Senior Citizens Health Insurance

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If there has ever been something that brought the world to a stand-still, it is most certainly COVID-19.  It has affected each and every human being on earth. But as the world came to a stop, many realised that being prepared for a crisis is the best way to fight it. It gave everyone the chance to think about how important it is to be healthy and safe.  It also gave everyone and the time to look after their loved ones, especially the elders in the family, who along with children were and still are, the most vulnerable against the deadly Coronavirus.  

Old age brings with it higher chances of falling prey to health issues and complications. And in today’s time when there is an unabated rise in the cost of healthcare facilities, affording treatment in a decent hospital can burn a big hole in the pocket. Investing in a good health insurance plan can not only help you deal with a financial crisis but also give you mental peace that even in case of a medical emergency, you have the shield of a health insurance plan.

Buying a  health insurance plan for senior citizens can prove to be a very wise step, however, there are many misconceptions when it comes to buying insurance for the elderly. So, we are going to discuss everything you should know about Senior Citizen Health Insurance.

Senior Citizen Health Insurance 

Custom-made for people over 60 years of age, Senior Citizen Health Insurance offers health insurance policies for the elderly. They cover common health problems faced by people in this age and also accidental hospitalisation, day-care procedures, health check-ups and critical diseases. 

Let us take a look at this example.

Roshan is a 35-year-old man, he lives with his wife, one daughter and retired parents. His father when in service had a health insurance plan, however, with his job the policy also ended. Since both his parents are now above 65, Roshan knew that a medical crisis could have an adverse effect on their otherwise comfortable life. He wanted to buy health insurance policies for them but had heard that health insurance for people above 60 is very expensive. 

But to his surprise, it wasn't so. When he compared the cost of treatment of different illnesses with the cost of the policy, he soon realised that buying health insurance policies for senior citizens is far more affordable than paying the long hospital bills. Roshan not only secured his savings but also felt satisfied knowing his parents would be financially secure even in case of a medical emergency. 

Features of Senior Citizen Health Insurance Plan 

Different health insurance plans come with different features, however, the following are the most typical to all:

  1. Most plans cover people who are between the age group of 60-75 years. However, it varies from plan to plan
  2. Coverage benefits and the sum insured of the plan depend on the age and health conditions of the senior citizen. The premium changes accordingly
  3. There is easy access to a variety of plans and companies is possible through the internet with easy access
  4. An indemnity-based health insurance plan for the senior citizen will cover you from COVID-19
  5. Some health insurance plans for the senior citizen have room rent caps and other sub-limits, but some don’t. However, health insurance plans without sub-limits and room rent caps are usually more expensive for similar coverage.
  6. The option of lifetime renewability is also available with most plans.
  7. The premium paid for the health insurance plan for a senior citizen is eligible for tax deduction under section 80D of the Income Tax Act upto INR 50,000 per annum
  8. Some plans have a pre-policy medical test, however, some do not. They only have a declaration of good health
  9. With the free-look period, you have the option to cancel the policy within a given number of days, even after buying, usually 15 days from policy inception

Points to consider while opting for the best Senior Citizen Health Insurance Plan:

  1. Pre-existing ailment coverage
    Since quite a few senior citizens have pre-existing ailments, it is a very important consideration to weigh while opting for a health insurance plan for a senior citizen. Most pre-existing ailments have a waiting period before the same is covered under the plan.

    Pro Tip: Check for the least waiting period for any pre-existing ailment that you might have at the time of applying for a health insurance plan for a senior citizen. It is advisable to compare senior citizen health insurance plans before purchasing one.

  2. Co-payment 
    Some senior citizen health insurance plans have a co-payment facility wherein a portion of each claim, about 10-20%, need to be paid by the insured.

Let me explain with an example. Suppose you have a health insurance plan for a senior citizen of INR 5 lakhs with a co-pay of 10%. Then, even for an INR 1 lakh claim, which is way less than the total sum insured, 10% of that, i.e. INR 10,000 needs to be paid by the policyholder while the rest 90% would be paid by the insurance company.

