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Health Insurance for Senior Citizens

Health Insurance Plans for Individuals above 70 years in India

Buying health insurance for senior citizens of any age group is not only important but also very easy.

With developments in the Indian Health Industry, health insurers are offering newer and better plans with attractive features. While a few years ago, health insurance plans for senior citizens was not available, now, more and more insurance companies are offering health insurance plans for senior citizens where individuals aged above 70 years can avail of the insurance plans. The market is currently flooded with a range of health insurance plans which are specifically designed for the geriatric population of India.

Absence of income post retirement and the rise of incidence of diseases in the older ages, have given rise to concerns among the population on how to bear the ever increasing medical costs incurred in the later stages of life. In such a scenario, senior citizen health insurance plans are a blessing for the common man, who can avail coverage in the older ages to take care of the rising cost of medical treatments commonly faced in the ripe old age.

The various senior citizen plans available in the market have certain common features which you should know before you venture to invest in the plans either for yourself or for your parents. Let us take a detailed look at the common features of senior citizen health plans currently available in the market.

  • Co-pay clause –co-pay clause is usually applicable for senior citizen policies wherein the insurer insists on the claim being shared by the individual in a certain predefined ratio. The ratio usually ranges in the zone of 10-30% and defines the proportion of claim that is to be paid by the policyholder every time a claim is raised. For instance, a plan with a co-pay limit of 20% indicates that in case of any claim that arises under the plan, 20% of the amount of claim will have to be borne by the policyholder and the insurer will honour the rest 80% of the claim. So for a Rs.10, 000 claim under the plan, you will have to shell out Rs.2000 yourself and your plan will pay Rs.8000.

  • Limits on Sum Assured –the Sum Assured available under the senior citizen plans is usually limited in amount. Since it is common knowledge that senior citizens present a higher risk of medical contingencies, insurers usually cap the maximum amount of coverage that can be availed. In general, the amount of cover granted ranges between Rs1-3 lakhs with an exception Star Health Insurance Red Carpet Plan.

  • Pre-existing clause –as is common in other health plans, pre-existing conditions which mean that the ailments you are suffering from at the time of buying the plan is excluded from the scope of coverage for some years. This is called the waiting period and senior citizen policies also have a waiting period clause for the coverage of pre-existing diseases. The waiting period ranges from 2-4 years.

  • Medical examination –Senior citizen plans may include a compulsory health check-up of the individual before the cover is granted. This is done by the insurance company to assess the overall risk presented by the individual. The cost of the required medical examination may either have to be borne by the customer or the company or both in a specified proportion.

Besides the above features, almost all other features of thesenior citizen health insurance planare similar to those present in normal health plans. Now, it is time to spoil you with the choices of senior citizen health plans available in the market and the respective features of each. Though many companies have policies which cover senior citizens, here we have chosen 4 insurance companies that offer specially designed senior citizen plans. Let us take a look:

1. New India Assurance Senior Citizen Mediclaim Policy –A policy which can be availed by individuals aged 60-80 years and which can be continued till the individual reaches 90 years of age if the plan is continuously renewed with the company. The basic coverage includes pre and post hospitalization cost, ambulance charges, hospitalization expenses for illnesses and injuries to name a few. To know more about this planclick here

2. Star Health Senior Citizens Red Carpet Policy –A plan which you can avail if you are aged 60 years and above and till 75 years. The plan can be renewed continuously for the entire lifetime. The coverage includes hospitalization expenses including pre and post hospitalization, ICU charges, surgeon’s fees, etc. To know more about this planclick here

3. Tata AIG Medi Senior Plan –The plan can be availed by individuals aged 61 years and above with no maximum entry age limit. The plan provides inpatient hospitalization, domiciliary treatment, organ donor expenses and ambulance charges among others. To know more about this planclick here

4. Apollo Munich Optima Senior Plan –A plan designed for individuals aged 61 years and above. Among the list of coverage’s provided, the basic ones include in-patient treatment, pre and post hospitalization, day-care procedures, ambulance charges, etc. To know moreclick here

The following table lists a comparative analysis between the above mentioned plans for a quick reference:

