Senior Citizen health insurance
Senior citizen health insurance, According to recent guidelines issued by IRDAI, every insurance provider has to offer health insurance coverage to individuals with an entry age up to at least 65 years of age. This is important for the senior citizens to be able to get themselves well insured during their later years.
Coupled with this, the feature that all health insurance companies offer life time renewability, the senior individual can be assured of a health insurance cover once they have been insured, subject of course to
timely payment of renewal premium. They also have the opportunity to port their policy to another insurer if they are not satisfied with the service level of the current insurance partner.
Why Should Senior Citizen buy Health Insurance Plans?
- Financial support at the time of a claim rather than they having to spend their hard earned savings
- Given the increasing healthcare costs in India due to medical inflation, the senior citizens can opt for a higher sum insured range under the these plans based on their lifestyle. They can also take into consideration their medical history and pre existing illnesses
- Almost all senior citizen plans offer coverage for pre existing illnesses after a defined waiting period, so that the senior individuals can then enjoy comprehensive coverage for their future
- Some Senior citizen health insurance plans offer free health check-ups which the policy buyers can avail annually free of cost, based on the number of claim free years they remained insured. It also helps in monitoring the insured person’s health, thereby promoteing a healthy lifestyle
- These plans cover Inpatient hospitalisation costs, including Doctor’s Fees, ICU and Room charges, apart from ambulance expenses, thereby reducing the impact of miscellaneous health care costs
Exclusions under Senior Citizen Mediclaim insurance Plans
There are some general exclusions of senior citizen health insurance plans which are not covered by the policy and are listed below, kindly however go through the policy wordings for the complete list of exclusions:
- Pre-existing diseases or injuries that are detected within 3/4 years before the inception of the first policy depending on the plan chosen.
- Mandatory Exclusion – Any diseases diagnosed during the first 30 days of the policy commencement date, except those due to accidents.
- Expenses as a result of self-inflicted injury (resulting from suicide and attempted suicide).
- Expenses incurred as a result of alcohol or drug abuse or any related diseases. Excess intake of alcohol or drugs that are not prescribed by any doctor.
- Experimental treatment, Sexually Transmitted Diseases (STDs) like HIV/AIDS, congenital disease, non-medical expenses under their policies.
- Non-allopathic treatments are not reimbursed or assisted under the Senior Citizen Health Insurance Policy.
- Any assistance for dental or oral treatment is not provided.
- Cost of dental treatment, spectacles or contact lenses and any cosmetic surgery.
- Treatment costs arising from injuries or diseases due to war, nuclear attacks, riots, strikes, etc.
What is Senior Citizen Health Insurance?
Benefits under Senior Citizens Health Insurance plans include:
Some of the key benefits under the Senior Citizen Mediclaim insurance plan include:
- Cashless Treatment – The insurance company will process all claims across all hospitals in their network on a cashless basis, subject to the claim being admissible under the policy
- Entry age restriction – Most policies have an entry restriction above 60/65 years of age. However all plans have a lifetime renewal facility
- Pre-Hospitalization coverage : You may incur some expenses before you are hospitalized, like doctors fees, pharmacy-related expenses, or diagnostic tests. All such costs will be covered by the insurer for up to 30-60 days before your hospitalization
- Post-Hospitalization coverage : After you get home from the hospital, there are still many expenses to be taken care of, like consultation fees, diagnostic tests, pharmacy-related costs among other things. The insurer will cover such expenses related to your hospitalization up to 60/90 days (as per plan) after your discharge.
- In-patient Hospitalization : The insurer pays for room charges, intensive care unit charges, doctor’s fee, diagnostic tests, medications, blood, oxygen, operation theater charges, etc. if you get admitted to a hospital for in-patient care, for more than 24 consecutive hours.
- Day Care Treatment (Hospitalization less than 24 Hours) : Treatments such as operations on the eyes (cataract), ligament tear, chemotherapy, Haemodialysis etc require you to stay hospitalized for less than 24 hours.
- Cumulative Bonus( No Claim Bonus) : You shall get guaranteed cumulative bonus (Normally upto 50-100% of Base Sum Insured. No claim bonus increases the sum insured for every claim-free year (or more as per the plan).The Sum Insured increases by 5/10% each year.
