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Senior Citizen Health Insurance

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.

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?

Features and Benefits of Senior Citizen Health Insurance in India

The Benefits of Choosing The Best Health Insurance Plan For Senior Citizens Are As Follows:

  • Enjoy higher sum insured benefit
  • Get tax benefit on health insurance premiums
  • Enjoy the free-look period on the policy
  • Day care costs which arise due to use of special equipment while treating procedures such as dialysis and chemotherapy are covered
  • Avail health check-ups annually
  • Cashless hospitalization can be availed if patient admitted for more than 24 hours – This comprises of doctor fees, medical bills, room charges, etc.
  • Option to renew policy available
  • Subject to the limit, ambulance expenses for transporting the policyholder shall be borne
  • Pre and Post hospitalization is covered depending on the number of days
  • Pre-existing diseases are covered subject to terms mentioned in the policy document
  • Quick and hassle-free claim settlement

What Is Covered In Senior Citizen Health Insurance Policy?

  • Hospitalization cover that includes room rent, hospitalization, medical treatment, etc.

  • Cashless Hospitalization that enables the insured under a senior citizen health insurance plan to make the most of the cashless facility during hospitalization and medical treatments

  • Day care and ambulance expenditures

  • No medical check-up is needed before purchasing senior citizen health insurance; however, this feature is open to the discretion of insurance companies

  • High coverage for sum insured

  • Quick and hassle-free claims settlement process

  • Pre-existing diseases are available on the discretion of insurance companies

What Is Not Covered In Senior Citizen Health Insurance Policy?

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

  • Any diseases contracted within 30 days of availing the policy
  • Any non-allopathic treatment
  • Expenses related to injuries caused by ownself
  • Any pre-existing injuries/diseases
  • Expenses as a result of drug abuse
  • Medical expenses during treatment of AIDS
  • Certain ailments like joint replacement etc. are covered only after 2 years of availing the policy
  • Cost of spectacles/lenses and dental treatment (except arising out of accident)
  • Cosmetic surgery
  • Injury due to war, act of foreign army etc.

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.

When Should You Purchase Senior Citizen Health Insurance?

Senior citizen health insurance plans are especially designed for those over the age of 60 years and are best-suited for retired individuals. These plans can either be purchased by senior citizens for themselves or by young individuals for their parents who have become senior citizens.

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.

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:

AgeAge 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 PolicyThe 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 InsuredWhen 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.
PremiumsAlthough 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 DiseasesIt is important to get the best senior citizens health insurance plan which covers many ailments including critical illnesses with progressing age.
Hospital NetworkWhen 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 PeriodInitial 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-PaymentsMany 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 ExclusionsThoroughly 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.

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 PlanMin AgeMax AgeSum InsuredMain Benefits
Senior Citizen Red Carpet Plan6075Rs. 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 Plan4670Rs. 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

Health Insurance For Senior Citizens

  • Apollo Munich's Optima Senior Health Plan
  • ICICI Lombard's iHealth Plan
  • Star Health's Red Carpet
  • New India's Senior Citizen Mediclaim Policy
  • National Insurance Varishtha Mediclaim

Conclusion

Imagine having to arrange for hospitalization and medical expenses in a matter of a few hours. More so, when you consider the exorbitant medical charges that are rapidly rising. Now, consider how it would have been had you been insured by a senior citizen health insurance plan. Wouldn’t that be convenient and ease your financial burden when such a situation arises, irrespective of whether it is a planned hospitalization or an unforeseen emergency? A senior citizen health insurance plan assures you the financial security during your post-retirement years when you probably would not have a high monthly income.

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Faqs on Senior Citizen Health Insurance

Why do senior citizens require health insurance?

The "Golden Years" aren't quite that golden as you age. The loss of regular income due to retirement can only add to the distress of an ailing health. Hence, unless you're born with a silver spoon, a decent health insurance plan can be your only Messiah during this stage of your life.

Are premiums for senior citizen health insurance plans expensive than standard health insurance policies?

As premiums are primarily dependent on the age of the insured member, the health plans for senior citizens are costlier than the regular health insurance. However, plans such as Star Health Insurance's Red Carpet for Senior Citizens offer coverage at standard premium irrespective of the age bracket.

What is the Price/Cost of Senior Citizen Health Insurance Package?

The price or cost of health insurance for senior citizens varies from one insurer to another on several factors. You can speak to the advisory team of Coverfox.com to get details of the best health insurance policy for senior citizens.

Will I get tax benefits on the premiums paid towards my parents' Senior Citizen Health Insurance Plan?

Under the Section 80D of the Income Tax Act 1961, Senior Citizens can avail tax benefit up to Rs.30,000 each year on the premium paid.. Similarly, if you are paying the premium towards your parents' policy, you can avail this benefit for yourself.

How to Claim Senior Citizen Health Plan easily?

You can contact Coverfox.com and give details of your registered mobile number and email id as all your details which is stored in the system would be fetched. The claim request would then be forwarded by the service management team to your insurance company. It would take approximately 15 – 20 working days for the claim to be settled.

How to Calculate Senior Citizen Medical Insurance Premium?

To calculate senior citizen medical insurance premium, the main factors that are considered are age, sum insured, and pre-existing conditions. At times, if your insurance company may hike your insurance premium if they find out that you are suffering from some pre-existing disease.

Can I buy senior citizen health insurance without medical test?

No you cannot buy senior citizen health insurance without medical test. The one exception is the Star Health Insurance's Red Carpet for Senior Citizens. In this, medical test is not required. You can always check the policy brochure before buying this plan.

What are pre-existing diseases / illnesses?

