Senior Citizen Health Insurance - Coverage & Claim Process

The benefits of senior citizen health insurance are as listed below:

Popular Health Insurance Plans for Senior Citizens

Following are the most popular senior citizen health insurance plans in India:

1. Bajaj Allianz: Silver Health Plan

1. Cashless facility in all of the network hospitals, under the Silver Health plan.
2. Bajaj Allianz Diagnostic centres can be used for a free health check-up after a period of 4 years which are claim free.
3. Extra 5% discount for the family, and a bonus which is cumulative at a 5% rate for every claim free year.
4. Individuals within the age group of 46 years - 75 years are eligible for this plan, after required medical tests

2. Oriental Insurance: HOPE - Health of Privileged Elders

1. The policy will provide the room rates, expenses related to nursing, to the limit of 1% of the sum insured.
2. The policy will include ambulance charges up to Rs. 1000/- or the actual expenses incurred.
3. All doctors, anaesthetist, surgeon, specialists charges are covered under the policy. As well as all the costs related procedures they will need to perform. Example, blood, oxygen tanks, surgical appliances, Dialysis, Chemotherapy, Radiotherapy etc.
4. If the insured individual will need intensive care, then intensive care unit will be covered to a limit of 2% of the sum insured per day.

3. United India Insurance: Senior Citizens

1. The policy will cover hospitalization for room and boarding expenses and expenses related to nursing to the limit of 1% of the sum insured or the actual expenses incurred whichever is less.
2. All doctors, anaesthetist, surgeon, specialists charges are covered under the policy. As well as all the costs related procedures they will need to perform. Example, blood, oxygen tanks, surgical appliances, operation theatre charges, x-rays etc.
3. Pre and post hospitalization charges are covered up to 30 days for pre hospitalization and 60 days post hospitalization.
4. For Cataract, Hernia, and Hysterectomy - the coverage will be 25% of the sum insured or the actual expenses incurred whichever is less.

  4. Star Health & Allied Insurance: Red Carpet

1. hospitalisation fees for patients
2. Cost of ambulance
3. Health check-up
4. hospitalisation costs both before and after

5. Care: Care Supreme

1. Insurer pays the full claim
2. No limits on room rents
3. Pre-existing conditions can be accessed starting on Day 30.
4. Unlimited Sum Insured restoration

6. Manipal Cigna Health Insurance: Prime Senior (Classic & Elite)

1. Option to utilise entire insurance claim payment
2. Expenses for inpatient care are covered up to a single AC private room
3. after three months, the option to cover pre-existing conditions

7. HDFC ERGO – Optima Senior

1. No sub-limits on room rent or treatment costs, ensuring full coverage flexibility
2. Pre-existing conditions covered after a 3-year waiting period (standard industry term)
3. Restore Benefit automatically replenishes 100% sum insured if exhausted in a claim
4. Longest post-hospitalization cover (90 days) compared to most competitors (60 days)
5. Lifelong renewability up to age 90 with stable premium increments

8. New India Assurance: Senior Citizen Mediclaim Policy

1. Eligibility for this policy, the individuals should be between the ages of 60 years - 80 years. This can continue up to 90 years if renewed without a break.
2. Pre and post hospitalization charges are covered up to 30 days for pre hospitalization and 60 days post hospitalization.
3. Hospitalization for illness and injuries will be covered and all treatments conducted will be covered as well.
4. All pre-existing ailments and diseases will be covered after the completions of 18 months with the continuous involvement with the company.

Why is it important for Senior Citizens to have a health insurance policy?

1. Increased Health Risks: As individuals age, the likelihood of developing chronic illnesses and health complications increases. Senior citizens are more prone to conditions such as heart disease, diabetes, arthritis, and other age-related ailments that can require ongoing and costly medical care.

1. High Medical Expenses: Healthcare costs, including hospitalization, surgeries, medications, and consultations, are steadily rising. Without health insurance, these expenses can be overwhelming, especially for those on a fixed income or without a steady source of income post-retirement.

1. Financial Security: Health insurance provides a financial safety net, protecting seniors from depleting their savings or relying on their children for medical expenses. It ensures that they can access necessary treatments without financial strain.

