As the name suggests, senior citizen health insurance plans are those policies that specifically cater to individuals over the age of 60 years. Inflation and rising medical costs are a concern for one and all. Added to this, as one’s age advances, medical complications and hospitalisation expenses start rising. For people who have already retired and are living on a pension or a limited income, health insurance expenses could cause a dent in their savings. Given these circumstances, it is wise for senior citizens to buy a comprehensive health insurance plan.
Health insurance plans for senior citizens offer many benefits, such as cashless admission, free-of-cost ambulance service, coverage for critical illnesses, etc. While there are several insurers, who offer health insurance plans for senior citizens, it is imperative that you choose one that best matches your needs and provides a health cover for all the major ailments.
Let’s take an example to demonstrate the working of a senior citizen health insurance plan. Ravi is a middle-aged professional with a wife and two children. While Ravi has a corporate health cover and an individual health cover to cover his wife, children, and himself, his dependent parents are left with no health insurance. Ravi’s father suffers from diabetes, and his mother also suffers from a few ailments. Ravi realizes that it is time for him to purchase a Senior Citizen Health Insurance Policy for his parents. After comparing the various senior citizen plans offered by insurers in the city, Ravi zeroes in on a plan that offers a comprehensive health cover. Ravi’s parents go in for a medical examination and get approved for the policy. Ravi chooses an optimum Sum Insured, for which he has to make a payment of around Rs.8,000 per month. Now, Ravi’s parents can avail cashless hospitalisation or have the insurer reimburse their hospitalisation expenses, whenever the need arises.
A senior citizen health insurance plan offers policyholders several benefits, such as:
Some of the key features of senior citizen health insurance plans are:
|Insurer Name||Plan Name||Age Range||Basis||Coverage Offered||Co-Payment||Waiting Period|
|Star Insurance||Senior Citizens Red Carpet Health Insurance Policy||60 – 75 years||Individual Plan||Up to Rs.10 lakh||
|Apollo Munich Insurance||Optima Senior Plan||61 years and above||Individual Plan||Up to Rs.5 lakh||
|Tata AIG General Insurance Company Ltd.||MediSenior – Senior Citizen Health Insurance Plan||61 years and over||Individual Sum Insured Plan||Up to Rs.5 lakh||
|Bajaj Allianz General Insurance Company Ltd.||Silver Health Plan for Senior Citizens||46 – 70 years||Individual Plan||Up to a maximum of Rs.50 lakh||
|Universal Sompo General Insurance||Senior Citizen Health Care Plan||60 years and above||Individual/Floater Plan||Up to a maximum of Rs.5 lakh||
|New India Assurance Company||Senior Citizen Mediclaim Policy||60 – 80 years of age||Individual Plan (can cover spouse)||Up to Rs.1.5 lakh||The insurer will pay the lesser of the following:
|Oriental Insurance||HOPE – Health of Privileged Elders Plan||60 years and above||Individual Plan||Up to Rs.5 lakh||
|United India Insurance||Senior Citizen Plan||61 years – 80 years||Individual/Floater Plan||Up to Rs.3 lakh||
|Religare Health Insurance||Care Freedom – Senior Citizen Health Insurance Plan||46 years and above||Individual/Floater Plan||Up to a maximum of Rs.10 lakh||
The Senior Citizens Red Carpet Health Insurance Policy from Star Insurance is for individuals between the ages of 60-75 years. While the policy term is only 1 year, the insurer guarantees lifetime policy renewal. The minimum and maximum sum insured for this policy is Rs.1 lakh and Rs.10 lakh, respectively. No medical test is required in order to purchase this policy. The policy also includes cover for out-patient medical consultation in hospitals and coverage for pre-existing diseases and specific diseases after completion of the waiting period.
The Optima Senior Policy from Apollo Munich caters to individuals who are above 61 years of age. A policy term of 1 year or 2 years can be chosen at the inception of the policy, with guaranteed lifetime renewal. Policyholders can choose a joint sum insured for themselves and their spouse, as per this plan. A sum insured of Rs.2 lakh, 3 lakh, or 5 lakh can be chosen, while purchasing the policy. The key benefit of this plan is that there is no maximum age of entry. Members can also avail cashless hospitalisation in any of the 4000 hospitals that fall under the insurer’s network, and are entitled to receive tax benefits.
The Medi Senior – Senior Citizen Health Insurance Plan provides a comprehensive health cover to those above the age of 61 years. The plan comes with a policy term of 1 or 2 years, and the cover can be purchased for the policyholder themselves and their spouse. You may choose a sum insured of Rs.2 lakh, Rs.3 lakh, or Rs.5 lakh, as per your requirements. The policy covers in-patient hospitalisation, pre- and post-hospitalisation expenses, day-care treatments, domiciliary expenses, organ donor procedures, and ambulatory services, after the due waiting period, if any, has been completed.
