Senior Citizen Health Insurance- All you need to Know

Published On 17 Mar 2019 By Mandeep Kaur Saini

Senior Citizen Health Insurance- Here’s What You Should Know

Old age makes one prone to illnesses, therefore, at such a stage of one’s life what a person requires is getting a proper health insurance plan to safeguard him from the rising costs of medicines, hospitalization and treatments. Not just getting a comprehensive health insurance plan helps a person to lead a stress-free life in his old age but also saves from a huge financial blow especially after the retirement period which can result in burdening the bread winner of the family due to the financial crisis.

So why to wait any further for such a situation to arise when insurance companies offer the best health insurance plans for senior citizens that too in a budget-friendly way? There are a plethora of plans now-a-days which makes it confusing for the people to choose the perfect fit for them. Therefore, to avoid such a mess, InsuranceDekho, through this article, will discuss everything you need to know about a senior citizens plan in India, that is, what it is, why it is important, benefits of buying it, top-notch health insurance plans for senior citizens, various government schemes for them and exclusions of senior citizen plan.

Importance of a Health Plan for Senior Citizen
In your old age would you prefer to be treated as a burden on your family? Obviously the answer is NO! And this is not the only reason which proves that getting a health insurance is a must, there are several other reasons that highlight the importance of health insurance for senior citizens. Below-mentioned are some of the factors that cannot be overlooked:

Coming of Medical Problems in an Old Age

It is very difficult to escape medical problems that comes only with the old age even if one maintains a healthy lifestyle and more than 90% of the senior citizens do not have a good and healthy lifestyle which leads to the increase in health related concerns. So it can be concluded by saying that as your age goes up, so does the probability of a person of getting diseases and medical issues. Most of the problems in the present time are neither too easy to treat nor are pocket friendly and due to this reason medical insurance can prove to be of great support for the sufferer as well as the family as a good policy also provides cover for major critical illnesses such as body part transplant, heart disease or diabetes as well.

Elimination of the Costs of Regular Medical Check-ups

Regular doctor visits are of extreme importance because the regular check-ups keeps you aware about your present health condition especially in the ripe years of your life when there is more probability of getting an illness. These help in detecting any new problem at the earliest so that you can take the necessary steps to take care of your present health state or get the medications in the early stage only to avoid any critical issue later on. To avail the benefit under your health insurance policy, all you need to do is to find its network hospital and under it the insured can easily avail free health check-ups on regular basis.

Health Insurance Plan Makes You Financially Independent

Due to the sky rocketing prices of the medical expenses in today’s time your medical expenses become a burden on the family when you are not anymore a earning member during your old age. So a health insurance plan is made to take care of all your medical expenses and which helps the senior citizens to not to depend on their family for their medical expenditures and to be financially independent during their lifetime.

Perfect Way to Invest Money for Your Old Age

Your entire savings might be wasted if not invested properly and what can be a better way than investing money in your health so that any illness, even a critical one, can be cured easily without even giving a second thought about money. The total cost of a comprehensive health plan including all the premiums is way less and you can easily afford a health plan without making a big dent on your savings.

Benefits of Senior Citizen Health Insurance
Mentioned below are some of the benefits of buying a senior citizen plan:

  1. Get higher sum insured coverage
  2. Enjoy tax benefits on health insurance premiums
  3. Day care costs are covered which arise due to use of special equipment while treating dialysis and chemotherapy etc.
  4. Annual health check-ups facility
  5. Cashless hospitalization can be availed if patient is admitted for more than 24 hours which consists of the doctor fees, medical bills, room charges, etc.
  6. Option to renew policy available (for lifetime in some plans)
  7. Ambulance expenses for transporting the policyholder depending on the limits
  8. Pre and Post hospitalization is covered based on the number of days
  9. Depending on the policy, pre-existing diseases are covered
  10. Fast and hassle-free claim settlement
  11. Get the 15 days free-look period on the policy

Features of Senior Citizen Health Insurance

Senior citizen health plans have certain common features about which you should have a prior knowledge if you are selecting the plan for yourself or your parents. Here is a detailed look at senior citizen health plans which are currently available in the market.

