Countless points can be considered while thinking about the reason to get a Senior Citizen Health Insurance plan, some of which have been mentioned below:

• Most of the people in India retire at an age between 56 to 62 years, and most of them stay unemployed after retirement, which makes them to be dependent financially on their pension accounts or children. In most cases, the pension amount received every month can be scarce and not enough to meet medical requirements and it can be bothersome for many to depend on their children
• As mentioned earlier, old age brings with itself physical and mental degradation and makes one more prone to illnesses and diseases, which again leads to frequent health check-ups
• Many of the medical check-ups and treatments can be expensive and can easily drain your savings
• To avoid various unforeseen circumstances during old age, regarding finances for medical check-ups and treatments
• Rising medical costs, even for routine medical check-ups, treatments, and services like ECG, Dialysis, Hemo-dialysis, CAT scans, MRI scans, Ultrasound scans, medical counselling, etc.
• Limited income after retirement or financial instability in the later stages of life
• Depending on children, family, or relative financially
• There is often a decrease in savings after retirement, certainly if an individual remains unemployed after retirement
• Medical Insurance schemes provide the option to plan and secure one's future, health-wise, without any stress. Even though both aging and falling sick are inevitable, still one can plan on how to counter it
• Through Healthcare Insurance policies, urgent healthcare expenditure is taken care of right away, in a rather hassle-free and systematic way, without giving any space for stress
• It is well known that a crisis like critical illnesses can be a great financial blow to one’s family. If the person who is suffering from the illness does not have medical insurance, then the head earner of the family would have to work harder to pay the medical expenses. This leads to a debt crisis in the family
• A person suffering from a critical illness has to apply for a medical loan if he/she is not insured by a medical insurance policy, which adds to the financial burden of that person
• Even if a person has a high monthly income from his/her pension account or is earning well after retirement, there are various unforeseen financial contingencies and expenses that he/she has to consider. This will reflect in the medical expenses if he gets sick during such a time
• Increased vulnerability, mostly in terms of finances, during illnesses
• Discontinuation of a person’s health insurance policy provided by his/her employer or the organization where he/she worked after retirement
• Seamless critical and terminal illness cover, including pre-existing diseases and ailments
• Medical Insurance policies offer the great option of cashless hospitalization, which is very helpful for those who are financially unstable during hospitalization

Features of Senior Citizen Health Insurance

The key features of senior citizens’ medical policy are as follows:

• Senior citizen health insurance are policies that are specifically designed for senior citizens, as in, they are health insurance for senior citizens above 60 years of age or between 60 to 80 years of age
• These policies offer coverage for senior citizens’ healthcare needs and requirements
• There is provision for returning, cancelling, or porting the policy if the policyholder is not satisfied with the terms of the policy. This can be done during the free-look period in the tenure of the policy
• These provide the opportunity for cashless hospitalization if the policyholder or the insured is admitted and undergoes treatment at one of the hospitals in the insurer’s hospital network. It includes doctor fees, various medical bills, charges of the patient room, etc.
• If the patient chooses a hospital for treatment that is not in the hospital network of the insurance provider, all medical expenses incurred by the policyholder is reimbursed by them as per the pre-defined Sum Insured
• Post-hospitalization, as well as pre-hospitalization expenses, are covered based on the number of days
• Health insurance policies for senior citizens offer a great option known as the co-payment option. This option reduces the number of premiums to be paid, and the policyholder is even liable to receive discounts from the insurer based on this. The catch is that a certain pre-defined portion of the healthcare expenses is borne by the insured or the policyholder
• These policies offer the provision to choose the Sum Insured as per the policyholder’s medical requirements
• Most of the health insurance plans for senior citizens provide medical coverage for the treatment of pre-existing diseases, though in case of some policies, this has to be added and paid for separately
• These also cover the various day-care expenses that arise as a result of the usage of special or advanced medical equipment while some treating procedures such as chemotherapy or dialysis

Benefits of Senior Citizen Health Insurance

The benefits of medical policy for senior citizens that a policyholder can enjoy are mentioned below:

• Tax benefits

  These policies entitle the policyholder to avail tax exemption or deduction, in addition to providing healthcare coverage and other health benefits, which is laid out by Section 80D of the Income Tax Act, 1961. According to this section, a policyholder is eligible for a rebate on income tax, if he/she holds a Senior Citizen Health Insurance, of up to an amount of INR 30,000. An additional rebate of an amount of INR 5,000 can also be availed in case of annual preventive medical check-ups

• Hospitalization expense coverage

  All of the medical expenses incurred by the policyholder during hospitalization is borne by the insurance provider, including cashless hospitalization, as well as treatment if the patient is hospitalized for more than 24 hours. This includes various medical bills, nursing fees, doctor fees, drugs and cost of medicines, charges of the room, etc.