Pre-existing conditions are the ailment or disease that existed before you bought a health insurance policy. This is significant because your insurer would not cover such pre-existing conditions, within 48 months of prior to buying the 1st policy. It means, pre-existing conditions can be compensated after 48 months of continuous insurance cover.

What is co-payment?

Co-payment is the part amount that you have to pay from your pocket for medical treatment and medication while your insurance company will pay the remaining amount. Co-pay policies are more applicable to senior citizen health insurance policies in India. While you would be paying just a part of it, majority would be paid by the insurer. The co-pay fees vary from one insurer to another. You would have to check your policy document to see if your senior citizen health plan has the co-pay option. Note that co-pay is different from co-insurance. The difference between co-pay and co-insurance is that in co-insurance the insurer and the insured person get into a contract where each party has to agree to the percentage of the total cost to be paid. Whereas, in co-pay, the insured person has to pay a fixed amount for various healthcare services and treatments.

What is pre-acceptance medical screening?

A pre-acceptance medical screening is a technique of identifying the presence of any undiagnosed disease or ailment in a person without the signs or symptoms. Insurers insist that the insured person undergo a medical test before accepting their proposal form as the insurance company can assess their risk properly. Based on the results of the medical screening, the proposal form for the insurance policy is either accepted or rejected (in case of pre-existing diseases that are excluded from the insurance policy).

What is free-look period?

A free look period is that duration where a policyholder is given time to think over and can terminate the insurance contract without any penalities. Depending from insurer-to-insurer, the free look period could last for around 10 days or more than that. The insured can decide whether they want to continue with the policy. If they aren’t satisfied, the policyholder can receive full refund for it.

What are tax benefits on senior citizen health insurance?

Tax benefits on senior citizen health insurance generally depend on the age of the insured person. If you are paying health insurance for your parents who are senior citizens above the age of 60, the maximum amount that can be capped is Rs. 30,000. As a taxpayer you can maximize your tax benefit up to Rs. 55,000 under section 80D you’re your age is below 60 but your parents age is above 60. If you are a tax payer above the age of 60 having health insurance for yourself and you are paying health insurance for parents, then you can get a maximum benefit of section 80 D up to Rs. 60,000. When it comes to the premium paid for self, children, spouse, or parents, the tax benefit that can be availed is around Rs. 25,000 a year.

What is cashless hospitalization?

Cashless hospitalization is the facility where an insured person can be admitted and undergo treatment without having to pay medical expenses directly to the hospital. With this facility, the insured person has to be admitted in any of the network hospitals tied up with the insurance company. On making a claim, the policyholder can inform the insurer and all the medical expenses would be compensated to the hospital directly by the insurance company. In short, the insured does not have to pay anything to the hospital and then wait for a reimbursement from the insurance company.

Why every senior citizen should purchase senior citizen health insurance plan?

  • Avail comparatively higher sum insured benefits than most other health insurance plans
  • Avail tax benefit on premium payments made towards senior citizen health insurance
  • Offers pre and post hospitalization
  • Includes a free-look period that offers policyholders a defined time period for taking a final decision on whether they would like to purchase the policy
  • Day care treatments are covered that arise as a result of the usage of tech-advanced equipment during medical treatments, like in the case of chemotherapy, dialysis, etc.
  • Includes annual health check-ups
  • Cashless facilities on hospitalization, doctors’ fees and room rent is applicable when the insured is hospitalized for more than 24 hours
  • Offers the flexibility of renewing the senior citizen health insurance policy for the lifetime
  • Includes expenditures made towards ambulance facilities
  • Pre-existing diseases may be covered after the completion of the waiting period, depending on the discretion of the insurance company
  • Fast and hassle-free claim settlement process

At what age will I be eligible for purchasing a senior citizen health insurance policy?

Senior citizen health insurance is designed for individuals between the age group of 60 years to 80 years of age, though it varies between insurance companies. However, children of senior citizens or those approaching 60 years of age are eligible for purchasing senior citizen health insurance plans.

At what age can I get senior citizen health insurance policy?

Senior citizen health insurance is designed for individuals between the age group of 60 years to 80 years, though it varies between insurance companies. Senior citizens or those approaching 60 years of age are eligible for purchasing senior citizen health insurance plans.

What is the tax benefit on senior citizen health insurance policy?

Tax benefit of up to Rs.50,000 as per Section 80D of the Income Tax Act, 1961, is offered on premium payments made towards senior citizen health insurance. This tax benefit includes preventive health check-ups as well, and is applicable when the policyholder’s parents are senior citizens, even though the policyholder himself/herself is less than 60 years.

How to claim mediclaim policy for senior citizens?

There are two claim settlement processes that you can choose from:

  • Cashless claims – This feature enables the insured to avail cashless benefits on hospitalization, medical treatment and other facilities at network hospitals of insurance companies. Most new age insurance companies offer this benefit to the policyholders of their senior citizen health insurance plans.

  • Reimbursement – For this traditional claim settlement process, the insured receives the reimbursement for his/her hospitalization and other medical expenditures on submission of relevant medical bills.

Is there any mediclaim policy for senior citizens in India?

Here are some senior citizen health insurance plans in India that you may choose from:

  • Apollo Munich's Optima Senior Health Plan
  • ICICI Lombard's iHealth Plan
  • Star Health's Red Carpet
  • New India's Senior Citizen Mediclaim Policy
  • National Insurance Varishtha Mediclaim
  • Senior Citizen Red Carpet Plan
  • Bajaj Allianz Silver Health Plan

What age can I get a health insurance policy for senior citizens?

Senior citizen health insurance is designed for individuals between the age group of 60 years to 80 years, though it varies between insurance companies. Senior citizens or those approaching 60 years of age are eligible for purchasing senior citizen health insurance plans.

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