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Advantages of Senior Citizen Health Insurance

Lifelong Renewability

Senior citizen health insurance can be renewed for life allowing you to get insured for life. This is an added advantage which allows you to enjoy the lifelong coverage at a cost-effective premium.

Cashless Treatment

This policy offers the benefit of cashless hospitalisation where your medical expenses are directly settled by the insurer. The insurers offer 5000+ network hospitals where you can avail this facility.

No-Claim Bonus

Senior citizen health policy awards bonus for every claim-free year if the policy is renewed without break. In such a case, either sum insured increases or premium decreases by a certain percentage or both.

Pre-existing Diseases Cover

Health insurance for senior citizen will cover all the pre-existing diseases insured may be suffering from, such as high cholesterol and diabetes after 12 to 24 months from the date of commencement of the policy.

Quick Guide to Senior Citizen Health Insurance

What is Senior Citizen Health Insurance?

Senior Citizen Health Insurance policy is a type of mediclaim policy that covers medical expenses incurred by an individual above 60 years old. It offers preventive health check-up facilities to the elderly and cashless hospitalization at network hospitals of the insurer. It also covers pre-existing diseases, critical illness, hospitalization expenses, and pre and post hospitalization expenses and coronavirus treatment.

Mediclaim Policy for Senior Citizens

Older people are more prone to certain diseases and health conditions as compared to younger people. The treatment of old age-related medical conditions is not only expensive but also time taking. If you buy a senior citizen health insurance policy from a reputed Insurer, you don’t have to worry about paying for the medical expenses arising out of health-related problems in your old age.

Key Features and Benefits of Senior Citizen Mediclaim Insurance

A senior citizen insurance policy offers a variety of benefits to elderly people. Below are some of the primary benefits of buying a health insurance for senior citizens in India:

  • Medical Coverage to Elderly People: People above the age of 60 years get health cover under senior citizen health insurance plans as regular Family Health Insurance Plan.
  • Pre-medical Screening: Most health plans do not require elderly people to undergo any medical screening before buying the policy, unlike regular plans.
  • Hospitalization Expense Cover: Policy covers senior citizens against a wide range of medical expenses, including pre-hospitalization, post-hospitalization, and in-patient hospitalization expenses.
  • Cashless Treatment-: Senior citizens can avail themselves of cashless medical treatment at network hospitals of the insurance company, provided they get admitted for a minimum of 24 hours
  • No Claim Bonus: It provides a No Claim Bonus to the senior citizens that allows them to avail a discount on renewal premium for every claim-free year. It can range from 20% to 100% in some plans.
  • Lifetime Renewability: Most senior citizen health insurances come with a lifetime renewability option.
  • Tax-Benefits: Senior citizen health insurance policy offers tax exemption benefits every financial year on the paid premium under section 80D of the IT Act.

Senior Citizen Health Insurance Coverage

The common coverage provided by Health Insurance for senior citizens are:

  • Hospitalization Expenses:: There are many hospitalization expenses like doctor fees, nursing fees, cost of medicine and drugs, room charges, ICU charges, cost of surgical appliances, and operation theatre charges are covered under Health insurance for senior citizen policy. The cost of artificial limbs, orthopedic implants, prosthetic devices, diagnostic tests, required during the hospitalization is also covered under senior citizens health insurance
  • Day Care Treatments: Specific daycare treatments that require less than 24 hours of hospitalization, like dialysis, chemotherapy, etc. are covered under most medical insurance for senior citizens.
  • Pre and Post-hospitalization Expenses: Medical costs before getting hospitalized and after getting discharged are also covered under a senior citizen mediclaim policy.
  • COVID-19 Cover: Mediclaim policy also pays for the cost of covid-19 treatment, up to the specified limit.
  • Organ Donor Expenses: Most senior citizens health insurance policy cover expenses donor incurred during organ transplants.
  • Ambulance Charges:It covers ambulance charges against transportation of the insured to the nearest hospital.
  • Pre-existing Diseases: Any pre-existing ailment or disease of the insured senior citizen is also covered after a fixed waiting period.
  • AYUSH Treatment Cost: AYUSH treatment taken in a government-recognized hospital or institute is covered under some senior citizen health insurance policies.
  • Domiciliary Hospitalization Cover: If the doctor suggests home treatment for the elderly person, then his/her insurance company will pay for domiciliary hospitalization expenses too.