• Pre and post-hospitalization expenses

  Coverage for all the expenses incurred by the policyholder for post and prior hospitalization is offered by the insurer, which depends on the number of days

• Emergency ambulance expenses

  Medical insurance for senior citizens also covers the cost of ambulance or emergency ambulance services

• The insurer also covers day-care expenses

  Day-care expenses incurred by the policyholder that arise due to the use of advanced medical procedures or pieces of equipment

• Pre-existing diseases

  Many insurers provide coverage for specific (pre-defined) pre-existing ailments and diseases, which is usually available after the waiting period of the policy

• Free health check-ups

  Almost all of the insurance providers offer free annual or semi-annual health check-ups

• Lifetime renewal

  Many insurers provide the option of lifetime renewal on health insurance plans for senior citizens which is advantageous for those who do not wish to take a break between their policy terms.

• Tax Benefits

  These policies entitle the policyholder to avail tax exemption or deduction, in addition to providing healthcare coverage and other health benefits, which is laid out by Section 80D of the Income Tax Act, 1961. According to this section, a policyholder is eligible for a rebate on income tax premium, u up Rs. 50,000, which was 30,000 earlier. 

Senior Citizen Health Insurance Plans in India

Some of the popular mediclaim policies for senior citizens are as follows:

• Bajaj Allianz Health Insurance Silver Health Plan

  With Bajaj Allianz Silver Health Insurance one can secure his/her retirement days with ease. It is a complete mediclaim policy that offers comprehensive coverage for elderly people.

  Policy coverage is as follows:

  • Hospitalization expenses
  • Pre-hospitalization and post-hospitalization expenses
  • Domiciliary treatment charges
  • Daycare treatment charges
  • Ambulance expenses
  • 5% cumulative bonus after every claim-free year
  • 5% discount on more than one member of the family is insured

• HDFC ERGO Health Insurance Health Optima Senior plan

   HDFC ERGO Health Optima offers 360-degree insurance coverage for senior citizens. Policy coverage is as follows:

  • Hospitalization expenses
  • Pre-hospitalization and post-hospitalization expenses
  • Auto recharge of base Sum Insured available (in case of exhaustion)
  • Family discount on the premium (for more than 2 members)
  • Domiciliary treatment charges
  • Daycare treatment charges
  • Ambulance expenses

• New India Assurance Sixty Plus Mediclaim Policy

  Senior Citizen health insurance from New India Assurance can be a good pick for anyone looking to securing their old age. The policy offers

  Policy coverage is as follows:

  • Hospitalization expenses
  • Ambulance expenses
  • Pre-hospitalization and post-hospitalization expenses (up to 30 and 60 days)
  • Discount on premiums to be paid on voluntary excess
  • Family discount available
  • One free health check-up every 4 claim-free years
  • This policy has the lowest premium

• Star Health Insurance Red Carpet plan

  Star Health Insurance Company is one of the first insurance companies in India to introduce a medical insurance plan specifically designed for senior citizens. Star Red Carpet provides insurance coverage to anyone between the age 60 to 75 years.

  Policy coverage is as follows:

  • Hospitalization expenses
  • Cost of drugs and medicines
  • Diagnostic and medical check-up expenses
  • Pre-hospitalization and post-hospitalization expenses
  • Domiciliary treatment charges
  • Daycare treatment charges

• Tata AIG Health Insurance Medi Senior Health plan

  Tata AIG Health Insurance offers great health insurance plans for senior citizens, out of which, possibly, the best is the Medi Senior Health plan.

  Policy coverage is as follows:

  • Hospitalization expenses
  • Pre-hospitalization and post hospitalization expenses
  • Family floater option is available
  • 5% discount on more than one member of the family is insured
  • Daycare treatment charges
  • Cost of drugs and medicines

Types of Senior Citizen Health Insurance plans

Medical insurance for senior citizens can be categorized into different types based on the following factors:

• Age criteria

  Some policies have a maximum age limit, while some do not have any age limit.

