Medical Insurance for Senior Citizens

As the healthcare industry pushes towards providing the best medical facilities to its citizens, the costs of treatment are also increasing exponentially. This rise in expenditure affects the senior citizens of our country the most as they are out of coverage from traditional health insurance products and are at a stage in their lives where they require medical attention on a regular basis. To add to their woes, many senior citizens don’t have stable sources of income as they are retired and hence cannot afford healthcare in crucial times.

Mediclaim for Senior Citizens

Source: India Today

As the Insurance Development Regulatory Authority of India  (IRDAI) only mandates purchase of health insurance up to 65 years of age, Senior Citizen Health Insurance plans are specially curated insurance products for senior citizens between the ages of 60-80 are designed to provide adequate cover for all their healthcare expenses, greatly easing any financial burden. 

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.

  • Locked Health Insurance Premiums: 

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

Senior Citizen Health Insurance Benefits

A few benefits that one can avail under senior citizen health plans in India are as follows –

  • 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

The senior citizen health insurance eligibility criteria are straightforward.

  • 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 senior citizen health insurance plans in India –

  • 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 Claim on Senior Citizen Health Insurance Online?

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 When Buying Senior Citizen Health Insurance

The following are a few points that you need to keep in mind when buying senior citizen health insurance plans in India.

  • Check with your insurer for the sub-limit on the policy and be prepared to cover the out-of-pocket expenses (if necessary).

  • The number of network hospitals provided by the insurer. 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 one.

  • 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 the health plan starts covering them.

  • Be well versed with the claiming process. Also, keep your family members informed regarding the same.

Conclusion

Though senior citizen insurance is an option that is readily available in the market, it is always best to ensure adequate coverage from a younger age and for a more comprehensive set of risks. The individual and family health insurance plans are an excellent choice for someone looking to get coverage for themselves and their family.

Considering the on-going situation, it is best to be prepared for unforeseen medical contingencies. You can buy health insurance plans at Finserv MARKETS and benefit from features such as easy online application process, cashless claim settlements, reinstatement benefits, tax benefits, etc. Moreover, you can buy/renew your health plans conveniently using the Finserv MARKETS App.

FAQs on Senior Citizen Health Insurance

  • ✔️How much does the senior citizen health insurance plan cost?

    Considering the health insurance plan is for senior citizens, it is bound to cost you more than other primary health plans. That is because the applicant is considered a high-risk applicant, and the age plays a vital role in determining the premiums. You can use the health insurance calculator to determine the premiums charged on your selected coverage and add-on benefits before buying the policy.

  • ✔️Is the cashless claim settlement facility available on senior citizen health insurance plans?

    Yes. The cashless claim settlement facility is available for all. Even senior citizen health insurance policyholders can avail it at the nearest network hospital.

  • ✔️Can I switch from my existing senior citizen health plan to another insurer?

    Yes. As per the IRDAI guidelines, if you are not satisfied with the benefits and features offered by your current insurer, you can switch to a reliable provider that fulfils your insurance-related needs.

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