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Overview of Senior Citizen Mediclaim Policy

Medical cover has become a quintessential requirement these days. Especially when it comes to elderly people, the chances of getting sick and contracting medical ailments are higher. So, it is advised that people in the older age group must have a health insurance plan. One such plan is the senior citizen mediclaim policy. Being a type of health insurance, a Mediclaim policy for senior citizens primarily covers the hospitalisation expenses incurred for the treatment of various illnesses. 

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 lakh or higher

Premium payable

Depends on the company's terms

Major cover

Hospitalisation expenses

Major exclusions

  • Self-harm

  • Cosmetic treatment

  • Drugs and intoxicants

Riders available 

Yes

Lifetime Renewability

Yes

Waiting period 

Yes

Read More: Senior Citizen Health Insurance Plans

Features & Benefits of Mediclaim for Senior Citizens 

Mediclaim insurance for senior citizens is meant to provide the much-needed financial assistance to deal with any medical crisis. Check out the features and several benefits of having the best mediclaim policy for senior citizens:

  • Tax Benefits

The Section 80D of Income tax allows all the senior citizens with an insurance plan to avail of tax benefits up to ₹50,000

  • Hospitalisation Expenses

In case the insured gets hospitalised for an ailment, the expenses for the same are covered. Right from the ambulance charges to the room rent and surgery charges, etc. are all covered. Some insurance providers also otter Pre and Post-hospitalisation expenses as well. So, depending on your requirements and preferences, you must choose a provider

  • Annual Check-Ups

It is vital that senior citizens go for regular health check-up and so, the best mediclaim policy for senior citizens also offer free annual health checkups

  • No CLAIM Bonus 

If the insured makes no claim in a policy year, NCB, that is, No Claim Bonus is offered. Under this, the insured may either get a discount on premium or renewal fees.

  • Cashless Treatment

Mediclaim for senior citizens provides cashless and reimbursement options. Under cashless, one can get treatment in one of the network hospitals of the health insurance company without having to pay directly from pocket.

Senior Citizen Health Insurance

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 lakh 

₹ 4450/year

Niva Bupa Health Companion

₹ 12.5 lakh

₹ 5085/year

Bajaj Allianz Individual Health Guard- Gold

₹ 50 lakh

₹ 2836/month

Reliance Health Infinity

₹ 1 crore

₹ 2119/month

What is Covered Under Mediclaim Insurance for Senior Citizens?

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:

 

  • Hospitalisation Expenses

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. 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, pacemaker, dialysis, chemotherapy, and radiotherapy 

  • Diagnostics

  • Pre and Post-hospitalisation expenses are covered to a certain extent only. However, some providers may not include these expenses

  • 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.

What is Not Covered Under Mediclaim Insurance for Senior Citizens?

The exclusion clause specifies all the causes of hospitalisation that remain out of the reach of a senior citizen mediclaim policy:

 

  • Existing diseases

  • Cosmetic surgery

  • STDs and inherent disease

  • Alcoholism

  • Self-harm 

  • Harm due to illegal activity 

Senior Citizen Mediclaim Premium Chart

The premium asked by your insurance provider must be affordable and within your budget. Also, you must enjoy sufficient coverage in return for a premium. Check out the premium charged to the different age groups for senior citizen mediclaim policy:

Age Group

Premium for Sum Insured (₹10 lakh) 

Premium for Sum Insured (₹15 lakh) 

60-65

4043

6006

66-70

4463

6626

71-75

4935

7329

76-80

5408 

8033

81-85

5948

8836

86 and above

6489

9639

How To Claim Mediclaim Insurance for Senior Citizens?

Raising a claim is the end motto of any insurance policy including the best mediclaim for senior citizens, The right claim process includes-

  • Cashless Treatment

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.

  • Reimbursement Claim

If the insured gets admitted to any other hospital than the network hospital, the following are the process for reimbursement claim:

 

Step 1

Inform your insurance providers once the disease is diagnosed.

 

Step 2

Collect all the necessary documents and submit to your insurance provider within the time limit given (after discharge from the hospital).

 

Step 3

Your insurance provider will assess all the details and approve the claim. Once approved, admissible expenses will be disbursed to your bank account.

Senior Citizen Mediclaims with respect to the Illness

The following table will help you get a fair idea of the maximum coverage that you can claim with respect to different illnesses: 

Name of the Surgery/ Illness

Maximum Charges

Cataract 

₹10,000

Prostate

₹18,000

Hysterectomy

₹22,000

Cholecystectomy

₹18,000

Hernia-Inguinal

₹16,000

Fissurectomy

₹9,000

Kidney stone/ Lithotripsy

₹13,000

Arthroscopy

₹10,000

Mastectomy(Radical)

₹36,000

Tympanoplasty

₹13,000

Septoplasty

₹9,000

PID-Discectomy

₹31,000

Conclusion

Senior citizen mediclaim policy has been one of the most popular insurance plans. This is primarily because of the specific coverages provided for affordable premium amounts. Also, senior citizens' needs differ from those of younger people. Hence, they also need special care. So, if you have older parents in the house, check out and buy for them the best mediclaim for senior citizens now! 

FAQs

  • ✔️What are the minimum and maximum age limits for purchasing a senior citizens mediclaim policy?

    People between the age of 60 to 80 years can apply for the senior citizens mediclaim policy. However, the age may vary from company to company.

  • ✔️Are riders available for senior citizens mediclaim policy?

    Yes. Some of the popular ones include

    • Outpatient treatment

    • Personal accident

    • Critical Illness, etc.

  • ✔️Is there a waiting period for the senior citizen mediclaim policy?

    Yes. Most insurance companies mention waiting until an insured can raise a claim.

  • ✔️Can I purchase and renew the policy online?

    Yes, you can buy or renew your mediclaim policy online through the official website of your insurance provider

  • ✔️What if I fail to pay the premium amount?

    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.