Guide To Medical Insurance For Senior Citizens

Senior Citizen Health Insurance

Source: India Today

As the insurance regulator IRDAI only mandates the purchase of health insurance up to 65 years of age, Senior Citizen Health Insurance plans are specially curated insurance products for senior citizens. Such an insurance plan covers individuals between the ages of 60-80 and is designed to provide adequate cover for all their healthcare expenses, greatly easing any financial burden.

Why Do You Need Senior Citizen Health Insurance?

Health insurance is a necessity for most individuals as it enables you to pay for medical emergencies as well as planned treatments. So, let’s understand why one must opt for health insurance for senior citizens:

• Soaring Healthcare Costs:

Healthcare costs have been rising with a sharp increase in medical inflation for many years now. Thus, to prioritise your health without worrying about the financial aspect, a health insurance policy for senior citizens is a must. You can rest assured as the plan enables you to gain access to the best medical facility and provides cashless treatments.

• Annual Health Checkups:

Most senior citizen health insurance schemes offer free annual health checkups to the insured. Due to this, you can opt for regular screenings and ensure your health is well. But it is recommended to understand the terms to avail the free annual health checkups under your plan.

• Lucrative Add-on Covers:

Health insurance plans come with lucrative add-ons such as critical illness cover. As a senior citizen, you can benefit from this add-on as the possibility of getting diagnosed with major ailments tends to rise with old age. However, you must purchase this cover separately from your base cover.

Senior Citizen Health Insurance Features

Some of the salient features of general senior citizen health insurance are as follows –

• Pre-Existing Illnesses Cover:

Most senior citizen health insurance plans in India offer coverage for pre-existing illnesses, usually after a waiting period of one year. The insurers also provide critical condition riders to provide additional coverage in times of need.

• Pre- and Post- Hospitalisation Expenses:

Several senior citizen health insurance plans will cover the pre- and post-hospitalisation costs that include medical consultation from specialists, diagnostic tests, ambulance charges, etc. However, get in touch with the insurer as this may differ from company to company.

• Alternative Treatment Coverage:

Depending on your insurance provider, the senior citizen health plan will provide cover for alternative treatments like Ayurveda and Homeopathy.

• Continuity Bonus:

The policy usually offers continuity incentives such as No Claim Bonus in health (NCB) for every claim-free year.

• Fixed Premiums: 

Most senior citizen health insurance premiums in India come with defined rates. That means the policyholder pays the same value for the chosen coverage, even when renewing the health plan.

Senior Citizen Health Insurance Benefits

Here are some of the benefits that you can avail under the best health insurance for senior citizens in India:

• No Medical Screening:

Most insurers do not request the applicants of senior citizen health insurance to undergo a medical test before buying the policy.

• Outpatient Department (OPD) Cover:

The policy offers OPD coverage so that it becomes easy to manage the financial needs when treating certain illnesses.

• Special Rewards:

A few health insurance providers also offer family rewards and discounts on senior citizen health insurance plans, mainly when the policy covers the spouse as well.

• Free Health Checkups:

The policy also provides free health checkups and diagnostic services at dedicated centres after the completion of the specified waiting period.

• Tax Benefits:

The premiums paid towards senior citizen health insurance can be claimed for tax deductions under Section 80D of the Income Tax Act, 1961. 

Exclusions in Senior Citizen Health Insurance

Whilst health insurance for senior citizens provides ample coverage to its policyholders; it does come with many restrictions. These restrictions are likely to vary from provider to provider. 

• The policy does not provide cover for cosmetic treatments such as plastic surgeries.

• The plan excludes coverage for sexually transmitted diseases such as HIV/ AIDS.

• Senior citizen health insurance plans do not cover medical expenses arising out of self-inflicted damage.

• The policy does not cover illnesses contracted within 30 days of the purchase of the health plan.

•  The insurer will reject the health insurance claims arising from alcohol and drug abuse.

• Certain treatments such as joint replacement surgeries would be covered after a stipulated waiting period which is usually two years.

• Injury due to war is exempt from coverage under these policies.

Eligibility Criteria for Senior Citizen Health Insurance

The eligibility criteria applicable to health insurance for senior citizens are:

• The applicant should be between 60 years and 80 years of age.

• The applicant should be aware of their pre-existing health conditions. Also, they need a relevant proof regarding the same. Hence, a medical checkup before purchasing the policy is highly recommended.

Documents Required To Apply For Senior Citizen Health Insurance

You need to submit the following documents when buying the best health insurance for senior citizens online –

• Duly filled application form

• Supporting documents for pre-existing health conditions

• Proof of age

• Medical examination test results (if requested by the insurer)

How to File Claims Under Senior Citizen Health Insurance?

In the case of medical contingencies, initiate the claim settlement process within 24 hours of the hospitalisation. On the other hand, for planned hospitalisation, inform the insurer 48 hours before the hospitalisation.

In either case, here’s how you can file a claim on your senior citizen health insurance plan -

1. Cashless Claim Settlement

   1. Submit the claim request form at the hospital insurance desk

   2. The insurer will send an acknowledgement once they receive your intimation

   3. If necessary, the insurer may raise a query

   4. Upon resolving the query and further verification, the insurer will settle the claim directly with the hospital

2. Reimbursement Claim Settlement

   1. Submit the reimbursement claim form along with the necessary documents with the insurer

   2. The insurer will raise a query if they need any additional documents

   3. Make sure that you submit the medical certificate issued by the doctor

   4. Also, submit the discharge form issued by the hospital

   5. Upon verification and approval of the claim application, the insurer will credit the settlement amount in your bank account

Points to Remember While Buying Senior Citizen Health Insurance

Let’s look at a few points that you must keep in mind to avail the best health insurance for senior citizens online:

• Sub-Limits:

Check with your insurer for any sub-limits applicable to your plan and go through the policy terms and conditions during the free-look period.

• Network Hospitals:

In the case of health insurance for senior citizens, ideally, it is preferred to select an insurer with a wide range of network hospitals under it. That way, you can seek cashless treatment at the nearest hospital without having to worry about any medical expenses.

• Waiting Period:

Consider the waiting period on certain health conditions, especially the ones you are suffering from. This will help you understand how long you have to wait until your health insurance for senior citizens plan starts covering them.

• Daycare Treatments:

The daycare treatment in health insurance covers numerous procedures and treatments that can be completed within 24 hours. So, make sure you go through the treatments covered under medical insurance for senior citizens to avail extensive coverage.

• Renewability:

It is always recommended to choose senior citizen health insurance schemes offering lifetime renewability so that you don’t have to buy another plan after you reach the maximum age limit.

• Other Insurance Features:

Health insurance offers several features such as domiciliary hospitalisation, daily cash allowance, organ donor cover, etc. So, you must ensure your insurance needs are met by understanding the benefits available under your plan and choosing the best health insurance policy for senior citizens.

Parting Thoughts

Though senior citizen health insurance is an option that is readily available in the market, it is always best to ensure you have adequate coverage from a younger age. Individual or family health insurance is an excellent choice as it enables you to customise your plan based on your insurance needs.

It is best to be prepared for unforeseen medical contingencies and beat the rising healthcare costs with the right backup. You can buy health insurance on Bajaj MARKETS and benefit from features such as easy online application process, cashless claim settlement, reinstatement benefits, tax benefits, etc. Moreover, you can buy/renew your health plans conveniently using the Bajaj MARKETS website or mobile app.

Most importantly, you can estimate the premium you need to pay with our easy-to-use health insurance calculator! Apply for health insurance today!