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Difference between government health insurance plans and private medical insurance policy

Team AckoOct 20, 2021

To provide affordable and quality healthcare, the Government of India (GoI) has introduced several government health insurance schemes to cater to different requirements. The health insurance schemes offered by the government include both the Central and State Government initiatives. Both government and private health insurance policies have their unique features and benefits. It caters to different requirements of the policyholder. Let’s look at how they differ.

Government health insurance plans vs. private medical insurance policy

Government vs. private medical insurance policy

FEATURES GOVERNMENT HEALTH INSURANCE PLAN PRIVATE HEALTH INSURANCE PLAN
Premium Lower premium Higher premium
Discount Highly discounted by the government Competitive pricing
NCB benefit NCB not available NCB available
Coverage Provides coverage with an upper limit Full coverage on most medical expenses
Sum insured amount Moderate sum insured amount Higher sum insured amount subject to payment of higher premium
Customers Targeted at low-income individuals or families Open to everybody

Difference between private vs government health insurance scheme for senior citizen

Increased health risks due to ageing and rising medical care costs warrant a health insurance plan that is suitable to your requirements. The Indian government offers several senior citizen specific health insurance plans that come with several benefits. The private sector has also launched several unique health insurance plans that can fit your budget and requirements.

But, how different are they? Let’s understand the difference between government and private health insurance plans for senior citizens so that you can make an informed choice.

Parameters Private Health Insurance Scheme for Senior Citizens Government Health Insurance Plan for Senior Citizens
Definition Any health insurance plan offered by a private general insurance company instead of the government is known as a private health plan. These plans provide access to the higher sum insured and advanced medical care, usually at a higher premium. Subsidised senior citizen health insurance plans by the government are referred to as government health plans. It could be free or reduced to provide access to quality healthcare at an affordable cost.
Coverage It covers a range of medical expenses that an individual may incur in a year. And access to a wide network of private hospitals. It covers a range of healthcare costs that an individual may incur in a year. Mostly these benefits are available in government hospitals.
Benefits Low-cost to high-cost policies, depending on the coverage you select, Access to advanced medical care, High sum insured Access to a vast network of hospitals, Access to top-up and super top-up plans, Restoration of the sum insured Low-cost policies, Backed by the government, Ensures the underprivileged have access to health insurance cover
Inclusions In-patient hospitalisation, Pre and post hospitalisation charges, AYUSH benefits Ambulance cost, Organ donor charges, Critical illness cover (If applicable), Daycare procedures (If applicable), Domiciliary hospitalisation Same
Exclusions Illnesses contracted within 30 days of policy commencement, Dental treatments unless it is due to an accidental injury, Sexually transmitted diseases (HIV/AIDS), Self-inflicted injuries, Cosmetic procedures, War and related perils, Hearing impairment, Vaccination/inoculation, Pregnancy, Treatment availed outside India, Treatment for alcohol or drug abuse, Psychiatric disorders Same
Tax Benefits Tax benefits under Section 80D Section 80D
Claim settlement Cashless and reimbursement Both
Pros Low-cost to high-cost premiums and access to advanced medical care Low-cost and affordable premiums
Cons High premiums Limited sum insured

Tips to remember before buying a private or a government health insurance plan for senior citizens

Here are some of the factors that you must consider while comparing private and government health insurance schemes for senior citizens.

  • Age: The entry and maximum age for renewal of the policy are essential factors in purchasing a senior citizen plan. Plans with lifelong renewability certainly offer more scope.

  • Sum insured: Having a higher sum insured or adequate coverage is vital while choosing a good health plan for senior citizens. Choose a plan that offers enough insurance coverage.

  • Waiting period: Opt for a plan with a lesser waiting period as senior citizens are prone to age-related illnesses.

  • Hospital network: Choose a plan that has a wider network of hospitals, especially if you are opting for a private health insurance plan for senior citizens.

  • Specific illness cover: Based on the individual’s specific health care requirements, opt for a plan that covers a specific illness which the individual may require.

  • Read the read and conditions: You must read the terms and conditions before opting for a senior citizen health plan. Understand the inclusions and exclusions to avoid unwanted surprises during claim settlement.

  • Cost: Typically, senior citizen health insurance plans are expensive due to higher deductibles and copay, especially when you are looking for a comprehensive cover. Choose a health insurance plan for senior citizens based on needs and the cost.

Frequently asked questions

Here are a few questions about private and government health insurance schemes for senior citizens.

Can anyone buy government health insurance policies for senior citizens?

Different health insurance plans have different eligibility criteria. You need to check the required criteria to buy government health insurance schemes for senior citizens.

What is a free-look period in a senior citizen health insurance plan?

The free-look period in a health insurance plan is a time period that allows the policyholder to review the terms and conditions of the plan and decide whether to opt for the plan or not. Normally, the free-look period of such plans is between 15-30 days. However, this may vary from insurer to insurer.

What is copayment in a health insurance policy?

The co-payment in a health insurance policy refers to an agreement between you and the insurance company. Here, you pay a portion of the medical care bill from your pocket, and the insurer will pay the balance amount.

Is there a difference between private and government healthcare?

There is no difference between these two types of healthcare. However, government healthcare is typically provided in a government based hospital, while private healthcare is offered at private hospitals. Also, amenities in private healthcare are slightly better and advanced than government healthcare.

I have a government senior citizen health insurance plan. Can I get additional coverage with a private senior citizen health insurance scheme?

Yes, having adequate coverage is crucial, especially if you opt for a senior citizen health plan.

Can I buy government health insurance plans for senior citizens online?

Some government health schemes can be bought through the direct bank debit facility; however, not all plans can be purchased online.

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