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Touching 60s? You can still get Health Insurance!

In recent years, life expectancy is witnessing an increase, thanks to growing advancements in medical and healthcare technologies. However, medical costs are simultaneously increasing due to medical inflation. Health insurance therefore becomes vital to tackle medical crises and save on medical costs.

While it is a breeze for younger people to get a health insurance policy, the same becomes a tough task for senior citizens. Once a person begins nearing the 60s, a key question that comes to mind is - “Can I buy health insurance at the age of 60 and above?”

If you too are nearing 60 and are unsure about being issued a health insurance policy, there’s hope. The Insurance Regulatory and Development Authority of India (IRDA) has mandated that general insurance companies must have a maximum entry age of at least 65 years for a standard health insurance policy. Therefore, no insurer can refuse to cover an older person or charge him extra premium without providing a fair and valid reason for doing so. IRDA says, "Such reasons should stand the scrutiny of reasonableness and fairness."

However, getting insurance at 60 (or later) could mean lower coverage, lower policy term, higher premium, and a range of mandatory medical tests. Why is it so? Because with progressing age, the chances of having a medical crisis/health disorder exponentially increase. When an individual is close to 60, factors like reduced physical activity, a sedentary lifestyle, chances of having a pre-existing disease, etc. all come together and put the person at a higher risk for health problems.

Health Insurance for senior citizen

Choosing the right health insurance plan at 60

Not having health insurance is risky, more so if you are a senior citizen. You could offset your risks with the following options:

1) Group cover:

If you are still employed, you could use your employer’s group coverage. If retired, you could have yourself added to your children’s group coverage. However, loss of employment either for you or your children could leave you without health cover.

2) Personalised health cover:

This is a more stable, reliable, and realistic option. Although getting a personalised health insurance policy at 60 years and above will require you to pay a higher premium, in case any medical crisis arises where you need to be hospitalised, every penny of that high premium will be worth it.

Several insurance companies have specially designed health insurance plans for those aged 60 and above. You would be the best judge about which plan is best suited to your specific health needs and current health condition.

Explained below are some health policy aspects that could help you make a more informed choice when thinking of buying health insurance at 60:

The insurance company’s claim settlement ratio (CSR)

The claim settlement ratio is computed as a percentage of the claims honoured by the insurance company to the total claims the company receives. It is highly recommended to pick a company having a high CSR. After all, the last thing anyone would want is to face hassles and delays during claim settlement.

Sub-limits

Most health insurance plans for older people have an insurance sub-limit for specific diseases, meaning, the insurance company does not provide coverage over that pre-determined limit for those specified disease. To avoid surprises at the time of filing claims, it is advisable to compare insurance sub-limits offered by different service providers and pick the plan that is in line with your personal health and family health history.

Age limits

Earlier, health insurance policies for senior citizens could usually remain in force till the policyholder turned 90. However, some insurance companies have recently started offering lifelong renewal health policies for senior citizens. When buying a health plan at an older age, it is important to be aware of the policy’s age limit and pick the one that gives excellent protection for the longest term.

Co-payment clause

Health insurance policies for the elderly usually come with a co-payment clause. This means that the policyholder undertakes to pay a fixed percentage of his/her medical expenses out-of-pocket in case of a claim, thus lowering the insurance company’s risks. The co-payment percentage is specified in the policy document – it is usually around 10-20% for senior citizen health policies. In some cases, it could be as high as 40%.

In a policy with an 80:20 co-payment clause, the policyholder’s liability is set at 20% in the event of a claim. Higher the policyholder agrees to co-pay, lower is the insurance company’s risk, hence the policyholder’s annual premium outgo becomes lower.

If your financial capacity permits, you may opt for a higher co-payment percentage. This would translate to a win-win situation for the insured as well as the insurer - lower premium for the former and lower risks for the latter.

Pre-existing diseases clause

All health insurance policies come with a waiting period for pre-existing diseases, although the duration may vary between insurers. An elderly policyholder who has a pre-existing disease would need to pay a higher premium.

However, since group insurance policies offer coverage for pre-existing diseases, the ideal health plan would be a blend of a personalised/individual health plan and a group insurance plan (as specified above).