Pro Tip: Look for a plan with as less co-payment as possible so that the claim burden is least on you.

Benefits of Senior Citizen Health Insurance

  1. Protects your Savings
    As you grow older, so do your chances to fall unwell. In such a situation an illness or a hospitalisation can dig in deep into your life’s hard-earned savings. A health insurance plan will help you secure your savings.

  2. Enhances your Mental Security
    With a health insurance plan, you not only secure your savings but also feel satisfied and at peace knowing that you would be financially secure even in case of a medical emergency. 

  3. Avail Cashless Hospitalisation
    In a health insurance policy, you can make a claim in two ways-Cashless or Reimbursement. A cashless claim can be made when you get your treatment at a network-hospital. It saves you from running around to raise money before hospitalisation.

  4. High Sum Insured
    As the risks and requirements of a senior citizen is generally higher than someone in their prime, you can avail the benefits that come along with a high sum insured.

  5. Simple and Easy Online Procedures
    Contrary to common beliefs, buying a senior citizen health insurance plan is not at all a big deal. From purchasing a plan to making a claim, it can all be done online. The procedures are self-explanatory and easy to follow.

  6. No Claim Bonus
    In case you do not make any claims in a policy year, you may be eligible for a discount that starts from 20% and can go as high as 100%.

  7. Pre and Post Hospitalisation
    Sometimes, apart from the hospitalisation, some expenses can themselves be as high as the treatment bill. Your health insurance plan would cover the medical expenses that are incurred before hospitalisation and also post-discharge. Make sure to check the number of days that are covered by the company you chose. 

  8. Health Check-Ups
    Your health insurance company would cover you for an annual check-up. 

  9. Domiciliary Care
    Though the criteria are different for different companies, most health insurance plans offer domiciliary care. It can come in very handy when the patient cannot be admitted to a hospital.

  10. Saves Taxes
    Whenever you purchase a health insurance plan, you save on taxes. But once you cross 60 years of age, you are eligible for more tax exemption.

What is Covered?

  1. Hospitalisation due to Accidents
    In case of an unfortunate road or any other accident, hospitalisation will be covered.

  2. Hospitalisation due to Illness
    When you get admitted to a hospital, for the treatment of an illness, once the waiting period is over, you will get a cover for the expenses made.

  3. Pre & Post Hospitalisation
    Your health insurance plan would cover the medical expenses that are incurred before hospitalisation and also post-discharge.

  4. Daily Hospital cash allowance
    The everyday expenses that arise due to hospitalisation are also covered. 

  5. Additional Cover-AYUSH 
    Some patients follow alternate therapies and for them, Ayurveda, Yoga, Unani, Siddha, Homeopathy are also covered as an add-on benefit.

What is Not Covered?

In every health insurance plan, there are certain services that are not covered, these are called exclusions. It is advisable that you go through all the exclusions carefully and remember them.

  1. Joint replacement surgeries will be covered only after a set period of time
  2. Within 30 days of purchasing the policy, only an injury will be covered not an illness
  3. Some health insurance plans may cover certain pre-existing diseases such as diabetes, asthma. This may be allowed after a  set period of time
  4. Dental treatments are not covered
  5. Cosmetic surgeries are not covered (except in case of injuries and burn)
  6. Self-inflicted injuries
  7. Accident/injury that occurs under intoxication
  8. Sexually transmitted diseases are not covered

How to Choose a Health Plan for Individuals above 60 Years of Age? 

Senior Citizen health insurance plans have a wide scope, hence it is important to see which plan would offer you the best cover. Given below is a list of 10 parameters that you must consider carefully before investing:

  1. Include Critical Illnesses
    Cancer, paralysis, kidney failure, cardiovascular diseases are certain expensive treatments. It is advised to look for a plan that offers coverage for such illnesses. If there is a specific disease that runs in your family, make sure you include that in your plan.