• Policy renewal

  There are mediclaim policies that offer lifetime renewal options, while some have an age limit associated with the policy renewal process.

• Co-payments

  All mediclaim policies for senior citizens are divided into those that offer co-payment and those that don’t.

• Pre-existing diseases

  Most of the insurance providers offer coverage for the treatment of pre-existing diseases and ailments, but some insurers do not provide coverage for it.

Documents Required to Apply for the Senior Citizen Health Insurance

An applicant applying for health insurance for senior citizens is required to have the following documents and submit them during the application and documentation process:

• Proof of ID – KYC documents such as Aadhar card, non-KYC documents such as Driving Licence, Passport, etc.
• Proof of Address – electricity bill or telephone bill with address, other documents with residential proof such as passport, Voter's ID card, etc.
• Proof of Age – Birth Certificate; Matriculation or Intermediate or Graduation certificate, etc.
• Proof of Income – Recent Salary Slip (of any of the last 3 months while applying)
• 2 recent passport size photographs
• Recent medical check-up report(s)
• Documents supporting the Medical treatment or the hospitalization history

Eligibility Criteria for Senior Citizen Health Insurance

The eligibility criteria of all the health insurance policies for senior citizens revolve around the following two factors:

• Age criteria

  For most of the medical insurance policies, the minimum entry age of the policyholder should be 60 years, while for some others, it is 45 years. The maximum entry age should be between 75 to 80 years.

• Pre-existing diseases

  Some of the healthcare policies need the policyholder to undergo medical screening. This is done by the insurers to check whether if the policyholder has any pre-existing diseases, disorders, or ailments. Some of the insurers tolerate and provide coverage for pre-existing diseases while some others do not.

Inclusions of the Senior Citizen Health Insurance

The inclusions of the senior citizen health insurance plans are mentioned below:

• Charges for emergency ambulance services
• Hospitalization expenses
• Pre-hospitalization and post-hospitalization charges
• Expenses incurred in the form of doctor’s fees, nursing fees, cost of drugs and medicines, etc.
• Cost of domiciliary treatment(s)
• Daycare treatment(s) and procedure(s) expenses
• Organ donor charges
• Critical and terminal illness treatment charges
• Cost of annual medical check-ups
• In some cases, the cost of treatment for pre-existing diseases

Exclusions of the Senior Citizen Health Insurance

The policy exclusions of health insurance for senior citizens are as follows:

• STDs/HIV/AIDS treatment charges
• Cost of treatments for drug/substance or alcohol abuse or rehabilitation for the same
• Expenses incurred due to weight control or non-allopathic treatments
• Metal insanity or disorder and congenital diseases treatment charges
• Suicide
• Self-inflicted injury
• Cost of spectacles or lenses
• Injury or disease inflicted during participation in adventurous or extreme sports or military operations
• A biological, chemical or nuclear threat
• External aids, dental treatment, pregnancy, and related treatments, etc
• Claims that are raised during the waiting period
• Expenses incurred due to treatment for ailments that arise within the first 30 days of purchasing the policy

Claim Process of the Senior Citizen Health Insurance

Mediclaim for senior citizens is the process that allows them to file a medical insurance claim on their policy when they have financial requirements on the grounds of medical expenses. The medical expenses include hospitalization charges (ideally at one of the hospitals in the hospital network of the insurer), cost of emergency medical treatment, etc.

In case the policyholder or the insured requires medical coverage or expense reimbursement after undergoing medical treatment or getting discharged from the hospital, he/she is required to file a claim and inform the insurer about the same within 24 hours.

Insurers offer a hassle-free claim process with minimal documentation to provide for the policyholder in the minimum time.

The policyholder has to file a mediclaim in the form of a claims form, which can be obtained at the nearest branch office or the official website of the insurer. This has to be duly filled-in and submitted with the insurer, with original policy documents in some cases, to raise a claim.

