Senior citizen health insurance offers coverage for senior citizens aged between 60 years and 80 years. Senior citizen health insurance plan is a necessity especially when you are planning to retire and live on pension or interest income from savings. A sudden medical emergency can result in a financial crisis. To avoid this, it is prudent to take a comprehensive insurance policy.
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According to the new guidelines by IRDA, every health insurance provider has to offer coverage to individuals, up to 65 years of age. These updated guidelines help individuals to get coverage at later stages of their life. Moreover, they allow them to switch insurers if they’re not satisfied with their current insurance provider. There is no dearth of insurance providers for elderly people. However, the challenge is to choose the right one.
Thus, we strongly recommended that you make proper comparison of different health insurance plans for senior citizens which are available in the market before purchasing. The online comparison is the right move to find and pick the best health insurance plan. Such a comparison will give you a fair idea on which is the best suited policy for you.
Features of Senior Citizen Health Insurance Plan
In various unforeseen circumstances, senior citizen health insurance plans will help you cope with your difficulties. These plans come with various salient features. They are as follows:
These plans are designed for senior citizens aged between 60 years to 75 years.
There is no need of any pre-medical test before buying health plan.
Offers free-lock in period on the plans.
Senior citizens can avail health check-ups on yearly basis.
Senior citizens can avail cashless hospitalisation service under this plan if the patient is admitted for over 24 hours. This facility includes medical bills, doctor fees, charges of the room, etc.
Pre-hospitalisation and post-hospitalisation is covered based on the number of days.
Senior citizen health plans offers cover for pre-existing diseases and specific ailments once the due waiting period is over.
Certain medical amenities such as ambulatory services are also covered by most of the senior citizen health insurance plans.
Popular Senior Citizen Health Insurance Plans Available in India
IRDA approved general insurance companies offer health insurance for senior citizens and have niche products to cater to this segment in our society. In India, these mediclaim policies ensure that you are financially protected during your golden years and are able to keep pace with sky rocketing medical costs.
Insurer - Policy Name
Pre & Post Hospitalisation Expenses
Bajaj Allianz - Silver Health Plan for Senior Citizens
46 - 70 years
50, 000 - 5 lakh
Up to 3% of admissible hospital expenses incurred
Covered from the 2nd year of the policy
After 46 years of age, required as listed below: Complete medical report, ECG, Fasting BSL, Urine R, Liquid profile, HbA1c, SGPT, CBC, SGOT, CBC, Sr. Creatinine
Star Health - Senior Citizen Red Carpet Health Insurance Plan
60 - 75 years
1, 00,000 - 10, 00,000
Only post hospital expenses maximum up to Rs. 5,000 excluding nursing charges, diagnostic charges, medicine, and consultation fee.
Coverage from the 2nd years of the policy
No pre-acceptance medical test required
National Insurance - VARISHTHA Mediclaim Policy for Senior Citizens
Covered after 1 claim-free year while policy remains in force
Not required if insured was covered by a health insurance for last 3 years; Required for rest
New India - Senior Citizen Mediclaim Policy
60 - 80 years (renewable up to 90 years of age
1, 00,000 - 1, 50,000
30 days pre-hospitalisation (max up to 5% of hospital bill) and 60 days post hospitalisation (max up to 10% of hospital bill)
Covered after 18 months of policy inception
United India - Senior Citizen Mediclaim Policy
61 - 80 years
1, 00,000 - 3, 00,000
30 days and 60 days respectively (max up to 10% of hospital bill; whichever is less)
Covered after 4 years of nonstop renewal with the company
Required and reimbursed only 50% and that even after proposal acceptance
Apollo Munich Health Insurance - Optima Senior
61 and above
2, 00,000 - 5, 00,000
30 days pre and 60 days post hospitalisation expenses
Covered after 3 years of nonstop renewal with the company
Required and reimbursed only 50% and that even after proposal acceptance
Oriental - Senior Citizen HOPE Health Insurance
60 and above
1, 00,000 - 5, 00,000
30 days and 60 respectively
Covered after 2 years of nonstop renewal with the company
Need to submit certain medical tests report issued by particular diagnostic centers
SBI - Arogya Top Up Policy
65 and above
Sum of 1, 00,000 - 5, 00,000; 1, 00,000 - 10, 00,000 (with deductibles)
60 days pre-hospitalization and 90 days post hospitalization expenses
Covered after 4 years of nonstop renewal
No medical test required up to 55 years of age if no medical history is there
Tata AIG - MediSenior Health Insurance
61 and above
2, 00,000 - 5, 00,000
30 days and 60 days respectively
Covered after 4 years of continuous renewal
Required and reimbursed only 50% and that even after proposal acceptance
6 Factors to Consider While Comparing Mediclaim Policies for Senior Citizens
Coverage: Firstly, ascertain your medical requirements, your health concerns and your spouse’s health concerns, age factor and other issues that might affect your health insurance premium.Take into consideration various health factors like your medical history, financial conditions etc. Check if the plan has sub-limits, co-payment clause, and room rent capping. Select a plan that offers maximum coverage and comes with minimum limitations.
