Health Insurance for Senior Citizens

What is Senior Citizen Health Insurance?

Senior citizen health insurance is a type of health insurance plan designed to pay the medical expenses of people aged 60 years and above. It covers pre-existing diseases, hospitalization, critical illness, surgeries, doctor visits, diagnostic tests, pre & post-hospitalization expenses, medicines, etc. It also offers cashless treatment at all hospitals across India, along with free preventive health check-ups.

Senior Citizen Health Insurance Plans at a Glance

The following table shows the most common features of senior citizen health insurance plans in India:

Latest Update on Senior Citizen Health Insurance

On January 30, 2025, the Insurance Regulatory and Development Authority of India (IRDAI) mandated that insurers cannot revise health insurance premiums for senior citizens by more than 10% in a year without prior approval. If an insurer intends to raise premiums beyond this cap or discontinue a senior citizen health insurance policy, it must first get approval from the IRDAI.

On September 12, 2024, the Union Cabinet announced a ground breaking decision to extend the Ayushman Bharat Yojana (AB PMJAY) to all senior citizens aged 70 and above. The scheme provides free medical insurance coverage of up to ₹5 lakh on a family floater basis, benefiting nearly 6 crore senior citizens across India.

List of Health Insurance Plans for Senior Citizens

The following table shows the list of various online health insurance plans for senior citizens:

*Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. This list of plans listed here comprise of insurance products offered by all the insurance partners of Policybazaar. For complete list of insurers in India, refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in.

Benefits of Medical Insurance for Senior Citizens

A senior citizen mediclaim policy offers a variety of coverage benefits to elderly people. Below are some of the primary benefits of buying a health insurance policy for senior citizens in India:

• Medical Coverage for Elderly People – People above the age of 60 years can get medical coverage under a senior citizen policy, as most regular family health insurance plans do not provide coverage beyond 65 years of age.
• Coverage for Hospitalization and Doctor Visits – Senior citizens are prone to age-related illnesses, leading to regular doctor visits, diagnostic tests, long-term medications, etc. Sometimes, it can also lead to expensive hospitalization. With medical insurance, senior citizens can get coverage for OPD expenses and hospitalization.
• Shorter Pre-existing Diseases (PED) Waiting Period – Most health insurance for senior citizen above 60 years comes with a shorter waiting period of 1 or 2 years for pre-existing diseases, such as diabetes, hypertension, asthma, high cholesterol, etc.
• Access to Critical Illness Cover – With old age, the possibility of being diagnosed with critical illnesses, like heart ailments, kidney problems, cancer, etc., becomes higher. These ailments are not only expensive but also take a long time to treat. Buying a senior citizen health insurance policy with critical illness cover can provide lump sum coverage to elderly people against these life-threatening diseases.
• Preventive Health Check-up Facilities – Senior citizens can avail free preventive health check-ups every year under most health insurance for elderly. It not only minimizes their out-of-pocket expenses but also diagnoses a disease at an early stage.
• Cashless Treatment – Senor citizens can avail cashless medical treatment at any hospital of their choice, with the cashless everywhere facility available under medical insurance, even if it is not a network hospital of the insurance company.
• No Pre-medical Screening Required – Some health plans for senior citizens do not require elderly people to undergo any medical screening before buying the policy, unlike regular plans.
• Lifetime Renewability – All health insurance plans for senior citizens come with a lifetime renewability option. Thus, elderly people will be covered under their mediclaim policy as long as they pay the premium.
• Tax Benefits – All senior citizen health insurance policies offer tax exemption benefits every financial year on the paid premium under Section 80D of the Income Tax Act, 1961.

Why is Health Insurance Important for Senior Citizens?

Now, the question arises as to why there is a need for a separate health insurance for senior citizens?

The answer is simple, it is to protect their life-long hard-earned money from being drained in one go due to health problems. In old age, even a small illness or injury can turn out to be a major risk factor and may require long-term hospitalization or medical care. A family floater health insurance may not be able to suffice their coverage requirements.

Senior citizens face severe health issues like heart diseases, diabetes, kidney problems, etc., due to their increasing age. By buying health insurance for parents, you can help manage the financial implications of hospitalization without exhausting their savings. 

