Health Insurance for Senior Citizens

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An Ideal Guide to Buying Health Insurance for Senior Citizens

Age is not just a number for the Senior Citizens. It is a factor that affects their golden days and how they spend their savings enjoying it. Health is the first companion that starts deserting them and drags along with it their hard-earned savings. A Senior Citizen Health Insurance can come to their aid at such times.

Costs for medicines, hospitalization and treatment are rising at an exponential rate. Add to it the handicap of limited income of senior citizens with no scope of increase in income. This problematic combination can make retirement a burden rather than a happy second innings. In such times, a senior citizen health insurance policy proves to be a boon.

Today, there are various health insurance plans specially designed for the Senior Citizens from a number of companies which might leave you wondering which will be the best. Allow us to simplify it for you.

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What is Senior Citizen Health Insurance and How Crucial is it?

Health insurance for senior citizens in India is offered by different insurance companies to financially secure those who are aged 65 years and above. The medical insurance policies for senior citizens are designed to cover all kinds of medical expenses that are incurred by the policyholder. Gifting health insurance to your aged parents or senior citizens in the family is the best way to care for their needs.

It is crucial to buy health insurance for senior citizens in India due to several reasons

  • Old age makes you prone to illnesses: After an age, a person wishes to retire and survive on the pension or the interest earned from savings. But growing older tends to attract ailments and contraction of diseases.

  • Stress-free planning with health insurance schemes: Though falling sick is inevitable with ageing, you can still plan to ensure all the urgent medical expenditure is taken care of in a systematic and hassle-free way.

  • Debt crisis in the family: Sudden crisis in terms of ailments can be a huge financial blow to your family. If the older person doesn’t have a senior citizen health insurance plan, then the breadwinner of the family would have to slog harder to pay off the medical expenses, manage household expenses, and pay off loans if any. This adds to the ill and aged person’s guilt, making them feel like a burden to the family. Why wait for such a situation to arise when insurers offer the best health insurance plans for senior citizens?

Featuresof Senior Citizen Health Insurance

The key features of a senior citizen health insurance plan are:

  • Premiums paid towards a senior citizen health plan is eligible for tax deductions . Get tax benefit on health insurance premiums
  • Comes with a free look period of 15-30 days
  • Day care costs which arise due to use of special equipment while treating procedures such as dialysis and chemotherapy are covered
  • Some plans also cover health check-ups
  • Benefits of Senior Citizen Health Insurance

    The key benefits of a senior citizen health insurance plan are:

  • Fast, convenient, hassle-free claim settlement process
  • Cashless hospitalization is available if the senior individual is admitted for more than 24 hours
  • Provides cover for doctor’s fees, medical bills, room charges, in-patient hospitalization expenses, etc.
  • Lifelong renewable facility is available
  • Emergency ambulance expenses for transporting the insured shall be borne by the insurance company
  • Pre and Post hospitalization expenses covered
  • Pre-existing diseases are covered subject to terms mentioned in the policy document
  • Top Health Insurance Plans for Senior Citizens

    Top Health Insurance Plans Sum Insured Tax Benefits Section 80D Renewability Co-Payment Medical Checkup
    Bajaj Allianz Silver Health Plan 50K to 5 Lakh Yes Lifelong Renewability 20% Pre - medical tests are mandatory for every proposal
    Star Health – Senior Citizen Red Carpet Policy 1 Lakh to 25 Lakhs Yes Lifelong Renewability 30% - 50% None
    Apollo Munich's Optima Senior Health Plan 2 Lakh to 5 Lakhs Yes Lifelong Renewability 15% - 30% Yes
    ICICI Lombard's iHealth Plan 3 Lakh to 50 Lakh Yes Lifelong Renewability NA Free at selected centres
    New India's Senior Citizen Mediclaim Policy 1 lakh & 1.5 lakhs Yes Lifelong Renewability 10% Yes
    National Insurance Varistha Mediclaim 1 Lakh & 2 Lakhs Yes Lifelong Renewability 10% - 20% Yes

    How to Compare Senior Citizen Health Insurance Plans?