Co-pay – Co-pay is the proportion of claim that is to be paid by the insured every time a claim is raised by him/her and the ratio usually ranges between 10 to 30% and the rest 70-90% will be paid by the insured depending upon the policy taken. For example, a plan with a co-pay limit of 25% indicates that in case of any claim, 25% of the amount of claim will be paid by the insured and the rest 75% of the claim with be paid by the insurance company. That means in case of INR 10,000 claim, INR 2500 will be paid by the policy-holder and the rest INR 7500 by the insurer.
Limits on Sum Assured – In the senior citizen plan, sum assured is usually limited in amount as in an old age there is a higher probability of getting a serious illness, therefore, insurers usually cap/limit the maximum amount of coverage that can be availed. Generally the amount of coverage ranges between INR 1 to INR 3 lacs.
Pre-existing Medical Condition – As it is the most common exclusion in almost all the plans which means that the ailments you are suffering from while buying the plan will be excluded from the scope of coverage for a few years, also known as waiting period, and senior citizen plans have a waiting period which ranges from 2-4 years.
Medical examination – Senior citizen health insurance plans most of the times include a compulsory health check-up of the insured before the cover is granted to assess the overall risk presented by the individual.

How to Select the Best Health Insurance Plan for Senior Citizens?
Everything should be clearly examined such as requirements of the insured, medical conditions, consider the inclusions, exclusions, claim process and waiting period, while buying a comprehensive health insurance plan for senior citizens as they deserve the best treatment post retirement. So while buying an insurance one must keep the following points in mind:

Take into Account the Medical History of the Individual: While choosing a health insurance plan for your parents in India, you need to know their medical history but in most of the cases people are unaware of prevailing medical conditions. Therefore, before providing such information to the insurer, it is always better to cross-verify to get a proper idea of parent’s medical history.

Compare and Choose the Best Plan: In today’s time when there are so many medical insurance companies in the country, it becomes important to compare the different schemes which can be done on factors such as coverage, add-ons, price, inclusions, and exclusions.
It is of great benefit if specific needs such as organ donor expenses, dialysis, chemotherapy, etc. are covered.

Fill Proposal Form Correctly: While selecting the plan, fill in relevant and accurate information in the proposal form as any incorrect information can cause problems and can lead to rejection of the form.

Select a High Sum Assured:  Choose a plan which has a higher sum assured which can cover all your medical expenses as old age requires more medical check-ups and are more prone to critical diseases. Note: Private insurance companies offer a higher sum assured for senior citizens compared to the public sector insurers.

Check the Waiting Period: Go for a plan which will have a lower waiting period for pre-existing disease cover so that the insurance cover can come in handy when the insured will need it the most.

Separate Insurance Policy for Parents: Do not include your parents who are senior citizens in the family floater plan as the premium will be based on the eldest member of the family. Additionally, the renewal age is also dependent on the age of the eldest member.  

Co-payment: Select a plan which will have lower co-pay (amount paid by the policy-holder whenever any claim is made) which is usually 20% (minimum) of the claim amount. However, some insurers offer reduction in co-pay with every renewal.

Renewal age: Choose a policy with the maximum renewal age (age till which a policyholder can renew his/her policy) and the most-preferred one is lifetime renewal option.

Insurance coverage: Select a policy which offers wider coverage of illnesses including medical conditions like diabetes, cancer, etc. and have a lesser waiting period.

Network hospitals: Choose a policy with a high number of network hospitals nearest to your location so that your parent can avail cashless hospitalisation in the network hospital in case of medical emergency.