1. Access to Quality Healthcare: With a health insurance policy, senior citizens can access better healthcare facilities and treatments. Many policies offer cashless treatment at network hospitals, allowing for immediate and hassle-free medical attention during emergencies.

1. Coverage for Critical Illnesses: Senior health insurance policies often include coverage for critical illnesses like cancer, heart attacks, and strokes. This coverage is crucial as treatments for such conditions can be extremely expensive.

1. Peace of Mind: Having health insurance gives seniors peace of mind, knowing that they are protected against unforeseen medical emergencies. It reduces anxiety about the financial burden of healthcare costs, allowing them to focus on their well-being.

1. Support for Family Members: Health insurance for senior citizens also reduces the financial and emotional burden on family members who might otherwise have to bear the cost of medical care for their elderly parents.

1. Tax Benefits: Premiums paid for senior citizen health insurance are eligible for tax deductions under Section 80D of the Income Tax Act, providing additional financial relief.

What is Covered and Not Covered under Senior Citizen Health Insurance?

Eligibility Criteria for Senior Citizen Health Insurance

1. Most insurers offer senior citizen health insurance for individuals aged 60 years and above.

1. Some policies may require a pre-policy medical check-up depending on age and health conditions.

1. Eligibility may vary based on existing illnesses and previous medical history.

1. Proof of age, identity, and address is typically required during the application process.

Documents Required

1. Pre-policy medical checkup documents
2. Duly-filled proposal form
3. Supporting documents for any pre-existing condition
4. Age proof

Claim Settlement Process for Senior Citizen Health Insurance

Plans for Senior Citizen Health Insurance require policyholders to submit a health insurance claim if they need emergency medical care or are admitted to the hospital. You can file a claim to receive cashless care at a network hospital or to be reimbursed for costs you incurred at a non-network hospital.

How to Select the Best Senior Citizen Health Insurance?

Keep these following points in mind to choose the best senior citizen health insurance plan - 

1. Before making a shortlist, compare the many new and old senior citizen health insurance policies available in India. You must compare several senior health insurance plans by taking into account a number of elements, including inclusions, exclusions, riders or add-ons, premium, etc.
2. If you want to purchase insurance for your parents or older folks, you must be informed of their medical history. Relying on their knowledge of their medical history may not be a smart choice because, occasionally, even they may not be aware of the health concerns they may be experiencing. You must thus double examine any such information before giving it to the insurance company.
3. You must choose a senior health insurance plan and provide accurate and relevant information. Any false information could result in the rejection of your application and could cause problems if you ever need to make a claim.

Tax Benefits of Senior Citizen Health Insurance

A senior citizen health insurance plan not only ensures the payment of medical bills, but also entitles you to a tax break under Section 80D of the Income Tax Act of 1961. If you have an older medical insurance policy for your parents, you may be eligible for a tax credit of up to Rs.50,000.

Tips for Reducing Premiums on Senior Citizen Health Insurance

• Opt for a higher deductible to lower the premium amount.
• Compare policies from multiple insurers to find the most cost-effective option.
• Maintain a healthy lifestyle to avoid higher premiums due to medical conditions.
• Choose a policy with essential coverage only, avoiding unnecessary add-ons.

Co-payment and Deductibles in Senior Citizen Plans

Co-payment means the insured pays a fixed percentage of the hospital bill, while the insurer pays the rest. Deductibles are a fixed amount the insured must pay before insurance coverage starts. Both help lower premiums but increase out-of-pocket expenses. Choose a plan that balances cost and coverage based on your healthcare needs.

Role of Pre-existing Conditions in Policy Selection

Pre-existing conditions play a crucial role in choosing a senior citizen health insurance policy. Insurers may impose waiting periods or exclude certain conditions from coverage initially. It’s important to disclose all medical history accurately to avoid claim rejections later. Selecting a policy that offers comprehensive coverage for pre-existing illnesses ensures better protection and peace of mind.

Final Thoughts

Senior citizen health insurance is essential to protect against rising medical costs and age-related health issues. Choosing the right policy involves understanding coverage for pre-existing conditions, co-payments, and deductibles. Comparing plans helps find affordable options with the best benefits. Ultimately, it provides financial security and peace of mind for seniors and their families.