    If you want to compare senior citizen medical insurance in India, you need to remember that the type of policy a person wishes to avail depends primarily on:

    • Fixed income amount
    • Financial status
    • Number of dependents
    • Health of dependents

    While doing a comparison on health insurance plans for senior citizens in India, consider the following parameters:

    Age Age plays an important role when buying health insurance for senior citizens in India. The decision to issue a policy depends on the age. Hence, one should buy at an earlier age to increase chances of getting better coverage. When it comes to public sector insurance companies, senior citizen health insurance plans offered by them are the ones in the 60-80 age group.
    A few insurers have no maximum entry age and allow entry even after 80. Always pick a medical insurance policy that goes on for a longer period. The age limit for renewal varies from one company to another so check the terms and conditions carefully before buying the policy.
    Number of Insured Persons on the Policy The number of insured persons in a policy depend on whether you want add your spouse to your plan, or you prefer buying a separate senior citizen health insurance plan for them. This decision is purely based on their medical conditions and your budget constraints.
    The Sum Insured When comparing different medical insurance plans for senior citizens in India, the sum insured is a vital element that needs to be considered. A rough calculation of the medical charges for the entire year will help you decide the desired sum insured amount. Consider the spouse’s medical necessities too if they are being covered in the policy.
    Premiums Although premiums for senior citizen health insurance policies are higher, they're totally worth it. At a stage in life when you should be unwinding and savoring the retired years, the last thing you should be doing is raising funds to take care of your medical expenses. A little bit of planning in your budget will easily sail you through the retired phase.
    Coverage of Specific Diseases It is important to get the best senior citizens health insurance plan which covers many ailments including critical illnesses with progressing age.
    Hospital Network When you age, nothing beats the comfort of a nearby hospital with cashless facility. Do enquire about the cashless tie-ups in the hospitals of your choice before making the payment.
    Waiting Period Initial waiting period: Mostly first 30 days from the policy issuance except for accidental injuries/hospitalization.
    Pre-existing Diseases: Most insurance companies have 2-4 years waiting period to cover any pre-existing conditions. The lesser, the better. Illness Specific: Many illnesses are covered only after a waiting period of around 2 years.
    Deductibles and Co-Payments Many senior citizen health insurance policies in India come with deductibles and co-payments. Therefore, check for the plans that have the lowest deductible and the least co-payment clause. On an average, 10% co-payment is quite standard.
    Inclusions and Exclusions Thoroughly check what your policy covers to avoid any surprises during claims. Read the policy wordings carefully to understand the scope of coverage. Every health insurance policy comes with certain exclusions, and Senior Citizens Health Insurance Plan is no different. As mentioned earlier, refer the policy wordings for the details about what the plan doesn't cover.

    All About Mediclaim Policies for Senior Citizens

    Being a senior citizen can seem quite daunting if you don’t plan your life and expenses properly. With a rise in age comes an increase in expenses, inflation, risk to health, etc. The best solution to the problems mentioned above is a mediclaim health plan for senior citizens. A senior citizen mediclaim policy is a must have if you are planning an early retirement with regular pension or interest income from savings.

    To boost mediclaim policies for senior citizens, the IRDAI has told insurers to provide cover to individuals up to 65 years of age.

    This has enabled individuals to purchase health insurance coverage, even at the later stages of life.

    Value added benefits of Mediclaim Policy for Senior Citizens

    The various benefits of a senior citizen mediclaim plan are:

    • You don’t require any pre-medical test before purchasing a health plan.

    • Senior citizens can avail health check-ups for free based on the features of the plan.

    • Cashless hospitalization service is available

    • Covers medical bills, doctor fees, charges of the room, etc.

    • Covers pre/post hospitalization expenses.

    • Covers pre-existing diseases and specific ailments post the waiting period.

    • The policyholder is eligible for tax benefits on premiums paid under Section 80D of the Income Tax Act, 1961. The maximum deduction you can claim is Rs. 50,000 in a financial year.

    • Many insurers offer lifetime renewals.

    • You can purchase a new senior citizen plan or renew your existing plan through the online mode. Many insurers provide this facility through their official website.

    Inclusions of Mediclaim Policy for Senior Citizens

    The inclusions under this policy are:

    • Ambulance charges - Covers expenses for emergency ambulance transport.