  2. Domiciliary Hospitalisation
    Due to unavailability of a hospital service/room or due to the patient’s condition, he/she may be advised domiciliary care. Your health insurance plan will offer coverage for doctor-prescribed treatment at home. Such a cover can come in very handy in life.

  3. Psychiatric Care 
    It has been found that 50% of the people above 60 years of age suffer depression and anxiety. Keeping this in mind, the help of a psychiatric can prove to be very helpful.

  4. Company Policy on Pre-existing Diseases
    A medical condition that a person already suffers from at the time of purchasing the health insurance policy is called a pre-existing disease or condition. 
    For example, before you buy a health insurance plan, you get yourself a health check-up, where it is diagnosed that you have asthma. So in this case asthma is your pre-existing disease or condition.

  5. Waiting Period
    All insurance companies set-down a specific time period starting from the date of purchase. During this time you are not eligible to make a claim for any benefit. However, most companies accept injury-related claims but not the treatment of diseases. Therefore, the shorter the period, the better.

  6. Select Higher Sum Insured with Budget-Friendly Premium 
    To bridge the disparity of high medical costs, try selecting a plan that comes with a higher sum insured. Do not settle for a plan that offers a lower sum insured only because you would have to pay a low premium.

  7. Look for Day-Care Cover
    Many treatments require less than 24 hours of hospitalisations, seek policies that would cover day-care expenses too.

  8. Network Hospitals in your Vicinity
    Health insurance companies have a lot of hospitals in their network, do not go by numbers alone. Rather select a plan that covers more hospitals that are close to your residence and thus convenient.

  9. Compare Co-Payments
    When the policyholder pays a certain percentage of the total medical expenses, and the remaining is paid by the health insurance company, it is called a Co-payment. The amount that you may have to pay depends on the company you select. There are certain companies that offer zero co-payment liability, where you do not have to pay anything.

  10. Check cap on room rent
    As a senior citizen, you may require long-term care or even an admission in the ICU. Prefer a plan that does not impose a cap on the room charges, this allows you to choose a room without worrying about the room rent. 

  11. Use a Premium Calculator
    Using a premium calculator will be very helpful in comparing different health insurance plans that come in your budget, all in a few clicks. When you enter your personal details and your requirements, you will see the premium that you would have to pay for a particular health plan. Select a plan that offers maximum coverage at most affordable rates.

With so many plans and so many health insurance companies all around, selecting the right one for you can be overwhelming. These are a few things to remember when buying senior citizen health insurance, keeping them in mind will surely help you make the right decision.

Senior Citizen Health Insurance Premium Calculator

As advised earlier, when contemplating buying a health insurance plan for yourself, it is important to do thorough research on the plans and the premiums that you would have to pay. A premium calculator is a very helpful online application that helps you see the premium that you would have to pay for a particular health plan. Just enter your personal details and your requirements, and you will see the premium amount. 
Let us take a look  at the steps to be followed when using a Senior Citizen Health Insurance Premium Calculator:

  • Step 1
    On a phone or computer, open any online Senior Citizen Health Insurance Premium Calculator
  • Step 2
    Follow the instructions on the page and select Senior Citizen Health Insurance
  • Step 3 
    You will be prompted to enter your age, contact details and a few other personal details
  • Step 4
    You will then be asked to fill in other details like the sum insured you require, your health condition details, pre-existing diseases and the add-ons you want etc
  • Step 5 
    Once all details are filled in, click on “Submit” or  “Continue” or “Get Quotes”
  • Step 6
    You will now see an approximate value of the premium that you would have to pay to buy that senior citizen health insurance policy

Senior Citizen Health Insurance Claim Process 

Every health insurance company has a set procedure that you need to follow to claim the expenses. Claims can be Cashless or Reimbursement. However, the first step to be followed in both situations is that you inform your health insurance company at the earliest. In case of a planned hospitalisation at least 3 to 4 days before hospitalisation and within 24 hours in case of emergency hospitalisation. 