Plan NameNew India Assurance Senior Citizen Mediclaim PolicyStar Healtd Senior Citizens Red Carpet PolicyTATA AIG Medi Senior PlanApollo Munich Optima Senior PlanUnited India Senior Citizens Healtd Plan
Entry Age60-80 years60-75 years61 years onwards61 years onwards61-80 years
RenewabilityTill 90 yearsLifelongLifelongLifelongLifelong
Sum Assured RangeRs. 1 lakhs or Rs. 1.5 lakhsRs. 1 or 1.10 lakhsNot mentionedRs. 2,3 or 5 lakhsRs. 1-3 lakhs
Coverage Included
  • Hospitalisation Expenses,
  • Pre and Post hospitalisation,
  • Ambulance Charges,
  • Ayurvedic Charges,
  • Unani or Homeopathic treatment upto a limit
  • Hospitalisation Expenses,
  • Ambulance Charges,
  • ICU Charges,
  • OPD Cost
  • Hospitalisation Expenses,
  • Pre and Post hospitalisation,
  • Ambulance Charges,
  • Day car procedures,
  • Domicilliary treatments,
  • Organ donor
  • In Patient treatment,
  • Pre and Post hospitalisation,
  • Organ donor expenses,
  • Day care Procedures,
  • Domiciliary
  • Hospitalisation expenses,
  • Day care treatments,
  • Ayush treatments,
  • Domiciliary hospitilisation
  • Co-pay Ratio10%30%15%-30%15%-30%20%
    Pre-existing waiting period18 months12 months48 months36 months48 months
    Medical Examination RequirementMedical Examination is required before the policy is granted at the cost of the customer. The expenses will be reimbursed after a block of 4 claim free years.No medical examination is required before granting the policy.Medical Examination is required before the policy is granted 50% of the cost of which will be paid by the company on policy acceptanceMedical Examination is required before the policy is granted 50% of the cost of which will be paid by the company on policy acceptanceMedical Examination is required before the policy is granted 50% of the cost of which will be paid by the company on policy acceptance

    This comparison table will help you build your confidence in buying the most suitable health insurance plan for yourself or your parents without ambiguity.

    Know About What’s The Procedure To File Senior Citizen Insurance Claim?

    Claims process for health insurance plans for senior citizens in India depends on the type of his/her hospitalization.

    Claims against Planned Hospitalization: Cashless claims against planned hospitalization are applicable on medical treatment of diagnosed diseases. Every insurance company has a list of network hospitals that are authorized to offer cashless facilities to the insured on hospitalization and medical expenses. Here is the claims process for planned hospitalization:

    • Fill up the claims form with details regarding the network hospital where the insured will be hospitalized.

    • Email the form or send it by fax to the insurance company or Third Party Administrator (TPA) for approval of the cashless claim at least 48 to 72 hours before the date of planned hospitalization.

    • After approval, the insurance company or TPA intimates the hospital about the approved claim amount.

    • After the completion of treatment at the hospital, the insurance company or TPA pays the incurred expenditures to the hospital - directly.

    • Claims against Emergency Hospitalization: Such claims are applicable for unforeseen emergencies rising due to an accident or a sudden medical condition. In such cases, the claims procedure to be followed by the insured or his/her family members is as below:
    • Inform the insurance company or TPA within 24 hours of hospitalization and send the filled up claims form by email or fax.
    • After reviewing the form, the insurance company or TPA approves or rejects the cashless claims request.
    • The insurer or TPA conveys the decision to the insured or his/her family member.

    Government health insurance plans for senior citizens

    Following are some of the health insurance plans for senior citizens offered by public sector insurance companies:

    • Health Insurance of Privileged Elders (HOPE) by Oriental Insurance:This senior citizen health insurance policy can be availed for any Indian citizen, aged 60 years and above, for hospitalisation in India only. The sum insured available include Rs. 1 lakh, Rs. 2 lakhs, Rs. 3 lakhs, Rs. 4 lakhs and Rs. 5 lakhs. The policy will reimburse payment of hospitalisation and/or domiciliary hospitalisation expenses for the diseases (specified) contracted or injury sustained by the insured individual. The claim settlement will be done by the Company/TPA either to the network hospital or to the insured.
    • Senior Citizen Health Plan by United India Insurance:This policy offers insurance cover to individuals between the ages of 61 years to 80 years, and a sum insured of Rs. 1,00,000 to Rs. 3,00,000. Hospitalization costs incurred in the country for treating ailments or injuries of the life insured are covered. Expenses related to certain day care procedures are also covered by the policy.
    • Senior Citizen Mediclaim by The New India Assurance:This policy can be availed by senior citizens between the ages of 60 and 80 years. In case the policy is renewed without a break, the insurance cover can be continued up to the age of 90. Proposers are required to undergo a prescribed pre-acceptance health check for the purpose of identifying any pre-existing diseases. The medical test is waived if the proposer already has a Mediclaim insurance with the company.