Here are some of the reasons why buying a senior citizen health insurance plan is a must:

1. Meet Medical Expenses of Senior Citizens

   As per the Longitudinal Ageing Study of India report, around 75% of senior citizens suffer from one or more chronic diseases like diabetes, heart diseases, etc. Health insurance for senior citizens caters to the health needs of elderly people aged 60 years and above by covering hospitalization costs, critical illnesses, day care treatments, etc.

2. Beat Medical Inflation

   Medical treatments are getting costly due to the rising medical costs. Even a brief hospitalization can generate a bill worth lakhs of rupees due to medical inflation. Buying a senior citizen health insurance policy becomes imperative for elderly people to access the best healthcare services without worrying about paying the bills.

3. Stress-free Retirement

   Paying off hospital bills can be financially distressing for elderly people after retirement. A long-term hospitalization can easily exhaust their lifelong savings and retirement funds in no time. A health insurance policy can bring peace of mind to senior citizens in medical emergencies.

4. Critical Illness Cover

   Elderly people are more prone to critical illnesses. This may require long-term treatment, and hence increased medical costs. Health insurance for senior citizens covers the cost of critical illness treatment, providing the much-needed support during a health crisis.

What is Covered by Health Insurance for Senior Citizens?

Health insurance plans for senior citizens cover the following:

• In-patient Hospitalization Expenses – It pays for hospitalization expenses, including room charges, doctor fees, medicine costs, ICU charges, orthopaedic implants, etc. of senior citizens.
• Day Care Treatments – It covers day care procedures that require less than 24 hours of hospitalization, like chemotherapy, dialysis, etc.
• Pre and Post-Hospitalization Expenses – It pays for medical costs incurred on doctor consultation, diagnostic tests, etc., before getting hospitalized and after getting discharged from the hospital.
• Pre-existing Diseases – It covers any pre-existing diseases of the insured senior citizen after a waiting period of 1 to 3 years.
• OPD Expenses – It pays for the cost of doctor visits, diagnostic tests, and medicines availed on an outpatient department (OPD) basis.
• Modern Treatments – It covers the medical expenses incurred on availing 12 modern treatments as listed by the IRDAI, including robotic surgeries, oral chemotherapy, etc.
• Home Care Treatments – It pays for expenses incurred on treatment done at home on a doctor's advice, which would have otherwise required hospitalization.
• Cataract Treatments – It pays for the cost of undergoing cataract surgery by the insured senior citizen.
• AYUSH Treatments – It covers treatments taken through Ayurveda, Yoga, Unani, Homeopathy and Siddha in a government-recognized AYUSH hospital or institute.
• Ambulance Charges – It pays for ambulance charges incurred on transporting the insured to the nearest hospital.
• Organ Donor Expenses - It covers the donor expenses incurred for the organ transplant surgery of the insured senior citizen.
• Domiciliary Hospitalization – It pays for domiciliary hospitalization of the senior citizen if the doctor suggests home treatment.
• Consumables Cover – It covers the cost of consumables or non-medical expenses incurred by senior citizens during hospitalization, such as the cost of gowns, cottons, syringes, etc.
• COVID-19 Cover – It pays for the cost of coronavirus treatment resulting from the COVID-19 disease.
• Mental Illness Cover – It covers the medical expenses incurred on the treatment of mental illnesses, including anxiety, depression, PTSD, etc.
• Preventive Health Check-ups – It pays for the cost of availing preventive health check-ups by the insured senior citizen.

What is Not Covered by Health Insurance for Senior Citizens?

Health insurance for senior citizens does not cover the following medical expenses:

• Dietary Supplements - It does not cover the cost for nutritional supplements and substances that can be bought without the doctor's advice.
• Self-inflicted Injuries - It does not pay for the treatment of injuries or illnesses caused by intentional self-harm or suicide attempt.
• Treatment for Alcoholism - It does not cover the treatment of alcoholism or drug abuse, or their consequences.
• Cosmetic Surgery - It does not pay for the expenses incurred on cosmetic procedures or plastic surgeries unless medically necessary.
• Non-accidental Dental Treatments - It does not cover dental treatment expenses other than those resulting from accidents.
• War-like Events - It does not pay for injuries resulting from war, war-like events or civil protests.

Note: The list of exclusions may vary from one plan to another.

What are the Factors Affecting Health Insurance Premium Prices for Senior Citizens?

Since health insurance plans for senior citizens already have high premiums, it becomes essential to understand the factors that can impact the premium prices for senior citizens.

