Complete Guide on Senior Citizen Health Insurance

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 only does getting a comprehensive health insurance plan help 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 breadwinner of the family due to the financial crisis.

So why 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 many plans nowadays, making it confusing for 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 for senior citizens, various government schemes for them and exclusions of senior citizen plan.

Importance of Health Plans for Senior Citizens

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

1. For Medical Problems in Old Age

It is very difficult to escape medical problems that come only with old age even if one maintains a healthy lifestyle more than 90% of senior citizens do not have a good and healthy lifestyle which leads to an 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 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 policies can prove to be of great support for the sufferer as well as the family as a good policy also provides covers major critical illnesses such as body part transplant, heart disease or diabetes as well.

2. Elimination of the Costs of Regular Medical Check-ups

Regular doctor visits are of extreme importance because regular check-ups keep you aware of 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 issues later on. To avail of 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 of free health check-ups regularly.

3. Health Insurance Plan Makes You Financially Independent

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

4. Perfect Way to Invest Money for Your Old Age

Your entire savings might be wasted if not appropriately invested 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 in 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. Daycare costs are covered which arise due to the use of special equipment while treating dialysis and chemotherapy etc.
4. Annual health check-up facility
5. Cashless hospitalization can be availed if the patient is admitted for more than 24 hours, which consists of doctor fees, medical bills, room charges, etc.
6. Option to renew policy available (for a lifetime in some plans)
7. Ambulance expenses for transporting the policyholder depend on the limits. 
8. Pre and Post hospitalization are 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-day 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 prior knowledge if you are selecting the plan for yourself or your parents. Here is a detailed look at senior citizen health plans that are currently available in the market.

1. Co-pay

Co-pay is the proportion of the 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 the claim will be paid by the insured and the rest 75% of the claim will be paid by the insurance company. That means in case of an INR 10,000 claim, INR 2500 will be paid by the policyholder and the rest INR 7500 by the insurer.

2. Limits on Sum Assured

In the senior citizen plan, the sum assured is usually limited in the amount as in old age there is a higher probability of getting a serious illness, therefore, insurers often cap/limit the maximum amount of coverage that can be availed. Generally, coverage ranges between INR 1 to INR 3 lacs.

3. Pre-existing Medical Condition

It is the most common exclusion in almost all the plans which means that the ailments or any pre-existing medical conditions you are suffering from while buying the plan will be excluded from the scope of coverage for a few years, also known as the waiting period, and senior citizen plans have a waiting period which ranges from 2-4 years. 

4. Medical examination 

Senior citizen health insurance plans most of the time 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 examined such as the requirements of the insured, and 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 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 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 the 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 that has a higher sum assured, which can cover all your medical expenses as old age requires more medical check-ups and is 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 that will have a lower waiting period for pre-existing disease coverage so that the insurance coverage can come in handy when the insured needs 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 that will have a 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 a reduction in co-pay with every renewal.
• Renewal age: Choose a policy with the maximum renewal age (the age till which a policyholder can renew his/her policy), and the most preferred one is a lifetime renewal option.
• Insurance coverage: Select a policy that offers wider coverage of illnesses, including medical conditions like diabetes, cancer, etc., and has 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 of cashless hospitalisation in the network hospital in case of a medical emergency.

Senior Citizen Health Insurance Exclusions

Below mentioned are the basic exclusions of senior citizen health insurance plans:

• Any disease detected within the 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 due to accident
• Cosmetic surgery
• Injuries due to war

Top Most 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 on a limited budget. The 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 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 – Up to 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

Various Govt. health insurance plans are provided by the Indian government for senior citizens to safeguard the health of senior citizens of our country. Let us have a look at these schemes: 

1. Varishta Mediclaim Policy

Varishta Mediclaim policy by the government is made for 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. A sum assured of INR 1 lac is provided for hospitalization, and in case of critical illnesses, the sum assured is 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, cataracts ad organ transplants, etc. are covered depending upon the policy contract.
5. One-fourth of the sum assured is for surgeons, consultants, specialists, and 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 hypertension do not require the waiting period if an additional premium is paid.
8. Post-hospitalization charges are covered up to 60 years of age.
9. Under the Income Tax Act, premiums of up to INR 15,000 are allowed as deductions.

2. National Mediclaim Policy

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

Key Features of National Mediclaim Policy

1. 140 days of daycare procedures
2. Ambulance charges up to INR 2000
3. Inclusion of physician, surgeon, anesthetist fees, room charges, transfusion, and injection charges
4. First 30 days of accidental cover
5. Medication and test 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 increased by 5%
9. Cashless treatment facilities are available at 6000 network hospitals in India.
10. Tax benefits are available on the premiums paid.

3. Central Government Employees and Pensioners Health Insurance Scheme

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

The plan includes one exclusive benefit that is not available in most of the plans available in the market, that is, No waiting period for coverage initialization and pre-existing conditions even for 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 provided.
4. Free specialist visits at government hospitals for check-ups.
5. OPD treatment and medicinal cost
6. Medication and consultation of Siddha, Ayurveda, and 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. The 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 these 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 coverage to reduce the premiums. Therefore, it is essential to not rely on just group/family health policies to offer health coverage 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 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. However 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 than 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 highlights the importance of senior citizen health insurance plans and how buying them is not a choice anymore but a necessity. There are so many plans available in India which provide 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. 

Also Read:

Factors to Consider in Choosing a Senior Citizen Health Insurance Plan​

New Health Insurance Guidelines to Benefit Senior Citizens?

Top 5 health insurance plans available at low premiums

Top health insurance plans with ambulance cover