Senior Citizen Health Insurance Plan

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.

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.

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.

• Entry/Exit age
• Maximum renewal age
• Co-payment
• Domiciliary treatment

• Age Proof
• Identity Proof
• Address Proof
• Income Proof
• Duly Filled Proposal Form
• Pre-Insurance Medical Tests

Health insurance that specifically caters to divergent healthcare needs of older people is known as senior citizen health insurance. Buying such a health plan has become necessity. As we grow old (i.e. after retirement), there are high chances of suffering from severe ailments. Moreover, the income post-retirement proves to be insufficient to cover hefty medical expenditure. A sudden medical emergency can result into a serious financial loss. With the right senior citizen health insurance plan, it is possible to keep all medical woes at bay. The following coverage is offered under this plan-

• Hospitalization coverage
• Day care costs
• Ambulance charges
• Pre-existing ailments

In this year budget, the basic exemption limit for senior citizens has been increased from Rs 20,000 to Rs 30,000 under Section 80D.  Moreover, if you buy health insurance for your parents, you also become eligible to get tax deductions under Section 80D.

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.

Usually IRDAI approved health insurance companies do not cover following expenses:

• Any pre-existing illness that was diagnosed 48 months prior to policy issuance
• Self-inflicted injury, including attempted suicide
• Due to drink & drive
• Cost of spectacles/contact lenses, dental treatment
• Medical expenditure on the treatment of AIDS
• Non allopathic treatment
• Cosmetic or aesthetic treatment
• Treatment for congenital diseases

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.

Yes, every good insurance company offers this cashless facility at their network hospitals.

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.

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.

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.

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.