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 characteristics of senior citizen health insurance plans in India:

Latest Update

On January 30, 2025, the Insurance Regulatory and Development Authority of India (IRDAI) mandated that insurers cannot increase 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 the ground-breaking decision of extending the Ayushman Bharat Yojana or AB-PMJAY to all senior citizens aged 70 and above. With this announcement, 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 health insurance plans for senior citizens available to buy online:

*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 plans for older people. 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 IT Act.

Why is Health Insurance Important for Senior Citizens?

Senior citizens face severe health issues, heart diseases, diabetes, etc., due to their increasing age. Health insurance for parents 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 medical inflation. Even a brief hospitalization can generate a bill worth lakhs of rupees. Buying a senior citizen health insurance policy becomes imperative for elderly people to avail 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.

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, and diagnostic tests, of senior citizens.
• Day Care Treatments – It covers day care treatments that require less than 24 hours of hospitalization, like chemotherapy, dialysis, etc.
• Pre and Post-Hospitalization Expenses – It pays for medical costs incurred 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 fixed 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 listed by the IRDAI, including robotic surgeries, oral chemotherapy, etc.
• Cataract Treatments – It pays for the cost of undergoing cataract surgery by the insured senior citizen.
• AYUSH Treatments – It covers AYUSH treatments taken through Ayurveda, Yoga, Unani, Homeopathy and Siddha in a government-recognized 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 gown, 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 and substances
• Self-inflicted injuries or suicide
• Treatment for drug or alcohol abuse
• Treatment cost of injuries caused by an act of a foreign army or a civil war
• Cosmetic surgery or plastic surgery
• Non-accidental dental treatments
• Sexually transmitted diseases
• Cost of lenses/spectacles

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

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, they must opt for a medical insurance plan with a higher sum insured of at least ₹15-25 lakh, depending on the city they reside in.

2. Maximum Entry Age

   Every senior citizen health insurance policy has different entry age criteria. Thus, before choosing a mediclaim policy, 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, senior citizens 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 health 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. Restoration of the Sum Insured

   Senior citizens must opt for a mediclaim policy that comes with unlimited restoration of the sum insured. With this benefit, the coverage amount of the policy will be 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.

6. Co-payment

   Most senior citizen health plans 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, elderly people should prefer to opt for a health plan with low to zero co-payment.

7. Free Medical Health Check-up Facility

   Most health plans provide preventive health check-ups after a block of every few years, depending on the claim history. However, a good health insurance plans for senior citizens offer free annual health check-ups to elderly people. Therefore, they must opt for a senior citizen health policy with a free preventive health check-up benefit, preferably once every year.

8. Policy Exclusions

   Every medical insurance policy comes with certain exclusions for which the insured is not covered. Therefore, senior citizens must check the policy document carefully to check the exclusions and know what exactly they are not covered for, preventing rejection of claims.

9. 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 policy premiums or an increase in the sum insured amount. Thus, elderly people should opt for a policy with no claim bonus or cumulative bonus.

10. 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.

Tax Benefits of Senior Citizen Health Insurance

A senior citizen health policy not only covers medical expenses but also allows policyholders to avail 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 if they buy a mediclaim policy for senior citizens.

Policyholders can also avail an additional tax rebate of ₹5,000 on payments made towards preventive health check-ups every financial year. 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 paying health insurance premiums for themselves and their children can avail 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.

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 Procedure:

   Step 1: Intimate 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 claims team of the insurer after careful review, and the claim amount will be reimbursed.

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
• Doctor’s consultation papers
• Pathological reports
• Chemist bills supported by doctor’s prescription
• Certificate of hospital admission and discharge
• Main hospital bill with payment receipts
• OT notes
• Stent or pacemaker invoices
• 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 as per their health needs.
• Senior Citizen Health Insurance Calculator - They offer the facility of a health insurance premium calculator that allows senior citizens to check the estimated premium for different policies before making the 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, saving a lot of time.

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