    What are the factors on which senior citizen policy can be compared?

    • Age of Entry:The entry age generally differs between health insurance plans and insurance companies. Select one that meets your insurance needs.

    • Maximum Age Limit:The maximum age varies between 80 years and 90 years, while sometimes it may be lifelong. Read through the policy document to be aware of the renewal age, so that you can take a conscious decision.

    • Sum Insured:Sum insured is the maximum coverage that a policyholder can avail for his/her medical expenses. Choose the sum insured as per your requirements, keeping in mind that it does not prove to be insufficient.

    • Premium:Your sum insured amount is one of the factors that will determine the premium you will have to pay annually. Some other factors are the type of your plan, number of insured members in the plan, etc. Consider these factors to decide on a plan whose premium you can afford paying.

    • Coverage:Take a close look at the features and benefits offered to know whether they are suitable for your unique insurance needs and then take a well-informed decision. For instance, if you suffer from a certain disease, make sure that your plan covers the same.

    • Type of Plan:If you are considering a plan for yourself, an individual senior citizen health insurance plan would be suitable for you as opposed to a family floater plan.

    • Co-pay Amount:If you feel the premium eligibility on your preferred plan is towards the higher side, find out whether the insurer offers the co-pay benefit. In most situations, individuals above the age of 65 years buying a new plan are usually required to pay a certain percentage of the hospital expenditures. Find out the co-pay amount applicable on your senior citizen health insurance plan.

    • Network Hospitals:Every insurance company has a large network of hospitals that are authorized to offer cashless facilities to the insured on their hospitalization and other medical benefits. Preferably, your health plan should include hospitals that are easily accessible or ones that you prefer.

    • Incurred Claim Ratio:This ratio represents the percentage of claims settled in a financial year. This gives you a fair idea of how quick or hassle-free you can expect your claims process to be, should such a situation arise.

    What is the minimum age for senior citizen mediclaim policy?

    The minimum age for most health insurance plans for senior citizens in India is 60 years and maximum is 80 years. However, it may differ between plans and insurance companies, extending to 90 years and even whole life.

    Which is the best health insurance plans for senior citizens in India?

    Some of the best senior citizen health plans in India are:

    • National Insurance Varistha Mediclaim
    • Oriental Insurance HOPE – Health of Privileged Elder
    • Bajaj Allianz Silver health
    • New India Assurance Co. Ltd.
    • Star Health Senior Citizen Health Carpet
    • New India Senior Citizen Mediclaim Policy

    Tax benefits in senior citizen mediclaim policy

    Annual premium of up to Rs. 50,000 paid towards Senior Citizen health insurance plans in India attract tax benefits as per Section 80D of the Income Tax Act, 1961.

    Inclusions & Exclusions of Senior Citizen Health Insurance Plans in India

    Read Inclusions of Senior Citizen Health Insurance Plans in India

    • Specific pre-existing illnesses, as mentioned in the policy document, after a certain number of policy years.
    • Medical expenses like ambulance charges
    • ICU expenses as well as pre and post hospitalization expenses
    • Day care charges that include special medical treatments and equipment like chemotherapy, dialysis, etc.
    • Medical charges towards anaesthesia, surgeon’s and doctor’s fees
    • Ayurvedic treatment is covered up to a specified percentage of sum insured.
    • Fast and smooth claim settlement process
    • Flexibility to choose preferred Sum Insured from the available options, as per one’s medical needs
    • Cashless benefits at network hospitals or else reimbursement of claims
    • Covers individuals as well as their spouse
    • Often includes the co-pay option that makes the insured eligible for lower premiums and even discounts
    • Free health check-up

    Read Exclusions of Senior Citizen Health Insurance Plans in India

    • Pre-existing illnesses are generally not covered up to a specified period from the date of the commencement of the senior citizen health insurance plan in India
    • Cosmetic surgeries, unless required because of an accident
    • Dental treatments, unless required because of an accident
    • Sexually transmitted diseases like AIDS
    • Maternity expenditures
    • Hospitalization and medical treatments undertaken anywhere outside India

    Recommended Link:Health insurance for senior citizens above 60 years