Senior Citizen Health Insurance

Senior citizen health insurance policies are specifically for senior citizens (those above 60 years of age and up to 80 years of age). It provides insurance coverage for any illnesses, medical treatments, or surgeries undergone by the insured as the years go by. This is especially important with the cost of healthcare rising exponentially. For senior citizens who are living on a pension, limited income, or are dependent on children, a senior citizen health insurance will help take care of any such expenses without draining their life savings. 

How do senior citizen health insurance plans work?  

Let’s illustrate how senior citizen health insurance plans work with an example. Christina is a senior-level management professional who is married and has a child. While her corporate health insurance policy takes care of the health cover for her spouse, parents, and child, the provision may not be sufficient for her aging parents and their medical needs.  

Christina realises that as her parents age, they may be more prone to illnesses or injuries which could take a financial toll on them. She wants to provide a comprehensive health insurance coverage for them and after meticulous research, decides on a senior citizen health insurance plan from a reputed insurer.  

After a medical examination, Christina’s parents are approved for the policy and will now receive reimbursement or cashless hospitalisation (in network hospitals) if any such issue arises. 

Senior Citizen Health Insurance Plans available in India 

Features and benefits of senior citizen health insurance plans  

1. Cashless hospitalisation: If a network hospital is chosen, the insured will get cashless hospitalisation where all the expenses are taken care of by the insured without the need to spend any money out of pocket. 
2. Reimbursement of expenses: Even if treatment is chosen at a hospital that is not on the list of network hospitals, the medical expenses will be reimbursed. 
3. Financial savings: Senior citizens do not have to use their life savings for any unexpected or planned medical/surgical procedures. This ensures that they can continue to enjoy a comfortable standard of living even when faced with a medical issue. 
4. Tax benefits: The policyholder is eligible for tax benefits on premiums paid under Section 80D of the Income Tax Act, 1961. 
5. Coverage for pre-existing diseases: Coverage is provided even if there are pre-existing diseases after the waiting period. This is beneficial for senior citizens who may already have certain illnesses. 
6. Co-pay option: The co-pay option can help reduce premiums and even receive discounts from the insurer. Under this option, a certain percentage of medical expenses is taken care of by the policyholder/insured. 
7. Miscellaneous expenses covered: Other expenses such as ambulance charges, pre- and post-hospitalisation expenses, etc., are also covered under the plan. 
8. Online enrolment and payments: You can enroll for a new policy or renew an existing one completely online on the insurer’s website. Payments can be made through a variety of options such as netbanking, debit card, credit card, etc. 
9. Lifetime renewals: Lifetime renewals are offered by many insurers to policyholders who do not have a break between the policy years. 
10. Flexible sum insured: The sum insured can be chosen as per your requirements.   
11. Claims process: The claims process is streamlined so you get quick resolution.   
12. Pre-medical tests: Pre-medical tests are not required for approval, although this might depend on the insurer’s terms and conditions. 
13. Pre-hospitalisation and post-hospitalisation: This may include diagnostic tests, consultation fees, nursing charges, medicines, etc., that are required before admission and after discharge from the hospital. 

Inclusions under senior citizen health insurance plans 

1. Pre-existing illnesses: This is dependent on the insurance firm and is applicable after the waiting period is completed. This can range from 1 year to 4 years of non-stop renewal with the insurer. 
2. Daycare treatments: Daycare treatments such as dialysis which do not require 24-hour hospitalisation. 
3. Ambulance: Expenditure for ambulance services. 
4. Hospitalisation expenses: Includes room rent, physician consultation fees, treatments, etc. 

Exclusions under senior citizen health insurance plans  

1. Claims raised during the waiting period. 
2. Medical conditions that are diagnosed within 30 days of buying the policy. 
3. Cosmetic surgeries. 
4. Non-allopathic treatments. 
5. Dental procedures (except when caused by an accident). 
6. The cost of contact lenses or spectacles. 
7. Congenital diseases. 
8. Treatments that come under AYUSH (Ayurveda, Unani, Siddha, Homeopathy). 
9. Injuries arising from war, criminal activities, armed conflict, invasion by a foreign military, etc. 
10. Treatment of HIV/AIDS. 
11. Drug-abuse related treatments. 
12. Treatment for self-inflicted injuries. 