Exclusions of Senior Citizen Health Insurance
Below-mentioned are the basic exclusions of senior citizen health insurance plans:

Any disease detected within first 30 days from the commencement of the policy
Any kind of non-allopathic treatment
Injuries caused by the insured himself
Pre-existing injuries/diseases
Expenses due to drug abuse
AIDS treatment
Cost of spectacles/lenses
Dental treatments except sue to accident
Cosmetic surgery
Injuries due to war

Topmost Senior Citizen Health Insurance Plans
There are a plethora of health insurance plans but choosing the best out of the lot can become a nightmare for many senior citizens or their children to select the most comprehensive plan yet in a limited budget. Following are the most popular senior citizen health plans available in India:

Senior Citizen Health Plan

Features

Star Health's Red Carpet

Sum insured – INR 1 lac to INR 5 lacs

Entry age - 60 to 75 years

Renewability - Lifetime renewability

Co-payment - 30-50%

Critical Illness cover - available

Waiting period for pre-existing disease coverage - 1 year

No pre-insurance medical test required

TATA AIG MediSenior Plan

Sum insured – INR 2 lacs to INR 5 lacs

Entry age - Minimum 61 years

Renewability - Lifetime renewability

Co-payment 15-30%

Waiting period for pre-existing disease coverage – 4 years

United India Senior Citizens Health Plan

Sum insured – INR 1 lac to INR 3 lacs

Entry age – 61-80 years

Renewability - Lifetime renewability

Co-payment- 20%

Waiting period for pre-existing disease coverage - 4 years

Apollo Munich's Optima Senior Health Plan

Sum insured – INR 2 lacs to INR 5 lacs

Entry age - Minimum 61 years

Renewability - Lifetime renewability

Co-payment- 15-30%

Waiting period for pre-existing disease coverage - 3 years

New India's Senior Citizen Mediclaim Policy

Sum insured – INR 1 lac to INR 1.5 lacs

Entry age - 60 to 80 years

Renewability – Upto 90 years

Co-payment - Voluntary payment

Waiting period for pre-existing disease coverage – 1.5 years (18 months)

ICICI Lombard's iHealth Plan

Sum insured – INR 1 lac to INR 10 lacs

Entry age - No maximum entry age limit

Renewability - Lifelong renewability

Co-payment - Voluntary payment

Critical Illness cover – available

Pre-insurance Medical Test is required

Waiting period for pre-existing disease coverage – 2 years / 4 years

National Insurance's Varishtha Mediclaim

Sum insured – INR 1 lac to INR 2 lacs

Entry age - 60 to 80 years

Renewability - Up to 90 years

Co-payment - 10%

Waiting period for pre-existing disease coverage - 1 year

Government Health Insurance Schemes for Senior Citizens
There are various health insurance plans that are provided by the Indian government for the senior citizen to safeguard the health of senior citizens of our country. Let us have a look on these schemes:
 

Varishta Mediclaim Policy
Varishta Mediclaim policy by government is made for the individuals between the age of 60 and 80 years. The policy period is only for one year but the renewal can be made up to 90 years.

Key Features of Varishta Mediclaim Policy:

  1. Sum assured of INR 1 lac is provided for hospitalization and in case of critical illnesses the sum assured id INR 2 lacs.
  2. Medicines, drugs, blood, oxygen, diagnosis charges etc. expenses are covered by half of the sum assured.
  3. Up to INR 1000 for emergency ambulance expenses.
  4. Critical medical problems such as benign prostatic hyperplasia, cataract ad organ transplant etc. are covered depending upon the policy contract.
  5. One fourth of the sum assured is for surgeons, consultants, specialists, medical practitioner’s fees.
  6. Expenses for illnesses like cancer, multiple sclerosis, stroke etc. are provided even without hospitalization.
  7. Pre-existing conditions like Diabetes and hypertensions do not require waiting period, if an additional premium is paid.
  8. Post hospitalization charges are covered up to 60 years of age.
  9. Under Income Tax Act, the premiums of up to INR 15,000 are allowed as deductions.