- AYUSH Cover : Some insurance plans allow the insured to avail treatment of your choice and hence support alternate treatments including Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy.
- Ambulance Cover : Medical emergencies can happen anytime. So, the insuer cover expenses incurred for transportation by an ambulance service provider to the hospital for treatment and back home after the treatment. The coverage limit shall depend upon the plan taken by you
- Domiciliary Treatment : Sometimes it is not possible to move the patient to a hospital because of their condition or lack of accommodation at the hospital. In such cases, the patient can be treated at home. This is called domiciliary hospitalisation. Medical expenses for such cases will be covered if the treatment continues for a defined period as per the policy coverages.
- Pre-existing Coverage / Disease : A pre-existing disease is any condition, ailment or injury or related condition(s), for which the insured person had signs or symptoms, and /or were diagnosed, and / or received medical advice / treatment within a defined period prior to 1st health insurance policy is issued under which the insured person was covered. Plans offer different waiting periods for Pre existing conditions from 24 months to 48 months.
- Out Patient Treatment (OPD Expenses) : Outpatient treatment refers to any diagnostics, consultations or treatment where a hospital admission is not required. It will often begin from an initial investigation following a referral from your family physician and can be for a consultation involving blood tests, x-rays, MRI scans and so on. Some insurance plans offer coverage upto a defined limit for OPD expenses.
- Health Check-up : This consists of measures taken for disease prevention, as opposed to disease treatment“. Health, disease, and disability are dynamic processes which begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primary, secondary, and tertiary prevention. Under section 80D, there is a defined limit of ₹5,000 per year for the insured, his/her immediate family and parents.
Some of the key insurance options for Senior Citizens Health insurance are highlighted in the table below:
|Insurance Company + Plan Name||Eligibility Criteria / Age||Sum Insured Options||Key Features||Waiting Period for Pre-existing Diseases||Medical Check-up|
Apollo Munich Health Insurance – Optima Senior
Any person whose age is 61 years and above.
No Maximum Entry Age.
|2, 3, 5 lacs||24 / 36 months depending on the treatment required||Insured will be called for a medical check-up on the basis of your age, health declaration and cover opted for. Your medical check-up will include a medical examination by a doctor, blood tests to measure your cardiac status, cholesterol levels, blood sugar levels among other things, urine analysis and cardiac tests to assess the status of your heart and kidneys.|
Star Health – Senior Citizen Red Carpet Health Insurance Plan
|Any person between 60 and 75 years of age at the time of entry can take this insurance policy.||1,2, 3, 4, 5, 7.5, 10, 15, 20, 25 lacs||12 months|
No pre-acceptance medical test required
However if following medical records of the person proposed for insurance are submitted, a discount of 10% of is allowed. – Stress Thallium Report – BP Report – Sugar (blood & urine) (Fasting / Postprandial) – Blood urea & creatinine
HDFC Ergo – Silver / Gold Plan
Any person whose age is 61 years and above.
No Maximum Entry Age.
|3, 4, 5, 7.5, 10, 15 lacs||48 months||Persons opting for a policy for the first time have to undergo a detailed prescribed Pre Health check up from an empanelled doctor in HDFC Ergo Network.|
Bajaj Allianz – Silver Health Plan for Senior Citizens
This policy covers members up to from 46 to 70 years of age
Renewal age upto 75 years
|50,000 – 5 lacs||12 months||Pre Policy Medical Check up required for this plan|
Tata AIG – MediSenior Health Insurance
Insureds of the age 61 and above
No Maximum Entry Age.
|1, 3, 5 lacs||24 / 48 months|
PPC Required and to be done at Tata AIG Authorised centres.
50% reimbursement of cost after proposal acceptance.
New India – Senior Citizen Mediclaim Policy
60 – 80 years (renewable up to 90 years of age
|Two Options of 1, 1.50 lacs||18 months / 48 months for certain ailments|
Persons opting for a policy for the first time have to undergo prescribed Pre Health check up from an empanelled doctor.
Cost of check up has to be borne by the proposer.
Care(formerly Religare) Health – Care Senior
Individual: 61 years and above Floater: 2 Adult (Self, Spouse, Father, Mother)
Entry Age Maximum : Lifelong
|3, 5, 7, 10 lacs||24 / 48 months depending on the ailments||No Pre Policy Medical Check up|