For the elderly, healthcare coverage is no longer a luxury, but a necessity. This is especially valid since they are more likely to face health concerns at this stage of their lives. To address this need, senior citizen mediclaim policies provide a safety net. These plans cater to older individuals by covering hospitalisation expenses during medical treatment.
The table below gives you a quick insight into the important terms of the senior citizen mediclaim policy:
Particulars |
Details (depending on the company) |
Age |
60-80 |
Sum insured |
₹1 Lakh to ₹15 Lakhs or higher |
Premium payable |
Depends on the company's terms |
Major cover |
Hospitalisation expenses |
Major exclusions |
|
Riders available |
Yes |
Lifetime Renewability |
Yes |
Waiting period |
Yes |
Read More: Senior Citizen Health Insurance Plans
Take a look at some of the best Senior Citizen Health Insurance plans that you can opt for:
Name of Plan |
Hospitalisation Cover |
Starting Rate of Premium |
Star Health Senior Citizen Red Carpet |
₹25 Lakhs |
₹4450/year |
Niva Bupa Health Companion |
₹12.5 Lakhs |
₹5085/year |
Bajaj Allianz Individual Health Guard- Gold |
₹50 Lakhs |
₹2836/month |
Reliance Health Infinity |
₹1 Crore |
₹2119/month |
When you shortlist the best mediclaim for senior citizens, make sure you thoroughly read all the clauses. One of the most important is the coverage. It clarifies to you all the claims you can make if the need occurs:
At the time of the policy purchase, a sum assured is guaranteed to the insured. If any medical help arises, the insured can make a claim for hospitalisation expenses up to the sum insured. The following covers are added under it:
Room charges
ICU charges
Nursing fees
Charges of the anaesthetist, surgeon, practitioner, consultant, etc.
OT charges
Medicine and drug expenses
Blood, surgical appliances, oxygen, anaesthesia, X-ray
Artificial limbs, stents, implants, pacemakers, dialysis, chemotherapy, and radiotherapy
Diagnostics
Pre and Post-hospitalisation expenses are covered to a certain extent only (not included by some insurers)
You may also be provided AYUSH treatment cover
Ambulance charges can also be claimed
The insurance company also covers the charges and expenses of the donor
The exclusion clause lists what a senior citizen mediclaim policy does not cover for hospitalisation. This includes:
Existing diseases
Cosmetic surgery
STDs and inherent disease
Alcoholism
Self-harm
Harm due to illegal activity
The premium asked by your insurance provider must be affordable and within your budget. Also, you must get sufficient coverage in return for a premium. Check out the premium charged to the different age groups for the senior citizen mediclaim policy:
Age Group |
Premium for Sum Insured (₹10 Lakhs) |
Premium for Sum Insured (₹15 Lakhs) |
60-65 |
4,043 |
6,006 |
66-70 |
4,463 |
6,626 |
71-75 |
4,935 |
7,329 |
76-80 |
5,408 |
8,033 |
81-85 |
5,948 |
8,836 |
86 and above |
6,489 |
9,639 |
Raising a claim is the main component of any insurance policy, including the best mediclaim for senior citizens. The claim process includes:
For cashless treatment, the insured must be admitted to one of the impanelled hospitals as specified by the insurance company. Once the disease is diagnosed, the insured must inform the insurance company or TPA (Third Party Administrator) about the same.
After being hospitalised, the bills will be settled between the insurance company and the hospital. The insured is only charged in case the expenses exceed the sum insured or for inadmissible expenses.
If the insured gets admitted to any other hospital than the network hospital, the following is the process for this claim:
Inform your insurance providers once the disease is diagnosed
Submit all the necessary documents to your insurance provider within the time limit given, after discharge
Your insurance provider will assess all the details and approve the claim
Once approved, all admissible expenses will be disbursed to your bank account.
People between the ages of 60 to 80 years can apply for the senior citizen mediclaim policy. However, the age may vary from company to company.
Yes. Some of the popular riders include:
Outpatient treatment
Personal accident
Critical Illness, etc.
Yes. Most insurance companies mention waiting until an insured can raise a claim.
Yes, you can buy or renew your mediclaim policy online through the official website of your insurance provider.
In case you do not pay the premium even after repeated notification, the policy will be terminated, and you shall also be liable for legal actions.