Senior Citizen Health Insurance

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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?

Senior citizen health insurance plans help the senior individuals cope up with health issues, the treatment for which costs are very high. Given that most seniors are living of their life savings / pension, these plans offer senior citizens’ financial help at the time of a claim. Some of the major reasons that make senior citizen health insurance important are below:

  • 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?

Senior Citizen Health Insurance Plans are specially rolled out in the India market to cater to the Health Insurance requirements of senior persons in the age group between 60 to 75 years of age. When it comes to health insurance for senior citizens, you would get several benefits. As most persons in this age category, and living of their life savings / pension, it becomes even more important that they do not spend these savings on a medical emergency, hence senior citizen health insurance plan is more of a necessity these days.

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 NameEligibility Criteria / AgeSum Insured OptionsKey FeaturesWaiting Period for Pre-existing DiseasesMedical Check-up
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 Medical Consultations as an out-patient in a Network Hospital.
No Third Party Administrator, direct in-house claim management, so faster and hassle-free claim settlement.
No Age based Premium Revision – Premium is Sum Insured based.
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
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 Avail 10% cumulative bonus up to your limit of indemnity for every claim-free year, maximum limit up to 50%.
Avail free health check-up at our designated medical centres at the end of four continuous claim-free years.
Insured Can opt for co-payment waiver.
12 monthsPre Policy Medical Check up required for this plan
New India – Senior Citizen Mediclaim Policy

60 – 80 years (renewable up to 90 years of age

Lifelong Renewal
Two Options of 1, 1.50 lacs 30 days pre-hospitalisation (max up to 5% of hospital bill) and 60 days post hospitalisation (max up to 10% of hospital bill).
Medical Check Up Upto 1% of Sum Insured subject to a 4 claims free years.
10% Discount for opting Voluntary Excess of Rs.10000/-.
10% Discount in case of Spouse is covered
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.
Apollo Munich Health Insurance – Optima Senior

Any person whose age is 61 years and above.

No Maximum Entry Age.

Lifelong Renewal
2, 3, 5 lacs No claim based loading or claim based underwriting.
30 days pre and 60 days post hospitalisation expenses covered upto SI.
140 day care procedures are covered.
One Second E-Opinion per policy year.
24 / 36 months depending on the treatment requiredInsured 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.
Tata AIG – MediSenior Health Insurance

Insureds of the age 61 and above

No Maximum Entry Age.

Lifelong Renewal
1, 3, 5 lacs 140 day care procedures are covered under this health insurance policy.
Organ Donor: Pays for medical expenses for an organ donor’s treatment during an organ transplant surgery.
Pre & Post Hospitalisations of 30 days and 60 days respectively.
24 / 48 months PPC Required and to be done at Tata AIG Authorised centres.

50% reimbursement of cost after proposal acceptance.
Care(formerly Religare) Health – Care Senior

Individual: 61 years and above Floater: 2 Adult (Self, Spouse, Father, Mother)

Entry Age Maximum : Lifelong

Lifelong Renewal
3, 5, 7, 10 lacs 50% increase in Basic / Medical SI per Policy Year in case of claim-free year; Max up to 100% of SI
Detailed health check-ups at no extra cost facilitate monitoring of the insured’s health and promote a healthy lifestyle
Pre-Hospitalization for 30 days & Post-Hospitalization for 60 days; Maximum up to SI
24 / 48 months depending on the ailmentsNo Pre Policy Medical Check up
HDFC Ergo – Silver / Gold Plan

Any person whose age is 61 years and above.

No Maximum Entry Age.

Lifelong Renewal
3, 4, 5, 7.5, 10, 15 lacs Get additional sum insured equivalent to the admissible claim amount upto a maximum of the basic sum insured.
Pay out a lump sum amount of Rs.15000 as recovery benefit if hospitalization exceeds 10 continuous days.
Alternate Treatment – support the healing powers of Ayurveda, Unnani, Sidha and Homeopathy treatment.
48 monthsPersons 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.
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