The Government of India’s Senior Citizens’ Health Plans

Having a health insurance plan in place is never so important as when one is a senior citizen. The high hospitalization costs incurred in case of unexpected illness is a shock which most people, especially retired persons are unable to bear. Due to the fact that increasing age is often accompanied by increasing illness, especially when one crosses the age of forty-five, it is best to have a health insurance policy in place.  There are several insurance policies tailored to the needs of senior citizens. What’s more, the government shows interest in these people by providing them a plan directly or through the insurers sponsored by it. Here’s a look at such plans.

PMJAY or Pradhan Mantri Jan Arogya Yojna

 This is a central government funded scheme which provides INR 5 lakh/ cover per family per year and includes coverage of senior citizens of eligible families. This is available for deprived families and identified occupational categories of urban workers’ families as categorised by the Socio-Economic Caste Census (SECC-2011) database on the basis of 6 deprivation criteria and 11 occupational criteria across rural and urban areas respectively. However, some states have expanded the scope of the scheme to include other categories of beneficiaries as well.

 A few key features of the scheme are as follows:

i. Secondary and tertiary hospitalisation care through a set of 1393 defined packages

ii. Pre and post-hospitalisation coverage apart from inpatient hospitalisation.

iii. No waiting period

iv. Cashless facility available at public hospitals and empaneled private hospitals

A beneficiary verification process is undertaken by the state government after which Ayushman Cards are issued to eligible beneficiaries.

HOPE by Oriental Insurance

Hope of Privileged Elders or HOPE by Oriental Insurance Company, specifically designed for seniors above the age of 60 is a senior citizen, specified disease insurance. The sum insured is INR 100,000/- at the minimum, and is available up to a maximum limit of INR 500,000/-. A few key features of the plan are listed below:

i. Specified Diseases covered up to specified limits.

ii. Covers treatment costs in recognized AYUSH Hospitals

iii. Covers the cost of telemedicine expenses

iv. NCD or No Claim Discount provided against premiums

v. Benefits of continuity are available while migrating from one policy to another

Some of the disadvantages of the plan are listed below:

 i. There is a mandatory co-payment of 20%

ii. Cashless services are only available through Third Party Administrators (TPA) and limited to INR 100,000/- only

iii. Except for hospitalization due to accident, there is a mandatory co-payment ranging from 20% to  90% as follows:

 Varishtha Mediclaim Policy for Senior Citizens by National Insurance Company Ltd.

 This plan is for seniors between the age of 60 to 80 with renewability available up to the age of 90. It offers a coverage of INR 1-2 lakh depending on the illness. While only INR 1 lakh coverage is provided for in-patient hospitalisation, for most illnesses, it provides a coverage of INR 2 lakh in the case of eight critical illnesses

Key Features of the Plan :

i. Room rent charges up to 1% of the sum insured per day

ii. Domiciliary Hospitalization coverage up to 20% of the SI

iii. Hospitalization expenses of donors covered subject to certain sub-limits specified.

iv. Cumulative Bonus is provided at the rate of 5% for every claim-free year

Some disadvantages are as follows:

i. Except in the case of cataract and benign prostatic hyperplasia, there is a mandatory co-payment of 10%

ii. Waiting period of one month for any claim except in the case of an accident. A waiting period of one year for pre-existing diseases with the exception of hypertension and diabetes

iii. Expenses due to malignant tumours, tumours arising out of HIV infections and skin cancer are not covered.

Senior Mediclaim policy by New India Assurance

This is a policy specially designed for those over 60 years of age.

Key Features:

i. Pre and post-hospitalisation expenses are covered up to 5% and 10% of the SI respectively

ii. Coverage of several day care Procedures

iii. AYUSH treatment coverage up to 25% of the SI

Some of the disadvantages of the plan are as follows:

i. Some of the diseases are covered subject to completion of the waiting period. For e.g. cardiac conditions under this policy have a waiting period of 90 days. Benign ear/nose/throat disorders, cataract or hernia have a waiting period of 18 months, while joint replacements and genetic disorders have a waiting period of as much as 48 months. However, if the policy has been ported or migrated as per the IRDAI norms, the waiting period will reduce to the extent of the prior coverage period of the previous policy.

ii. Coverage of genetic disorders, mental illness and neuro-degenerative disorders is limited to 25% of the sum insured.

Senior Citizen Mediclaim Policy by United India Assurance

 This is a policy for persons between 60 to 81 years of age with a renewability feature post this age subject to continued renewal during the preceding period.  The SI ranges from INR 1-3 lakhs.

Key Features:

i. This plan offers coverage of pre and post-hospitalisation expenses in addition to in-patient hospitalization

ii. Domiciliary hospitalisation expenses are also covered

iii. Specified day care procedures are covered under the plan

iv. Treatment under AYUSH streams of medicine are also covered subject to defined limits.

Some disadvantages of the plan are as follows:

i. Certain conditions such as hernia and cataract are only covered up to a maximum of 25% of the SI

ii. ICU expenses find limited coverage – up to a maximum of 2% of the SI

iii. The policy can not be bought online.

Having a health insurance policy once one crosses the age of sixty is almost considered to be an essential budget item in today’s scenario where hospitalisation costs are increasing. Plans offered by several government insurance companies, designed for senior citizens, are worth considering in this context.