  • Cashless Claims
    Cashless claims are easy. When you go to a network hospital for your treatment:
    • Present your Policy/Health Card along with simple documentation. The list of documents is given below
    • Along with the Policy/Health Card, you need to submit the Cashless Claim Request Form
    • Submit the signed form and the other required documents such as pre-authorization form
    • The hospital along with TPA, Third-Party Association, will check your forms and documents, and if everything is found in order, your claim will soon be processed

  • Reimbursement 
    In case you could not go to a network hospital and were hospitalised/treated in some other non-network hospital, you must inform your health insurance company within the first 24 hours of hospitalisation. You will have to fill in the Claim Form and submit certain documents. The hospital and the TPA will analyse the paperwork. When everything is found in order, your claim will be processed. The expenses that you have incurred on the treatment will be reimbursed to your account.

Documents Required

Here is an exhaustive list of documents that the hospital or health insurance company might ask for. Remember to keep them safe and together. Your family members should also know about them so that in case you are hospitalised, they know where all the important documents would be.

  • Policyholder’s name and name of the insured family member for whom the claim is being made
  • Policy number
  • Health/Policy Card
  • Kind of illness/injury
  • Details of the Hospital and Medical Practitioner/Doctor
  • In case of a planned hospitalisation the proposed admission date 
  • Discharge summary

The company may ask for any other documents too such as:

  • Valid Photo Identification document of the insured member who has been hospitalised
  • Claim Form-filled and signed
  • Bills and receipts of the Treatment
  • Pathological and Diagnostic Test Reports
  • Doctor’s letter that advises hospitalisation
  • Doctor’s prescription of tests, medicines and consultations
  • Ambulance Bill, if used
  • A Medico-Legal Certificate or copy of FIR in case of an accidental injury
  • Pre-authorization Form, for a cashless claim

Read your policy documents carefully so that you do not miss on any important information/document.

Best Senior Citizen Health Insurance Plans in India (2020) 

To help you in selecting the best senior citizen health insurance, here is a list of the top 5 Senior Citizen Health Insurance Plans in India (2020):

Name of the Company & the PlanHighlights of the suggested plan
TATA AIG - Medisenior
  • 140 day-care procedures
  • Domiciliary Hospitalisation
  • No Claim Bonus
  • Organ Donor Expenses
  • Discounts if family members are covered
Religare Health Insurance Company - Reliance Care Freedom Policy
  • Free health check-ups
  • Over 170 day-care procedures
  • Cashless hospitalisation
  • Affordable
  • Coverage for dialysis
  • Domiciliary Hospitalisation
  • Restoration of the sum insured
Oriental Health Insurance - HOPE
  • Domiciliary Hospitalisation
  • Pre & Post Hospitalisation
  • A waiting period of 48 months for pre-existing diseases
  • No claim bonus
  • Discounts on co-payment
Star Health Insurance Company - Star Health Senior Citizens Red Carpet
  • Constant premium throughout the policy tenure
  • Coverage till 75 years of age
  • No pre-entry health check-ups
  • A waiting period of 12 months for pre-existing diseases Domiciliary Hospitalisation
  • In-house claim settlements
  • Available as Family floater/ Individual basis
National Health Insurance - Varistha Mediclaim
  • 140 day-care procedures
  • Domiciliary Hospitalisation
  • Free health check-ups available
  • Optional critical illness benefit

Network Hospital List is Important

A healthcare centre or a hospital or a medical clinic that has a tie-up with the health insurance company for giving cashless treatment to the policyholders is called a network hospital. When you buy health insurance, the policy papers will contain a list of network hospitals.

In a network hospital, you do not have to run around to collect funds for the treatment. Your health insurance company will settle the bills directly and thus make your hospitalisation easy and burden-free. Without having to give up on quality healthcare you can avail the best facilities without worrying about the expenses.

As suggested earlier, select a plan that covers more network hospitals that are close to your residence and thus convenient.

Frequently Asked Questions
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