Health Insurancne for above 60 Years

About senior citizens’ health insurance plans

Entry age: Most PSU companies offer mediclaim for senior citizens aged between 60 and 80. Some companies however limit the entry age for senior citizens to 69 years. Several private insurers offer health insurance without any maximum entry age.
Renewal age:This is the age limit up to when the policy can be renewed. Although the limit is generally 90 years, it may vary between different insurance companies.
Premium: An elderly policyholder is generally prone to ill health or may even be suffering from a pre-existing disease, as a result of which the insurance company charges an extra premium. This is to compensate for the additional risk the insurance company takes on to cover an older policy holder.
Sum assured: Public insurers providing health insurance for senior citizens offer lower coverage compared to private insurers. While the former offers around one to two lakhs sum assured, private insurers can offer as high as 15-20 lakhs under family floaters. However, the premium and co-payment clause must be paid attention to.
Tax benefits: Premiums paid for senior citizens’ health insurance policies are tax exempt under Section 80 D of the Income Tax Act.
No Claim Bonus: If you purchase a senior citizen’s health policy and do not make any claims in the policy year proceeding the year of subsequent policy renewal, the policy’s sum assured will be increased by a certain percentage, as specified in the policy. This percentage varies from company to company and the bonus so earned is called the No Claim Bonus (NCB).

You may also like to Read: Need of Health Insurance for Senior Citizens

 

Some popular Senior citizen health insurance plans

 Plan    Entry age (Years)  Policy term (Years)  Renewability  Sum insured (INR)
Bajaj Allianz General Insurance - Silver Health Plan  Minimum: 46 Maximum: 70 Minimum: 1 Maximum: 3  Till age 75 years Minimum: 50,000 Maximum: 5 lakhs
Bajaj Allianz General Insurance - Individual Health Guard  Minimum: 18 Maximum: 65 Minimum: 1 Maximum: 1  Till age 80 years Minimum: 1 lakh Maximum: 10 lakhs 
Max Bupa - Heartbeat  No age limit for enrolment - The policy covers everyone from newborns to senior citizens  Minimum: 1 Maximum: 1  Lifelong / No Limit Minimum: 2 lakhs Maximum: 50 lakhs 
Oriental Insurance - Senior Citizen HOPE  Minimum: 60 Maximum: No limit  Minimum: 1 Maximum: 1  Till age 80 years Minimum: 1 lakh Maximum: 5 lakhs 
National Insurance - Varistha Mediclaim for Senior Citizens  Minimum: 60 Maximum: 80  Minimum: 1 Maximum: 1  Till age 90 years 1 lakh for hospitalisation and domiciliary hospitalisation cover;2 lakhs for Critical Illness cover 
Star Health and Allied Insurance - Senior Citizen Red Carpet Plan  Minimum: 60 Maximum: 74  Minimum: 1 Maximum: 1  Lifelong / No Limit Minimum: 1 lakh Maximum: 2 lakhs


Maximum entry age limits for other health insurance plans (For dependent parents)

  • New India Assurance – 80 years
  • ICICI Lombard General Insurance – 60 years
  • Cholamandalam General Insurance – 65 years
  • Reliance General Insurance – 80 years
  • IFFCO Tokio General Insurance – 70 years
  • Tata AIG General Insurance – 60 years
  • Apollo DKV – 60 years

Conditions for some senior citizens’ health plans

  • While some insurers reimburse the cost of medical tests that a policyholder over 45 years undergoes, some insurers do not reimburse anything, while certain others only reimburse a part of it.
  • Some policies for senior citizens cover ambulance charges, or provide a critical illness cover as a rider. However, the catch is that the actual ambulance charges paid out are capped at a certain limit, and only specified critical illnesses are covered.
  • In case of some policies, pre-existing diseases are never covered under the Critical Illness rider offered (hospitalisation expenses are covered under the health cover). Also, while critical illness policies typically pay out a lump sum on diagnosis of the covered critical illness, senior citizens policies sometimes do not – however, they do reimburse the incurred medical expenses.
  • Certain senior citizen policies cover specified diseases like cardio vascular disease, orthopedic diseases, cancer, stroke, knee replacement and so on. However, it must be noted that even though you pay the premium for the full sum assured, you will qualify to receive only a part of the sum assured in case of diagnosis with those specific diseases covered under the policy.
  • In some senior citizen policies, you would probably see that the feature which is most appealing to you is capped to a certain limit or has certain clauses attached to it.

Conclusion

60 is a delicate age to get health insurance and may seem like a daunting task. Therefore, before deciding on any policy, it is vital to read the policy document in detail to understand what exactly is offered and what is not. In case of doubts or queries, have it clarified with your insurance company/agent immediately.

While it is non-negotiable to have health insurance at and beyond 60 years, it is equally crucial have a policy that is particularly beneficial in your specific case. With adequate research, understanding, and care, finding the perfect health insurance plan even for 60+ individuals could be a cakewalk.

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