• Age - It is one of the most important factors that affect the health insurance premiums. As the age increases, the policy premium also rises. Hence, the premium for a health insurance plan for a 70-year-old senior citizen will be higher than the premium for a senior citizen insurance plan for a 65-year-old.
• Pre-existing Diseases - If the senior citizen already has pre-existing disease/s, their insurance premium will be higher than that of an elderly person who does not have any pre-existing condition.
• Pre-policy Medical Test Results - While some insurers may not require the senior citizen to undergo a pre-policy medical test, most of them have made it a necessary requirement. If your pre-policy medical check-up results show potential 
• Co-payment - Choosing a senior citizen mediclaim policy with a higher co-payment allows one to avail a higher discount on the policy premium. However, one must remember that the policyholder has to pay this amount from their own pocket. 
• Geographical Location - The location of the senior citizen's residence also impacts the health insurance premium prices. For instance, tier-1 cities usually have a higher premium than tier-2 or tier-3 cities as residents in metropolitan cities are more exposed to pollution and lifestyle-related health risks.

Key Factors to Consider While Buying Health Insurance for Senior Citizens

Take a look at the various factors to consider while buying a mediclaim policy for senior citizens:

1. Sum Insured

   Senior citizens are more vulnerable to diseases & infections due to their increasing age and may require medical attention more frequently than younger people. As a result, the best health insurance for senior citizens could be the one with a higher sum insured of at least ₹15-25 lakh, depending on the city of residence and individual health conditions.

2. Maximum Entry Age

   Every senior citizen health insurance policy has different entry age criteria. Thus, before choosing a mediclaim for senior citizens, it is essential to check the maximum entry age and determine if the senior citizen is eligible to buy the policy.

3. Policy Coverage

   Before buying health insurance for elderly, one should check the coverage offered by the policy to know exactly what they are covered for. It is better to choose a senior citizen plan that covers them for day care procedures, modern treatments, OPD expenses, second medical opinions, domiciliary hospitalization, etc., for which they are more likely to raise a claim.

4. Pre-existing Diseases Waiting Period

   Elderly people are more likely to have pre-existing diseases that are expensive to treat and can exhaust all their savings. Therefore, they should opt for a senior citizen insurance plan that comes with a minimum waiting period for pre-existing diseases. In fact, several plans today offer PED coverage from day 1 on the payment of an additional premium.

5. Pre-policy Medical Check-up

   Most health insurance policies require the senior citizen to undergo pre-acceptance medical check-ups. However, there are a few senior citizen health plans that do not require them to undergo the pre-acceptance check-up, regardless of the senior citizen's age or the sum insured. 

   Before finalising the medical insurance, you must thoroughly read the pre-policy medical check-up conditions, especially if you have pre-existing conditions, as this may lead to higher premiums or rejection of the policy. 

6. Restoration of the Sum Insured

   Senior citizen health plans that come with unlimited restoration of the sum insured can prove to be exceptionally beneficial for older people. With this benefit, the coverage amount of the policy is restored by 100% unlimited times in a year if it gets exhausted due to claims. However, check if the policy activates the restoration benefit for claims related to the same or unrelated illnesses.

7. Co-payment

   Most health insurance for senior citizens above 60 years come with a co-payment clause, where the policyholder agrees to pay a part of the claim amount during claim settlement. Only the remaining portion of the claim amount is paid by the insurance company. Hence, health cover for senior citizens should have low to zero co-payment.

8. Free Annual Health Check-ups

   Most health plans provide preventive health check-ups after a block of every few years, depending on the claim history. A good health insurance plan for senior citizens offers free annual health check-ups. Therefore, they should opt for a senior citizen health policy that includes a free preventive health check-up benefit, preferably once every year.

9. Policy Exclusions

   Every senior citizen medical insurance policy comes with certain exclusions for which the insured is not covered. Therefore, senior citizens must carefully review the policy document carefully to check the exclusions and understand what exactly they are not covered for, thereby preventing claim rejections.

10. No Claim Bonus/ Cumulative Bonus

    Almost all insurance companies provide a no claim bonus discount or cumulative bonus if no claims are filed by the policyholder in the previous year. This results in either a decrease in health insurance premiums for senior citizens or an increase in the sum insured amount. Thus, elderly people should opt for a policy with a higher no claim bonus or cumulative bonus benefit.