National Mediclaim Policy
National mediclaim policy is for the people who lie within the age range of 18 to 65 years but the policy period is only for a year but it relevant for senior citizens the policy provides the benefit of lifetime renewal to the policy holders. The sum assured is between INR 50,000 to INR 5 lacs.

Key Features of National Mediclaim Policy

  1. 140 days of day care procedures
  2. Ambulance charges up to INR 2000
  3. Inclusion of physician, surgeon, anaesthetist fees, room charges, transfusion and injection charges
  4. First 30 days of accidental cover
  5. Medication and tests charges inclusive of blood, oxygen etc.
  6. 4 years waiting period for pre-existing conditions
  7. Sum assured can be raised on renewal up to INR 5 lacs
  8. For a claim free year, the sum assured is automatically raised by 5%
  9. Cashless treatment facilities are available at 6000 network hospitals in India.
  10. Tax benefits are available on the premiums paid.


Central Government Employees and Pensioners Health Insurance Scheme
Central Government Employees and Pensioners Health Insurance scheme is made especially for the employees of central government (newly recruited as well as the retired one). The sum assured under this plan is of INR 5 lacs with a minimal premium.

The plan includes one exclusive benefit which is not available in most of the plans available in the market, that is, No waiting period for coverage initialization and the pre-existing conditions even for the major critical illnesses like diabetes, hernia, cataract, etc. whereas the other plans have a minimum waiting period of 2 years - 4 years.

  1. The coverage period is for the lifetime of the insured.
  2. Reimbursement for the cost of medical apparatus such as artificial parts and hearing aids.
  3. Pre-existing conditions, pre and post hospitalization and maternity benefits are the provided.
  4. Free specialist visits at government hospitals for check-ups.
  5. OPD treatment and medicinal cost
  6. Medication and consultation of Siddha, Ayurveda, Unani systems of medicines and homeopathy.
  7. Reimbursement in case of emergency treatments both at government and private hospitals.
  8. Cashless treatment for the insured at diagnostic centers and authorized hospitals.
  9. Under this plan, additional members can be covered if a fixed additional is paid per member.
  10. Policy period is for the lifetime even for the beneficiaries.


Myths about Senior Citizen Health Insurance:
When it comes to senior citizens health insurance, there are several myths surrounding it and due to this misconceptions many people do not purchase it for themselves or their parents. Listed below are some of the myths that need to be busted:

Group Health Insurance is Sufficient:
Many people believe that the group health insurance/family floater plan offered by the company will provide enough coverage for their parents. Many individuals have been rationalising the cover in order to reduce the premiums. Therefore, it is very important to not rely on just group/family health policies to offer health cover to your parents. It is always advisable to buy a separate senior health insurance plan for your parents if you do not want your entire sum assured to get spent on a single person.

Pre-existing conditions:
Most of the health insurance companies do not cover pre-existing ailments especially when it comes to senior citizens. Due to this reason, many stop themselves from buying a health insurance policy. But many of the insurance companies cover pre-existing diseases after a waiting period of 2-4 years.

Insufficient Coverage:
Many people consider health insurance policies to be useless as they do not provide coverage for certain existing conditions. But this is not true because the diseases are covered by most of the companies but also after a pre-defined waiting period. Other this this, coverage for hospitalization, day-care procedures other ailments and accidents are always covered.

Higher Cost:
Health insurance plans are more expensive for senior citizens as they are more likely to get illnesses but there are many senior citizen policies, even the government ones, which will not affect your pocket and offer comprehensive health coverage to your parents.

Conclusion:
The article clearly highlights the importance of senior citizen health insurance plans and how buying it is not a choice anymore but a necessity. There are so many plans available in India which provides amazing benefits with the maximum sum assured. Therefore, save yourself from burning a hole in your pocket tomorrow and go for medical insurance today for your parents as prevention is better than cure.