Exclusions of Senior Citizen Health Insurance Coverage

Below is a list of medical expenses exclusions under a senior citizen insurance:

  • Pre-existing diseases or injuries.
  • Expenses arising out of self-inflicted injuries or suicide attempt
  • Expenses arising from drug, alcohol, or other substance abuse and related treatment
  • Medical conditions diagnosed within 30 days of purchasing the policy (accidental injuries would be an exception)
  • Expenses related to non-allopathic treatment
  • The treatment cost of injuries caused due to an act of war with enemy army or a civil war
  • Cosmetic surgery
  • Cost of dental treatment or lenses/spectacles, unless arising from an accident.
  • Treatment cost of AIDS

Here it is important to note that the list of exclusions varies from one plan to another.

Claims Procedure of Senior Citizen Health Insurance

Senior Citizen health insurance plans require policyholders to file a health insurance claim if they get admitted to a hospital or avail an emergency medical treatment. A claim can be raised either to avail cashless treatment at a network hospital or alternatively get reimbursement of expenses incurred at a non-network hospital. The process of filing a reimbursement and cashless claim is given below:

Senior Citizen Health Insurance reimbursement claim Procedure:

Steps are involved in lodging a reimbursement claim:

  • Immediately notify the insurance company in case of hospitalization
  • Collect all the medical reports and documents during hospital discharge
  • Fill up and sign the Claim Form
  • Submit the Claim Form to your respective TPA or the insurer along with all the required documents like doctor’s prescriptions, pathological reports, chemist bills, certificate of hospital admission and discharge summary.
  • The claim is reimbursed by the claims team after careful review the claim documents

Senior Citizen Mediclaim Policy Cashless Claim Process:

If one avail medical treatment at a network hospital, then he/she can file for a cashless claim under a senior citizen health insurance policy:

  • Get hospitalized in a network hospital of the insurance provider
  • Fill out the pre-authorization form available at the hospital and submit same with the hospital authorities
  • The hospital will send the pre-authorization request to the TPA that needs to be approved by the insurance company or the claims team to initiate cashless hospitalization and treatment of the insured elderly person.
  • Obtain the required treatment after approval and get discharged
  • The insurance company will settle the claim directly with the hospital directly

Why Do You Need Health Insurance for Senior Citizens

Elderly citizens need to have senior citizen insurance coverage as they are prone to face severe health issues due to their increasing age. Covering senior citizens under the mediclaim policy can help you to manage the financial implications of hospital treatment. Some of the other prominent reasons why you need to buy a senior citizen insurance are:

  • To Meet the Rising Healthcare Costs:: With medical treatment and hospitalization costs getting costly, buying a senior citizen insurance policy has become imperative
  • Critical Illness Cover: With increasing age, the possibility of being diagnosed with critical illnesses like heart ailments, kidney problems, cancer, etc. becomes higher. With senior citizen insurance, you can also opt for coverage for critical illnesses in your basic plan or as an add-on cover.
  • Annual Health Check-up Facilities: Senior citizens can avail free health check-ups on a yearly basis under most senior citizen health insurance policies. Some plans may offer this feature after every two or three claim-free years.
  • Peace of Mind: Having a senior citizen insurance can bring peace of mind to senior citizens. The mediclaim cover takes care of their treatment costs for both minor and major illnesses.