Co-Payments: Co-pay is the fixed amount that the policyholder pays from his own pocket for the covered services. Most of the senior citizen health insurance plans come with a co-payment clause depending on the treatment and medication required. Choose a plan that charges a lesser percentage of co-pay.
Lifetime renewal: Check if the medical insurance plan doesn’t come with a cut-off renewal age. Choose a plan that offers lifetime renewability option. As you grow old and your health issues increase, it will become challenging for you to purchase a new plan.Usually, health insurance providers offer a grace period to their customers. It allows easy renewal in case the due date is missed.Most of the health insurance companies such as Max Bupa and Apollo send a reminder to the policyholders to help them renew the policy in time. Timely renewal will save you from unnecessary stress.
Waiting Periods: Before buying health insurance, it’s important for you to have some knowledge about the waiting period. It is the duration for which the insured person has to wait unless the illnesses that are listed in the policy are covered. During this period you cannot file a claim for such illnesses. In some cases, the health insurance company offers coverage to some of the prior illnesses on payment of extra premium. Most of the health insurers have a waiting period clause before the beginning of the medical policy. Any pre-existing illness may require costly medical treatment. That is why it is recommended that you opt for a policy with a minimal waiting period.
Pre-Existing Diseases: Some insurance companies cover pre-existing illnesses and some don’t cover it all, so it is better to assess before you make the purchase. Some insurers cover it after 48 months, and some cover it after 24 months. In case of senior citizens, most of the pre-existing health issues can lead to rejection as well. So, select a plan that comes with a minimal pre-existing clause.
Free-look Period: A free look period is a time in which a new policyholder can end the policy without penalties. It is usually 15 days that allows the insured to decide whether to continue or discontinue. If the insured is not satisfied and wishes to cancel it, then he is eligible to get a full refund.
It has been overriding aggressively with the regulatory actions like:
In the year 2006/2007, when a few of the insurers radically elevated premiums for hospitalization policy, it set down a tam for any such revision
Government constituted a Committee on Senior Citizens Health Insurance to go in some special requirements
Numerous recommendations were implemented for this committee
IRDA issued the instructions below about the health insurance for senior citizens to the insurance companies: • People must be permitted to purchase a new senior citizen health insurance plan up to the attainment of age of 65 years • If the proposal gets rejected, it should be given in writing with valid reasons • A senior citizen insured must have an option to alter his TPS anywhere feasible • Minimum 50% of the pre-insurance medical investigation cost might get reimbursed where the insurer accepts the risk • No insurance company can decline the renewal of any health insurance scheme except on the grounds of misrepresentation, moral hazard or fraud
Things to Keep in Mind When Buying Mediclaim Policy for Your Parents
Scores of young individuals are on pins and needles when talked about the health requirements of their parents, peculiarly when their parents are the senior citizens. A few employers cater to provide cover their employees’ parents under the group health insurance plans. This provides some breathing space to the youthful individuals seeking some solutions to the health issues of their senior citizen parents. Nevertheless, not all have the privilege to avail this sort of protection for their parents. The ones who have no access to such an arrangement, they have to buy senior citizen mediclaim policy for their parents. Moreover, the one who is covered under the group health insurance plan offered by the employer may not find it sufficient and might want to get another one.
No matter what the case is, purchasing a health insurance plan for the senior citizen is a chore and for a lot of young individuals, it is cumbersome to choose one for their elderly loved ones. Let us endure the significant factors, which a young individual should keep in mind while buying senior citizen health insurance.
Efficacy of Process of Claims
Claim settlement ratio and claim settlement time should be the two most significant factors taken into consideration. Faster the claim settlement time and higher the claim settlement ratio usually means that the insurer is doing a great job with candid and authentic claims.
Many of the health insurance policies do not cover Day-care methods. Also, in order to make a mediclaim, hospitalisation is mandatory for at least duration of 24 hours. However, you must be grateful to several modernisations, today; many methods do not need any hospitalisation. Therefore, it is better to choose a plan covering the highest number of day-care techniques.