    • Daycare treatments - Covers daycare treatments such as dialysis and other treatments which do not require 24 hour hospitalization.

    • Hospitalization expenses - Includes room rent, physician consultation fees, doctor’s fee, treatments, etc.

    Exclusions of Mediclaim Policy for Senior Citizens

    The exclusions under this policy are:

    • Treatment cost of HIV/AIDS/STDs

    • Cost of lenses/spectacles

    • Dental Treatment

    • Drug abuse related treatments

    • Cosmetic Treatment and Surgery

    • Congenital diseases

    • Non-allopathic treatments

    • Claims raised during the waiting period.

    • Ailments diagnosed within 30 days of buying the policy.

    Eligibility Criteria - Application for Mediclaim Policy for Family

    The eligibility criteria is as follows:

    • Entry age for the policyholder is 46 years, maximum age is 65 years.

    Documents required to buy mediclaim policy for senior citizen

    The documents required to purchase a mediclaim plan are:

    • KYC - Proof of ID and Address

    • Proof of Income

    • Age Proof

    • Medical Check-up/Report if required

    • 2 Passport-size photographs

    • Application Form

    Documents required for claim under a mediclaim policy for senior citizen

    The following documents are required to raise a claim under a mediclaim policy for senior citizens

    • Claim Form/Pre-authorization Request Form.

    • Attending physician's statement.

    • Attested copies of all medical records.

    • NEFT mandate form

    For a Death Claim:

    • Original policy documents

    • Original/attested copy of death certificate issued by the local municipal authority.

    • Death claim application form (Form A).

    • NEFT mandate form attested by bank authorities along with a cancelled cheque or bank account passbook.

    • Nominee's photo identity proof such as copy of Passport, PAN card, Voter identity card, Aadhaar (UID) card, etc.

    Medical Natural Death:

    • Attending physician's statement (Form 'C').

    • Medical records (admission notes, discharge/death summary, test reports, etc.).

    Accidental Unnatural Death:

    • Copy of the First Information Report (FIR) or Panchanama/Police complaint.

    • Copy of Post Mortem report (PMR)/Autopsy and Viscera report.

    • Copy of the Final Police Investigation report (FPIR)/Charge sheet.

    What Is Covered In Senior Citizen Health Insurance Policy?

    • In-patient Hospitalization for treatment of injury/accident/disease
    • Cashless Hospitalization at network hospitals
    • Day care procedures
    • Pre-existing diseases post waiting period
    • Hospital Room Rent and Ambulance Expenses
    • Some insurers offer free medical check-ups once a year
    • Critical Illness Rider Option
    • Pre and Post Hospitalization expenses
    • AYUSH
    • Organ Donor expenses
    • Domiciliary expenses

    What Is Not Covered In Senior Citizen Health Insurance Policy?

    What Is Not Covered Under Senior Citizen Health Insurance? Let’s find out

    Here is the list of exclusions:

    • Expenses arising from HIV/AIDS/STDs and related diseases
    • Non-allopathic treatments, congenital diseases, mental disorder or insanity, cosmetic surgery and weight control treatments
    • Self-inflicted injury
    • Suicide
    • Nuclear, chemical or biological threat
    • Pregnancy, dental treatment, external aids
    • Alcohol/substance abuse
    • Participation in military operations
    • Participation in extreme sports

    For Example: Asha, a 62 year old woman was suffering from asthma for a very long time. After doing a medical check-up, her insurance company rejected her proposal form as her condition was found to be a pre-existing ailment, which was an exclusion in her senior citizen health insurance policy document.

    Reasons for change in premium of health insurance for senior citizens plan

    Sometimes, the insurance company may hike the premium of the senior citizen health insurance plan if the policyholder is found to consume alcohol, tobacco, or be involved in other activities that can deteriorate their health conditions.

    IRDAI Rules and Regulations on Government Senior Citizens Health Insurance Policies

    IRDAI or Insurance Regulatory and Development Authority of India have been authorized with the responsibility to monitor the provisions of government-backed health insurance policies that are customized for senior citizens, among various other tasks. It keeps a close tab of the features and benefits offered through senior citizen health insurance plans and regulate them at frequent intervals to ensure their welfare.

