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Health Insurance for Senior Citizens: Features, Benefits and Limitations

Team AckoAug 12, 2021

Increasing age demands more medical attention and consequently more expenses. Health insurance for senior citizens reduces the financial strain caused by frequent medical expenses. These insurance policies are designed especially for elderly people and cater to their medical needs. Health insurance can ensure timely treatment and better health outcomes.

Senior Citizens Health Insurance

Health insurance plans for senior citizens

People above the age of 60 years are considered senior citizens, and they can buy a dedicated health insurance policy. This type of insurance is called Health Insurance for Senior Citizens. Buying a separate policy for them is advised as senior citizens might face recurring health issues, and a normal plan may be insufficient to cover their insurance needs.

Key features and benefits of senior citizen’s mediclaim policy

Following are the key features of buying a senior citizen health insurance cover.

Lifetime renewability 

Some health insurance plans have a limited renewability option that does not allow a policyholder to renew the policy after a certain age. However, most insurance companies allow a lifetime renewability option for their senior citizen health insurance plan.

Cashless claim facility

The insurance company will bear most of the hospitalisation cost when the policyholder opts for a cashless claim facility. A senior citizen or their family members do not have to worry about arranging funds to get treatment if admitted to a network hospital and availing of a cashless claim.

Discounts

Many health insurance discounts like No Claim Bonus (NCB), renewal discounts, etc., help to reduce the premium of a senior citizen health insurance plan.

Less waiting period

The waiting period on a senior citizen plan is less as compared to other health insurance plans. The policyholder can claim for the cost of treatment without waiting for years.

Tax benefits

Many tax benefits are announced each year for buying health insurance for senior citizens. More on this, in the later section. 

Inclusions of senior citizen’s medical insurance

The coverages of a senior citizen plan are defined in the insurance policy. These are conditions under which a policyholder can raise a health insurance claim. Here is a list of general inclusions of a senior citizen’s health insurance coverage. These can differ from insurer to insurer.

  • Hospitalisation: Covers the cost of treatment against illness or injuries. Hospitalisation includes expenses related to doctor's visits, room rent, operation theatre charges, etc.

  • ICU charges: ICU charges are much higher than normal room rent expenses. These are covered under the senior citizen health insurance policy.

  • Ambulance charges: Charges related to transporting the insured to the nearest medical facility as per the terms and conditions of the health plan.

  • Pre and post-hospitalisation: Coverage for expenses related to pre-hospitalisation for up to 30 days and post-hospitalisation for up to 60 days.

  • Daycare treatment: Small medical procedures that do not require hospitalisation for more than 24 hours come under daycare treatment. For example, cataract surgery is covered.

  • Domiciliary treatment cover: Coverage for treatment availed at home.

  • Second opinion: Includes consultation fees from another medical practitioner.

  • Annual preventive health check-up: Expenses related to full-body health check-ups to detect any future ailments.

Exclusions of senior citizen’s medical insurance

Following are the general exclusions of a senior citizen health insurance plan. Consider going through the policy document for a detailed list of exclusions.

  • Intentional injuries including self-harm or attempted suicide.

  • The need for medical treatment from taking part in an adventure sport.

  • Injuries as a result of war.

  • Venereal diseases or STDs (sexually transmitted diseases).

  • Cosmetic surgery unless necessary due to an accident.

  • Dental treatment unless necessary due to an accident.

  • Medical treatment related to obesity.

  • Treatment or surgery related to gender replacement.

  • Unproven medical treatments are not covered.

  • Maternity expenses.

  • Experimental therapies.

What is the claim process for a senior citizen health insurance plan?

The claim process for health insurance plans is quite simple. First, the policyholder needs to inform the insurance company about the hospitalisation or other claims as per the health plan. Then they can choose to get the claim settlement in either of the following ways.

Senior citizen medical insurance reimbursement claim procedure

The policyholder files for a reimbursement claim when he/she pays the entire medical bill first. Here are the steps to file a reimbursement claim.

Step 1:  Inform the health insurance company while availing treatment for a medical condition.

Step 2: Pay for the medical event and collect all necessary documents.

Step 3:  Raise a claim by following the process specified by your health insurance provider.