Check out the catalogue of network hospitals around you and check whether they include the services that you often come across. It is also a vital factor that is to be considered if you are travelling or moving cities, as your health insurance must travel along with you. Moreover, you can avail your cashless facilities in network hospitals.
A lot of insurance companies provide a no-claim discount or a no-claim bonus if no claim is lodged by the policyholder. In such a case, either the premium decreases or the sum insured increases or both.
Hospitalisation expenses are the medical expenses that are incurred before and/or after hospitalisation. For the period of hospitalisation, a few parts of the treatment extend further than the hospitalisation. Visiting the doctors regularly for follow-ups, medication to be taken or follow-up examinations to be made comes under the post-hospitalisation expenses. The expenses that are relevant to the treatment for which the individual has been admitted to the hospital must be considered under the Pre-hospitalisation and post-hospitalisation expenses.
Discreet Individual Policy for Parents:
If an individual is purchasing a mediclaim policy for their parents, who have attained an age of 60 years or above, then he should not include them in their family floater plan. They should purchase an individual health plan. This is because the premium under family floater scheme basis the eldest member who is covered in the plan. Even the highest renewal age is fully dependent on the covered eldest member's age. Hence, if and when the age is fissured, all the members of the family will lose the cover.
The senior citizen health insurance policy's premium is very high due to the risk associated with age is high too. Despite the plan's basic premium, you might have to make an extra payment for pre-existing diseases.
Free Medical Health Check:
Hunt for a health insurance plan that allows the policyholders to medical check-up for free. The check-up or tests have no impact on the premium while the policy comes up for the renewal.
Benefits of Senior Citizen Mediclaim Policy
A senior citizen mediclaim policy is just another type of health insurance, specifically drafted for senior citizen in our families. Such a mediclaim policy requires a person to be at least 60 years old to avail the coverage and benefits associated with the policy. Below are primary benefits of a mediclaim policy for senior citizens:
Hospital Expense Cover: Expenses incurred on a patient if the hospitalization (cashless treatment) is more than 24 hrs, including room charges, doctor fees, nursing fees, cost of medicine and drugs, etc.
Day care costs which arise from use of special equipment or procedures like chemotherapy, dialysis, etc.
Medical costs prior and post hospitalization provided the number of days is variable
Ambulance charges for transporting the insured, subject to maximum limit
Existing diseases are also covered, subject to terms and conditions of the policy
Senior Citizens Health Insurance Exclusions
Although a health insurance policy covers most of the health hazards when diagnosed, there are times when mediclaim cover for a senior citizen is denied. Below is a list of common exclusion of a senior citizen health insurance policy:
Pre-existing diseases or injuries
Expenses arising out of self-inflicted acts
Expenses arising from drug abuse
One or more medical condition diagnosed within 30 days of purchasing the policy
Expenses related to non-allopathic treatment
The treatment cost of injuries caused due to an act of foreign army or a civil war
A cosmetic surgery
The cost of dental treatment or lenses/spectacles unless arising from an accident
Treatment cost of AIDS
How to Claim Mediclaim for Senior Citizens?
Mediclaim for senior citizens allows the policyholders to file a health insurance claim when they get hospitalized or have to avail emergency medical treatment. These policies facilitate raising a mediclaim to avail cashless treatment at a network hospital or for expense reimbursement post discharging from the hospital. In any case, the policyholder must inform their insurer about the same within 24 hours of hospitalization without failure.
In order to file mediclaim, fill out the claim form obtained online from the respective insurer's website or obtained from the insurer's office, and then submit it back to the insurer. Attach the medical bills and reports given by the doctor/hospital as the supporting documents. Make sure to meet all the requirements for faster claim processing.
Tax Benefits of Senior Citizen Health Insurance
This health policy not only provides you with an assurance for health benefits when you might actually need them but also entitles you to avail tax exemption under section 80D of the Income Tax Act, 1961. You are eligible for an income tax rebate of Rs. 30,000 if you hold a mediclaim policy for senior citizens for your elderly parents. You can also avail am additional rebate of Rs. 5,000 for preventive health checkups annually.
If you're still earning and also paying health insurance premium on behalf of your son or daughter, then you can avail an additional income tax rebate of Rs. 25,000. This means that you can avail tax deduction of max up to Rs. 60,000 under section 80D.
Benefits of Buying Senior Citizen Health Insurance Policy from PolicyBazaar
Are you an older person stuck in a health insurance crisis? PolicyBazaar is you savior. If you're an elderly person, you may find yourself in a crisis-no longer covered under employer's health insurance policy but needing medical policy for senior citizens more than you ever did before.