The Silver Health Plan for Senior Citizens comes with a policy tenure of one year. However, policyholders, once enrolled, can renew their policy year-after-year. The minimum sum insured that you can choose is Rs.50,000, and the maximum sum insured that you can choose is Rs.50 lakh. The health cover can be used by both the policyholder and his/her spouse. The plan offers several benefits, including coverage for pre- and post-hospitalisation expenses, ambulance charges, coverage for pre-existing diseases after the waiting period, a cumulative bonus of 10% for every year that no claim has been made, etc.
The Senior Citizen Health Care Plan from Universal Sompo General Insurance Company provides cover for medical expenses to individuals over the age of 60 years. There is no maximum age at entry for this policy. This health insurance policy comes with policy term options of 1 year, 2 years, or 3 years. The minimum sum insured for this policy is Rs.1 lakh and the maximum sum insured amount is Rs.5 lakh. Policyholders also have the option of extending the health cover to their spouse, and will be entitled to receive a 10% family discount for the same.
The Senior Citizen Mediclaim policy from New India Assurance offers coverage for medical expenses to anyone between the ages of 60 to 80 years. However, if the policy is renewed without any breaks between consecutive years, the plan can be continued till the insured reaches 90 years of age. Apart from the hospitalisation/medical expenses, the insurer will also cover your pre- and post-hospitalisation charges, ambulance bills, and also offers limited health cover for AYUSH treatments. The policyholder can opt for a joint health cover for themselves and their spouse, and will receive a discount amounting to 10%, for the same. The minimum and maximum sum insured is Rs.1 lakh and Rs.1.5 lakh, respectively.
The Health Of Privileged Elders (Senior Citizens Specified Diseases Insurance) Plan from Oriental Insurance offers a health cover to people over the age of 60 years, for certain specific illnesses, which are mentioned in the policy brochure. The sum insured amounts that the policyholder can opt for are Rs.1 lakh, Rs.2 lakh, Rs.3 lakh, Rs.4 lakh, or Rs.5 lakh. The policy buyer can also opt for voluntary co-payment and will receive a discount for the same. The insurer also offers policyholders a no-claim discount for every claim-free policy year.
The Senior Citizen Plan from United India Insurance offers coverage for medical expenses arising due to hospitalisation, day-care procedures, pre- and post-hospitalisation expenses, etc. The minimum age of entry, for this policy, is 61 years and the maximum age of entry is 80 years. Cashless treatment can be availed in around 7,000 hospitals across India. The insured can extend the cover to their spouse, dependent parents, and any dependent children, and avail a family discount of 5%. The minimum sum insured is Rs.1 lakh and the maximum sum insured is Rs.3 lakh.
The Care Freedom - Senior Citizen Health Insurance Plan from Religare can be purchased by any individual over the age of 46 years. There is no maximum age of entry for this plan. Policyholders can choose a sum insured of Rs.3 lakh, Rs.5 lakh, Rs.7 lakh, or Rs.10 lakh, as per this plan. The plan also covers pre- and post-hospitalisation expenses, ambulance charges, domiciliary hospitalisation charges, and a dialysis cover, among other things. You can also choose a policy term of 1 year, 2 years, or 3 years, and also renew your policy for life. You can choose an individual policy type or a floater policy to cover your entire family. If you opt for a floater policy, you can extend the cover to a maximum of 6 family members.
The general exclusions which apply to most senior citizen health insurance plans are listed below:
While this is a general list of exclusions for which you will have to bear all hospitalisation expenses, you will still need to read your policy brochure carefully to know your policy-specific exclusion criteria.
There are many misconceptions about senior citizen health plans available in the market today. Given below are some of the common misconceptions:
Health insurance companies generally conduct a medical screening before issuing policies so that they can ascertain the level of risk that the policyholder carries. Medical screening is mostly conducted for people above the age of 45 years or people who are into drinking or smoking. Once the medical examination is done, the insurer will decide how much the person will have to pay for the insurance. Not maintaining good health or being a smoker does not mean health insurance will be denied to him/her.
Many people are under the impression that a health insurance policy will not be utilised on a regular basis so it is best to invest less in the policy. However, a cheap insurance policy will have very restricted coverage and most beneficial features will be left out. Thus, the cheapest plan is not necessarily the best plan.
Being fit is highly commendable but that does not mean that a person does not require health insurance coverage. Anybody could meet with an accident, be diagnosed with an illness like malaria or dengue, or suffer from an age-related health issue. It is, therefore, advisable to buy a health insurance policy that offers coverage for medical expenses. Anyway, maintaining good health will give rewards to the insured too. If a person does not make a claim within the policy period, he/she is given a no-claim bonus. A no-claim bonus, according to the insurance plan, will offer a discount on the premium payable or offer an enhancement of the sum insured of the policy.