Senior citizen medical insurance cashless claim process

The cashless claim can be availed of from a network hospital only. A network hospital is any medical facility that has a tie-up with your health insurance company. An insurance company with more network hospitals can provide better cashless facilities as the policyholder does not have to go far to find a network hospital. Here are the steps to get a cashless claim against your senior citizen health insurance policy.

Step 1: Visit a network hospital to avail of medical treatment and inform your insurer.

Step 2: Submit necessary documents like health card, authorisation form, etc.

Step 3: Pay the applicable deductibles. Your insurer will bear the major part of the hospital bill.

Tax benefits on senior citizen health insurance

Senior citizen health insurance plans attract a tax benefit u/s 80D(2)(b) of the Income Tax Act, 1960. A tax benefit of Rs. 25,000 is applicable for each senior citizen parent. This benefit includes the cost of a preventive health check-up worth Rs. 5,000.

A tax benefit further stretches for the treatment of specific diseases. A deduction of up to Rs. 1 lakh can be availed under section 80DDB of the Income Tax Act, 1961 if the policyholder and insured, both are senior citizens.

Note: These tax figures are as per the financial budget 2021-22, and are subject to changes.

Why should senior citizens buy a health insurance policy?

Senior citizens need more medical attention as compared to others. Thus, hospital visits may become frequent with increasing age and the increased cost of treatment can put a burden on the finances. Senior citizen health insurance provides a helping hand here. Take a look at the following list to know more.

  • The majority of the hospitalisation expenses are borne by the insurance company.

  • Preventive health check-ups (covered under health insurance) can detect the early signs of disease.

  • Cashless hospitalisation reduces financial stress.

  • Timely medical attention can be sought as daycare treatments are also covered under senior citizen health insurance.

  • Many pre-existing diseases are covered under a senior citizen plan (subject to the terms of the policy).

Eligibility criteria

Eligibility criteria for buying a senior citizen health insurance plan is decided by each insurance company for their policyholders. Usually, for senior citizens, the starting age for buying health insurance is 60 years. Some plans offer lifetime renewability and there might not be a set exit age on the policy. To buy a senior citizen health insurance plan, the person should also be a resident Indian and must have at least one identity proof.

Required documents

Here is an indicative list of documents that can be necessary for submissions while buying or renewing a senior citizen health insurance policy.

  • Previous health insurance (if applicable)

  • Voter ID card

  • PAN card

  • Aadhaar card

  • Passport

  • Birth certificate

Tips to choose the right to health insurance coverage for senior citizens

A senior citizen plan is slightly different from a regular health insurance plan. Here are some tips to buy the best plan available.

  • Compare senior citizen plans offered by various insurers online 

  • Check the reputation of the insurance company by visiting their social media handles

  • Select plans with more coverage and less premium

  • Buy health insurance plans that offer coverage for daycare procedures and ambulance charges

  • Opt for a senior citizen health insurance cover with lifetime renewability

  • Choose a health insurance company that has a wide network of hospitals with cashless facilities

  • Speak to the insurer and understand if related pre-existing illnesses are covered

  • Select a senior citizen health insurance plan with less waiting period

  • Look for a plan that has a free look-up period

  • Use the health insurance premium calculator to understand the approximate cost of the policy

It is important to note that senior citizens need frequent medical attention. This can increase the premium and deductibles on their insurance plan. However, these expenses still seem insignificant as compared to the coverage a senior citizen health insurance policy provides.

Frequently asked questions

Take a look at the following common queries about senior citizen health insurance plans.

Are health insurance plans available after the age of 60?

Yes, health insurance plans are available after the age of 60 and can go up to 75 to 80 years as per the terms of the insurance company. These plans are called Senior Citizen Health Insurance Plans.

Which is the best government plan for senior citizen health insurance?

A senior citizen between the age of 60 to 65 years can avail of the Aarogya Sanjeevani health insurance policy. This plan provides coverage for COVID-19 as well.

Is it a good idea to buy a separate health insurance plan for senior citizen parents?

Yes, buying a separate plan will help cater to their growing medical needs without putting a burden on the Family-floater plan.

How much does a senior citizen health insurance plan cost?

The cost of a senior citizen health insurance plan depends upon various factors like the extent of coverage, add-ons, benefits of the plan, the exact age of the insured, etc. These costs may vary for different insurance companies.

Are senior citizens covered under family insurance?

Yes, senior citizens can be covered under the family’s health insurance plan. Having a higher sum insured will be helpful to get complete coverage.

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