    Here are some of the regulatory activities undertaken by IRDAI in the recent past:

    • Implemented a strict cap on the maximum limit for premium payments when premiums were being drastically increased by insurance companies in the year 2006 and 2007.
    • Formed a committee on Health Insurance for Senior Citizens to plan, formulate and implement necessary requirements seamlessly. Several recommendations of this committee were implemented, proving its efficiency and effectiveness.
    • IRDAI has made it mandatory for insurance companies to not reject the renewal of a senior citizen health insurance plan except reasons like misrepresentation of facts, fraud and moral hazard.

      • IRDAI has also made these features compulsory for government-backed senior citizen health insurance:
      • A minimum of 50% of the expenses incurred for pre-insurance medical examination may be reimbursed when the insurance company accepts the risk.
      • Policyholders of senior citizen health insurance plans can be offered the convenience of switching to another Third Party Administrator (TPA), as per his/her preference.
      • Individuals are offered the flexibility to renew senior citizen health insurance policy till the maximum age of 65 years.
      • Rejection of every proposal for senior citizen health insurance plans have to be given in writing, along with reasons supporting the rejection.

    How to Select the Best Health Insurance Plan for People Above 60?

    Buying health insurance for aging parents has to be done carefully as you would want them to deserve the best. Keep the following points in mind while choosing medical insurance for parents above 60 years:

    • Know the medical history: While buying a health policy for your senior citizen parents, you need to know their medical history. But, sadly they too may be unaware of many prevailing medical conditions that they suffer from. In such cases it would be difficult to rely solely on their knowledge of their medical history. Before providing such information to the insurance company, it is always better to cross-verify.

    • Compare and choose plan: There are many existing and new senior citizen medical insurance plans available online in India. It is essential to compare between the different schemes. Comparison between the various health insurance plans for senior citizens can be done on factors such as coverage, price, riders/add-ons, inclusions, and exclusions.

    • Fill proposal form: While selecting the policy, fill in relevant and accurate information. Incorrect information could cause problems and your insurer will reject the application.

    • Do a medical check-up: The insured would have to undergo a medical screening after submitting the proposal form. The doctors on the panel of the insurance company would verify the information related to the medical conditions of the policyholder. Depending on the health of the insured, a few medical tests would be conducted by the doctor. Some of the tests include lipid profile, blood routine, sugar, urine routine, kidney and liver function, sonography, etc. Note: There are certain senior citizen medical insurance plans that don’t require pre-policy medical screening tests.

    For Example: Mayur lives with his wife who is a homemaker, 2 school-going kids and his parents. He earns around 50,000 per month and is the only bread-earner of the family. Since his parents are aged above 65, he decided to purchase a senior citizen medical insurance plan for them. Sudden medical crisis could leave the whole family financially crippled. That was something Mayur didn’t want.

    So, after assessing his parents' medical history by going through all their earlier medical reports, he browsed the web and searched health insurance plans for parents. Their pre-policy medical check-up showed normal reports and the insurance company accepted the proposal form. The policy that Mayur chose for his parents required him to pay just Rs. 6000 per month. This was the best decision that Mayur took as it left him and his parents financially secure and happy.

    Some Insurers that offer Senior Citizen Health Insurance

    Buying a health insurance plan when you are beyond 60-65 years of your age can be a bit taxing on your budget. However, with the kind of coverage these Senior Citizen Health Insurance plans offer, the investment is entirely deserving. You are at an age where even a small hospitalization can lead to drilling bigger holes in your hard-earned savings, and hence, you need a secure and substantial financial backing to tackle all your medical expenses.

    Insurance Plan Min Age Max Age Sum Insured Main Benefits
    Senior Citizen Red Carpet Plan 60 75 Rs. 1-10 lakhs
    • No pre-policy medical check-up required
    • Available with greater Sum Insured coverage up to Rs.10 Lakhs
    • Lifetime Renewability
    Bajaj Allianz Silver Health Plan 46 70 Rs. 50,000-5 lakhs
    • This plan has waiting period for pre-existing diseases is 1 year
    • No limit on room expenses
    • Covers pre-existing diseases up to 50% of sum insured