Earlier, only treatments that required 24 hours of hospitalisation were covered under a senior citizen health insurance policy but today, certain out-patient treatments are also covered. For example, a cataract surgery does not need 24 hours of hospitalisation but is still covered under most health insurance policies. The policy document provides a list of day care procedures that are covered under the policy. Apart from day care procedures, certain health insurance plans cover dental treatment, Ayurveda treatment, doctor’s consultation, and so on.
Health insurance plans have certain exclusions such as the treatment of HIV, congenital diseases, pregnancy-related complications, injuries caused by self harm, etc. Also, the illnesses or treatments that are covered under the plan have sub-limits. So, the expenses incurred for a particular treatment can be availed only up to a certain percentage of the sum insured.
Most insurance plans have an initial waiting period of 30 days. So, you will be able to get coverage under the policy only after the completion of the waiting period. In addition, specific treatments have longer waiting periods such as 1 year or 2 years. And in case the treatment arises from a pre-existing disease, you will have to wait for a much longer period. In case you do not disclose that you suffer from that particular illness, the claim for the treatment may be rejected altogether.
Buying an insurance policy online is easy. One can shop through the insurer’s website or through a third-party aggregator. Buying a policy online is not risky as the policy document will be available to you on your mail and will also be delivered to you once it is issued. In addition, it is easy to renew policies online. Once the renewal premium is paid online through a safe gateway, the policy is renewed.
As established earlier, it is important to purchase a senior citizen health insurance policy. Here are a few factors of the policy you should bear in mind before you purchase it:
For most people, as their age increases, their medical and hospitalisation expenses will also increase. Added to this, the older you become, purchasing a health insurance plan becomes more and more difficult. Hence, it is advisable to purchase a senior citizen health insurance plan as soon as you turn 60 and renew it every year, for maximum benefits.
The premium that one will have to pay towards a senior citizen health insurance plan may be slightly more, when compared to a regular health insurance plan, due to the advanced age of the policyholder. Increased age may lead to more medical complications, for which insurers will charge more. However, buying a health insurance policy is imperative for senior citizens, as it helps safeguard their savings during the later years of their lives.
There is no limit to the number of claims you can make during your policy year. However, you will have to ensure that your claims do not exceed your sum insured. If they cross the sum insured amount, your claim will be rejected, and you will have to bear the expenses.
Most insurers will allow you to purchase a joint senior citizen health insurance plan for both you and your spouse. This is a very viable option, since many insurers will also give you a family discount for the same.
The hospitals which come under your insurer’s network will provide you the added benefit of availing cashless treatment or hospitalisation, while non-network hospitals don’t give the policyholder this option. However, since you can’t always pre-plan your hospitalisation, even if you were to seek treatment at a non-network hospital, you can claim for a reimbursement from your insurer after you produce the due documents and hospitalisation bills.
If you have undergone hospitalisation/treatment at a non-network hospital, you will need to submit the following documents when filing a claim for reimbursement.
You will be eligible for cashless treatment only if you seek treatment or undergo hospitalisation at a network hospital. Ensure you visit your insurer’s website or nearest branch to find out what hospitals falls under your insurer’s network.
Most senior citizen health insurance plans will cover the following:
You can purchase a health insurance policy even if you have a pre-existing condition or ailment. However, you can make claims for expenses caused due to your pre-existing condition only after completion of the due waiting period, which is set by your insurer.
Most insurers will reimburse you for any pre- and post-hospitalisation expenses that you may have incurred due to your actual hospitalisation, provided it falls within the limits that are pre-set by the insurer.
All the premiums that you pay towards your health insurance plan are eligible for tax benefits under Section 80D of the Income Tax Act, 1961. As per the income tax laws, senior citizens can avail tax benefits up to a maximum of Rs.30,000, every year.
Yes, all health insurance plans will come with a waiting period. The general waiting period for all claims is 30 days. In most cases, the waiting period for specific illnesses and pre-existing diseases will be between 2 and 4 years.
All policy buyers are provided a free-look period, during which they can review the policy terms and conditions and return the policy, if they are unsatisfied with it. The free-look period for most policies will be 15 or 30 days. Any premium that you may have paid will be returned to you, provided you cancel your policy during the free-look period.
Most policies come with a compulsory co-pay, while some policies also give policyholders the option to choose a voluntary co-pay during the purchase of the policy. If you choose a higher co-pay, your payable premium amount will be lower, and vice versa.
The maximum age until when you can purchase a health insurance policy will vary from insurer to insurer. Some insurance policies have no maximum age of entry, and can simply be purchased by anyone over the age of 60 years. However, some insurance policies come with a maximum age of entry, after which new policies cannot be purchased. If you have been renewing your policy year after year, with no breaks, then most insurers will offer you guaranteed lifetime policy renewal.