Things to consider when planning to buy Health Insurance Policy for Senior Citizens

A senior citizen Health Insurance policy offers health insurance coverage to elderly people who are vulnerable to serious illnesses that may require expensive treatment. You can easily buy a health insurance plan for senior citizens online from Key features that should be considered while buying a senior citizens health insurance plan are:

  • Day Care Treatments : With the advancement in medical technology, a lot of treatments like dialysis, chemotherapy, radiotherapy, etc. can be done through day care procedures. Unlike in a regular health insurance policy, a senior citizen need not be hospitalized for at least 24 hours to raise a claim. Therefore, it is better to choose a senior citizen plan that covers a lot of day care procedures.
  • Cashless Hospitalisation: Most insurance companies today have a broad network of hospitals where you can avail yourself of cashless hospitalization facilities.
  • Efficacy of Health Insurance Claims : Insurer with a high claim settlement ratio and a less claim settlement time, should be preferred.
  • No Claim Bonus : Almost all insurance companies reward policyholders with a no claim bonus discount on premium if no claims are lodged in the previous year. .
  • Free Medical Health Check-up Facility: The best senior citizens health insurance plans allow the policyholders to avail medical check-up for free on an annual basis.
  • Co-payment: Several senior citizen health insurance policies come with a co-payment clause in which a part of the claim amount must be paid by the policyholder and the remaining by the insurance company. Therefore, one must opt for a plan with low to zero co-payment.
  • Policy Renewability : Always look for a senior citizen health insurance plan that offers a lifetime renewability option so that you won’t have to buy another health plan in your old age. Medical insurance for senior citizens that ceases to renew, especially after 60 years, is not the right plan for senior citizens.
  • Pre-existing Diseases Waiting Period : Older people are more likely to have pre-existing diseases whose treatment can exhaust all your savings. Therefore, you should opt for a senior citizen health Insurance policy that comes with a minimum waiting period for pre-existing diseases.
  • Domiciliary Hospitalization : In a situation where an elderly person’s health condition may not allow him/her to get admitted to a hospital, a health plan with domiciliary hospitalization cover can relieve the policyholder from financial distress.

Tax Benefits of Senior Citizen Health Insurance

The key benefit of the policy is, the Insured person is eligible for tax benefits under Section 80-D of the Income Tax Act 1961 in respect of the premium paid by any mode other than cash. Under Medical insurance for senior citizens, policyholders may avail a higher deduction of up to 50,000 for payment of premium towards medical insurance policy. This limit is 25,000 in the case of Non-Senior Citizens.

Senior Citizen Health Insurance FAQ

Senior Citizen Mediclaim policy is a type of health insurance plan that covers medical expenses incurred by people above the age of 60 years. This mediclaim policy offers preventive health check-up facilities to the elderly and cashless hospitalization at network hospitals of the insurance company.

Deciding the best health insurance for senior citizens depends on the buyer’s individual needs. You can pick the most suitable mediclaim policy as per the personal needs of senior citizens, such as health status and so on. Given below is the checklist to help you buy the best senior citizen health insurance:

  • Opt from plans with lower pre-existing diseases waiting period
  • Choose from the Insurers with large number of Network Hospitals
  • Select plans with free medical check-up Facility
  • Go for a plan with No Claim Bonus (NCB) benefit
  • Opt for No co-payment
  • Yes, there are several health insurance plans for senior citizens that cover critical illnesses. While some plans offer coverage for critical diseases as an in-built cover, others offer it as an add-on cover which can be opted by paying additional premium.
    Most senior citizen mediclaim policies provide the sum insured on an individual basis.


    What should you consider while buying health insurance for senior citizens?

    People who are looking for health insurance for their senior citizen parents, or senior citizens who want to buy health insurance for themselves, should consider the following points which will help them to buy the right policy:

    Age: Most of the health insurance companies offer policies for senior citizens, but they limit the entry age as 65....

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    How does portability work in case of Senior Citizen Health Insurance?

    In case you are not satisfied with the services and coverage of your senior citizen health insurance, you can think of porting the policy. The portability also results into waiving off waiting period for pre-existing ailments with the new insurer if you have served the same number of years in the current insurance policy. Also, portability happens....
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    What happens when you cancel a senior citizen health policy midway through the policy year?

    If you have a senior citizen health insurance policy, it is feasible to cancel the policy midway through the policy year.

    Here it is important to note that a health insurance company can also cancel the insurance policy by sending 30 days’ notice at the insured’s last registered address. In such a case, the insurer shall refund the premium to the policyholder....

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