Backed with a team of experts, we at PolicyBazaar facilitate a quick and easy comparison of available health insurance mediclaim policies and thus, help in saving your time and money. There are various IRDAI approved companies offering senior citizen health insurance plans to old people and thus, an online comparison will ensure that you only fall to the right plan.
All you need to do is fill a simple form with information about yourself and your insurance requirements. Once you submit it, you will soon get quotes for affordable these senior citizens health insurance plans. The best part is that our insurance experts are standing by to talk with you and answer your query, if any.
What is Senior Citizen Health Insurance?
It becomes increasingly difficult to get a decent health cover as one grows older. Health insurance designed to specifically fulfill the healthcare needs of the old aged is termed as Senior Citizen Health Insurance. It is a bit pricier than regular health insurance.
Why insurance for Senior Citizen?
The reason is quite obvious. With a person growing, the frequency and severity of illness increases too. Thus, aged people have higher healthcare costs to bear. But more often than not, the people in this age group have no regular source of income apart from the pension. That is the reason, getting a health insurance at this point of time becomes all the more important.
What should I look out for in Senior Citizen insurance?
Health insurance for senior citizens comes with stringent medical check-ups, limited coverage and extensive exclusions. One should look out for the following parameters while buying it.
Maximum renewal age
Documents Required For Senior Citizen Health Insurance?
Duly Filled Proposal Form
Pre-Insurance Medical Tests
Do I need to go through medical screening before purchasing a health plan?
Yes, you need to go through medical screening before buying a senior citizen health plan. As an old aged individual you are a riskier deal for the insurance company. Hence, most of the insurance companies need the applicant to go through medical screening.
What are the things to look out for in a senior citizen plan?
Health insurance for senior citizens comes with a limited coverage. One should look out for below parameters while purchasing such a plan
Co-payment= It is the part of the eligible claims that an insured has to pay, while the remaining portion of the claim will be paid by the insurance company. Usually, this ratio of premium payable varies from 10-25%. It means, for every claim of Rs 100, a policyholder has to shell out Rs 25 before the company contributes Rs 75. For a policyholder, main benefit comes in the form of low premium rates.
Maximum renewability age= Always look for a product which offers maximum renewability. A product which ceases renewal when you need it most, especially after 60 years, is not a right plan.
Waiting period for existing illnesses = As you grow old (i.e. after retirement), so is the list of existing diseases. You should look for the insurance plan that has low waiting period for existing illnesses.
Check terms and conditions related to medical check-ups= Most of the IRDA approved insurance companies insist on health checkup of the proposer before issuing policy and accepting the premium. You may be asked to bear check-up expenditure. So you should look for a plan that asks for limited medical tests and also bears some part of test expenses.
Do all insurance companies offer cashless hospitalization?
Yes, every good insurance company offers this cashless facility at their network hospitals.
What are continuity advantages available in health insurance?
When you port your insurance policy from one insurer to another, you are allowed to carry forward your continuity advantages which you have gained by being under continuous health coverage for certain number of years. It plays an important role when at a later stage you want to add existing illness clause in your policy.
The continuity would also be applicable on time-bound exclusions, for example, most of the insurance policies exclude joint replacement surgeries for a period of 2 years. But at the time of portability, the continuity would be considered for these conditions also.
For instance, Mr. Vijay Sharma (i.e. the insured) decided to port his ten-year-old health insurance policy from New India Assurance to Apollo Munich health plan. As Mr. Sharma had spent enough time with New India Assurance, therefore, he doesn’t need to serve the waiting period to cover existing illnesses.
He also earned cumulative bonus (it is a bonus given to policyholders who do not make a single claim in a year) in his first policy which is added to the sum insured by the new plan. In this case, waive off waiting period and carry forwarding of bonus are called continuity advantages.
Who will bear the cost of pre-insurance medical checkup and where it will be conducted?
Usually, the applicant has to bear costs of medical test held prior of taking policy. IRDA approved insurance companies arrange the appointment with their empanelled hospitals.
Do companies offer free annual health checkups in health policies?
There are some insurers which offer this benefit to their policyholders (in terms of sum assured) once in a block of four claim-free years. Also there are some IRDAI approved insurance companies which are offering this facility every year, even if you have applied for a claim. So it is best to read your policy wordings to get clear idea.
To initiate the process, call up the insurer’s toll free number or visit the nearest branch office of the company. If tests are done at an empanelled center, the customer is not asked to pay any amount as the insurer pays the center as per agreed rates. However, if the insured gets the test done at a nearby lab then he has to pay charges which he can later reimburse from the company.
Whom should I submit claims- TPA or insurance company?
Claims should be submitted to the TPA except in cases where there is no TPA and the insurance company is doing in-house claim settlement.
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