Waiting period for claims 

All insurers have a waiting period during which you cannot raise any claims for any of the diseases that are covered under the policy. However, injuries or hospitalisation that arises because of accidents during the waiting period are covered.  

The general waiting period is usually 30 days. For pre-existing diseases, it could range anywhere from 12 months to 48 months.  

Factors to consider when selecting a plan 

These are the important factors to be kept in mind when selecting a senior citizen health insurance plan: 

• Premium: Always have a clear idea of how much premium you can afford to pay every month or on an annual basis. Whether you are buying the policy for yourself as a senior citizen or you are younger and buying it for your parents or in-laws, deciding on the premium amount will help you in financial planning. 
• Sum insured: Decide how much sum insured you may require on a yearly basis, keeping in mind both planned and unplanned medical treatments. 
• Number of people insured in the policy: Some policies allow you to take coverage for two people, so you could include your spouse (or both your parents) as the case may be. If it does not allow it, you will need to take two separate policies. 
• Waiting period: The waiting period is a crucial factor to be taken into account when comparing different policies. Different insurers mandate different waiting periods. The lesser the waiting period, the better it is, whether it is for pre-existing illnesses or specific illnesses that may develop in the future. 
• Exclusions and inclusions: These are important factors that should not be overlooked. The policy document and the website of the insurer will have details of this in detail. It will tell you what expenses are covered and not covered under the policy. This will ensure that you are not taken by surprise when a medical emergency occurs. 
• Coverage of a wide range of diseases: There are any number of diseases that could develop as the body ages. That’s why it is important to carefully evaluate what diseases are being covered under different policies and choose the one that offers the most comprehensive coverage, whether it is for common or uncommon illnesses. 
• Co-payments and deductibles: Co-payment is a fixed amount that you agree to pay for treatments while deductible is an amount that you will pay every year before the insurer starts coverage for the expenses. Both options will help to reduce your premiums. It is beneficial to opt for this if you have a lump-sum amount that you can keep aside for healthcare every year. 
• Network hospitals: You will get cashless hospitalisation in network hospitals and reimbursement in others. It helps to select an insurance company that has network hospitals in your vicinity. This makes it easier and faster to get medical help when you need it suddenly.  
• Maximum age for renewal: With longer lifespans now the norm, it is important to have a health insurance policy covering you for as long as possible. The maximum age varies from insurer to insurer. You will be able to renew your policy only for as long as the maximum age allows. 

Tax benefits of senior citizen health insurance plan 

Premiums paid on the senior citizen health insurance plan are eligible for tax deductions under Section 80D of the Income Tax Act, 1961. The maximum deduction that you can claim is Rs.50,000 in a financial year. 

How to file a claim 

You can file a claim in two different ways: 

Reimbursement of expenses: To obtain reimbursements, you would have to submit all the relevant bills, documents, and results along with a duly-filled form to the insurer. 

Cashless treatment: To avail cashless treatment, you would first have to fill out the form available at the hospital desk or insurer’s website, submit it to the insurer, and wait for approval. Once approval is received, you can go ahead with the cashless treatment. 

FAQs (Frequently Asked Questions) 

1. What is the right age to purchase a senior citizen health insurance plan? 

The minimum age is usually 60 but there are plans that offer senior citizen health insurance policies from the age of 46 years and above. The maximum age is in the range of 75 to 80 years, dependent on the policy. The earlier you buy it, within this age range, the better it will be. 

2. Is the policy available for people who already have pre-existing illnesses or who smoke? 

Yes, smokers and people who have pre-existing illnesses are eligible for a senior citizen health insurance plan but would have to undergo a medical screening test first. 

3. Can I cancel the policy after purchasing it, in case I find a better policy later? 

Most insurance companies provide a free-look period that ranges from 15 to 30 days. You will get back the premium you paid only if you cancel within this free-look period. 

4. Will I get tax deductions on the premium paid towards my parents’ senior citizen health insurance plan? 

Yes, you are eligible for tax deductions if you are paying the premium for your parents. 

5. What if I forget to renew my policy within the due date? 

Insurance companies provide a grace period within which you can renew your policy.