Documents that are/may be required while raising a claim are as follows:

• Claims form or the pre-authorization request form
• Original policy documents
• Statement of attending physician
• Copy of all medical records attested by the physician
• NEFT form
• ID proof of the insured
• Copy of FIR, FPIR and post mortem report (in case of unnatural death)
• Death claims form (in case of natural death)
• Copy of death certificate (in case of natural death)

Renewal Process of the Senior Citizen Health Insurance

The renewal process refers to the renewal of the policy term after its maturity. In case the policyholder wants to renew his/her policy. He/she has to fill up a renewal form that can be collected from the nearest branch office or downloaded from the official website of the insurer and submit with the same.

The policyholder also has to submit original policy documents as well as ID proof while renewing the policy.

Some of the insurance companies have an age limit for the renewal process, but most of them offer lifetime renewal; that is, the policyholder can renew his/her policy as many times as he/she wishes until they reach their exit age.

How to buy Senior Citizen Health Insurance?

Individuals looking to purchase a Senior Citizen Health Insurance plan can do so by 2 ways:

Offline – This is the relatively hard method to buy a health insurance plan. One has to go to the nearest branch office of the insurance company that they want to buy the policy from. They can then check the policy's details and, if satisfied, ask for an application form that they have to submit with the insurer. This is often a bothersome way.

Online – Nowadays, almost every insurance provider has a website. One can simply open the website on their browser, check the details of the policy, and purchase the one that suits their needs. This is a hassle-free way where an individual can buy a policy from their home with the click of a button.

Buying Senior Citizen Health Insurance Plans in India: Factors to Consider

Choosing a Health Insurance plan is often a tiring or tricky task if the person who is about to purchase one does not understand the factors it entails.

Therefore, it is essential to check out the factors involved and other things to keep in mind while comparing or choosing a mediclaim policy.

The factors are as follows:

• Coverage

  The individual applying for medical insurance for senior citizens should ascertain the medical requirements of the potential policyholder and accordingly select a plan that covers those requirements.

  Let’s say a son wants to get a medical insurance plan for his father and mother, then before purchasing the plan, he should first check out the medical requirements of his parents, as in what sort of medical attention do they require.

  After confirming this, he should then focus his concentration on the plans available in the market that meet his parents’ needs.

• Co-payments

  Regarding coverage provided by a medical insurance policy, some of the medical charges, which are a fixed amount, have to be paid by the policyholder. This amount is known as the Co-pay of a medical insurance policy, which the policyholder pays for from his pocket for corresponding covered services.

  Almost all senior citizens’ mediclaim policies come with a pre-defined co-payment clause, which specifies the amount that the policyholder has to pay. This depends on the required medication and treatment.

  Thus, it is favourable to choose a plan that levies a lesser percentage of co-payment.

• Waiting Periods

  It is mandatory for an individual, planning on purchasing a senior citizen's mediclaim policy, to have some knowledge about the policy’s waiting period.

  This is the period in which the insured has to wait to claim on medical grounds unless the listed illnesses in the policy have coverage. During this, one cannot file a claim for any such illnesses. Though, many of the insurers offer coverage to pre-existing ailments and illnesses for extra premium payment.

  Like co-payments, almost all insurance companies have a waiting period clause. Thus, it is recommended to choose a plan with a relatively minimal waiting period.

• Free-look Period

  In case a policyholder wants to end an on-going medical insurance plan without penalties or paying extra charges, he/she can do so during the free-look period.

  Most insurers provide a15 day duration to the policyholder to decide whether to extend the tenure of the policy or end the contract without any payment. Individuals should look for policies that have the maximum duration of the free-look period (comparatively).

• Lifetime Renewal

  Many plans have a cut-off renewal age; that is, the terms and conditions involving those plans restrict a policyholder to renew it after reaching a certain age (cut-off renewal age).

  Timely renewal is an essential aspect of continuing to enjoy having a medical insurance policy and not having unnecessary stress.

  Therefore, it is wise to make mediclaim for senior citizens keeping the cut-off renewal age in mind. One should go for those plans that offer lifetime renewal for their policies.

• Pre-existing Diseases

  Individuals who suffer from persisting or pre-existing diseases before purchasing a medical insurance plan should consider the fact that some insurance providers do not cover treatments and check-ups for these diseases while some do.

  Also, among those companies that cover these diseases or illnesses, some offer coverage for a short duration while some for a longer duration. All medical policies have a pre-existing clause, and it is favourable to choose a policy that has a relatively minimal pre-existing disease clause.

Senior Citizen Health Insurance FAQs