11. Efficacy of Health Insurance Claims

    The claim settlement ratio and the claim settlement time taken by the insurance company should also be considered while buying a senior citizen health policy. If an insurance company's claim settlement time is shorter and the claim settlement ratio is above 90%, it means the chances of claims getting settled quickly are higher, ensuring a stress-free claim process at the time of need.

Tax Benefits of Senior Citizen Health Insurance

A senior citizen health policy not only covers medical expenses but also allows policyholders to avail a tax exemption under Section 80D of the Income Tax Act, 1961. It provides an income tax deduction of up to ₹50,000 per financial year on the premium of a mediclaim policy for senior citizens.

Policyholders can also avail a tax rebate of ₹5,000 on payments made towards preventive health check-ups every financial year. However, this amount is a part of the total Section 80D tax rebate limit. Moreover, they can also get a rebate of up to ₹1 lakh under Section 80DDB if the senior citizen undertakes treatment for a critical disease.

Moreover, senior citizens who pay health insurance premiums for their children can avail of an additional income tax rebate of ₹25,000 per year. This means they can avail a total tax deduction of up to ₹75,000 in a financial year under Section 80D. Or if they are paying a premium for their parents (who must also be senior citizens), they can avail a total tax rebate of up to ₹1 lakh.

How to File a Claim for Senior Citizen Health Insurance?

Senior citizens can file a cashless or reimbursement health insurance claim if they get hospitalized for a planned or emergency medical treatment. The process to file a cashless claim and reimbursement claim under senior citizen health insurance plans is given below:

1. Senior Citizen Health Insurance Cashless Claim Process:

   Step 1: Get hospitalized at any hospital of your choice.

   Step 2: Notify the insurer about your planned hospitalization at least 48 hours before, and an emergency hospitalization within 24 hours.

   Step 3: Fill out the pre-authorization form available at the hospital and give it to the hospital authorities.

   Step 4: The hospital will send the pre-authorization request to the TPA or the claims team of the insurer to initiate cashless hospitalization of the insured elderly person.

   Step 5: The claims team will verify the document and approve/reject the cashless claim request.

   Step 6: If approved, obtain the treatment and get discharged from the hospital.

   Step 7: The insurance company will settle the claim with the hospital directly.

2. Senior Citizen Health Insurance Reimbursement Claim Process:

   Step 1: Inform the insurer about your emergency hospitalization within 24 hours. In case of planned hospitalization, notify the insurance company at least 48 hours in advance.

   Step 2: Obtain treatment and collect all medical documents during hospital discharge.

   Step 3: Fill out and sign the claim form and submit it to the TPA or the insurer along with all the required documents.

   Step 4: The claim will be settled by the insurer’s claims team after careful review, and the approved claim amount will be reimbursed to the policyholder’s bank account.

Documents Required to File a Health Insurance Claim for Senior Citizens

The following documents must be submitted to file a reimbursement claim under a senior citizen health insurance policy:

• Claim form
• Copy of the health insurance policy
• ID, age and address proof
• Hospital bill with payment receipts
• Certificate of hospital admission and discharge
• Doctor's consultation papers & pathological reports
• Chemist bills supported by a doctor's prescription
• Any other document required by the insurer

Benefits of Buying Senior Citizen Health Insurance from Policybazaar

Policybazaar Insurance Broker Private Limited offers multiple benefits to policyholders when buying a senior citizen health insurance policy. Take a look at them below:

• 30-Minute Claim Support – By buying health insurance from Policybazaar.com, senior citizens can get 30-minute claim support in more than 120 cities across India.
• 24x7 Claim Assistance – Policybazaar offers round-the-clock claim assistance to elderly people after purchasing the policy.
• Online Comparison - Elderly people can make an unbiased online comparison of various senior citizen health insurance policies available in the market to find the most suitable policy according to their health needs.
• Senior Citizen Health Insurance Calculator - The health insurance premium calculator on Policybazaar.com allows senior citizens to check the estimated premium for various policies before making an actual purchase.
• Expert Advice - A qualified team of experts is available to answer all queries and help elderly people buy the right senior citizen health insurance policy.
• Quick Policy Purchase - Senior citizens can purchase a mediclaim policy on Policybazaar.com within minutes without the hassle of long paperwork, thus saving a lot of time.

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