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Individual Health Insurance Plans for Senior Citizens in India


Summary

Senior Citizen

Senior citizen health insurance is a contract between the insurance company and the insured customer in which the insurance company agrees to settle the health insurance claim of the insured up to the sum insured limit for any insured illnesses or disease excluding the copay for each and every claim, in return for a nominal amount known as premium.

The senior citizen health insurance is a separate health insurance policy designed by the insurance companies to provide healthcare protection to the senior citizens. Most of the health insurance of senior citizens do not have mandatory medical pre-policy check ups but there would be a co-pay of a certain limit of the claim at the time of claim settlement

The health insurance scheme for senior citizens introduced by the insurance companies has gained traction in recent days as many senior citizens are purchasing the policies. The premium to be paid in senior citizen health insurance plans is also quite affordable when compared to the general health insurance plans which can include senior citizens. Senior citizen medical insurance offers preventive health care check-ups, cashless claim settlement facility to the senior citizens at any of the network hospitals of the insurance company. 

The health insurance for senior citizens covers the pre-existing diseases, specific diseases and other illnesses after a waiting period of 2 years to 4 years, pre and post hospitalization expenses, coronavirus covid-19 treatment expenses and critical illness hospitalization expenses.

It is very important for the senior citizens to have a separate health insurance plan as the normal plan with other than senior citizens would have higher premiums as the premium in a health insurance policy is calculated on the basis of age of the applicant. Higher the age, higher would be the premium in a health insurance policy. 

To avoid such scenarios insurance companies have launched senior citizen health insurance plans in which the senior citizens more than 60 years of age can avail separate health insurance plans which comes with all the coverage.

The rising health care costs have made it mandatory to avail senior citizen medical insurance. Senior citizens would be mostly dependent on their savings during their old age and any one hospitalization event can push them into debt trap, to avoid such debt traps senior citizens should purchase a health insurance scheme for senior citizens

The senior citizen health insurance plan covers the hospitalization costs, surgery costs, room rent, ICU charges, organ donor expenses, pre and post hospitalization expenses, ambulance charges, domiciliary hospitalization cover, nursing charges, day care procedures etc. up to the sum insured limit mentioned under the policy.

The maximum liability of the insurance company would not exceed the sum insured limit under the policy. Senior citizen medical insurance policies also provide an option to reinstate the sum insured under the policy in case the sum insured is exhausted due to any hospitalization.

ItemStar Senior Citizen Red carpet health insurance policyCare Senior Citizen Health insurance planNivi Bupa Senior First Family Health insuranceAditya Birla Active Care Senior Citizen Health insurance
Entry AgeMinimum age at entry – 60 years

Maximum age at entry – 75 years

Minimum age at entry- 61 years, 

Maximum age at entry – no upper age limit

Minimum age at entry- 61 

Maximum age at entry – 75 years

Minimum age at entry- 55 years 

Maximum age at entry – 80 years 

RenewalLifelong renewability regardless of the health status or previous claims made under the policyLifelong renewability regardless of the health status or previous claims made under the policyLifelong renewability regardless of the health status or previous claims made under the policyLifelong renewability regardless of the health status or previous claims made under the policy
Policy TypeIndividual sum insured and floater sum insured Individual sum insured and floater sum insured Individual sum insured and floater sum insured Individual sum insured and floater sum insured 
Sum InsuredRs.1 Lakh to Rs.25 LakhsRs.3 Lakh to Rs.10 LakhsRs.5 Lakh to Rs.25 LakhsRs.3 Lakh to Rs.25 Lakhs
Pre-policy medical check-upNot mandatory. If certain records are submitted customers can avail 10% extra discount on the premium. No pre policy medical check-upNo mandatory pre policy medical check-upNo mandatory pre policy medical check-up
Day care proceduresAll day care procedures are covered up to the sum insured mentioned under the policyUp to the sum insured limit. 541 day care procedures are coveredAll day care procedures are covered up to the sum insured mentioned under the policy586 day care procedures are covered up to the sum insured limit
Room rentUp to Rs.10,000/- depending on the sum insured optedSingle private AC room or maximum of 1% of Sum insured per daySingle private AC room or shared roomSingle private AC room or shared room
AmbulanceMin & Max limit for hospitalization- Rs. 600 & Rs.1500

Min & Max limit per policy period- Rs. 1200 & Rs.3000

Up to Rs.2000 per hospitalizationRoad Ambulance- Up to Rs. 2.5k per hospitalization.

Air ambulance- Up to Rs.2.5 Lakhs per hospitalization

Up to Rs.5000 per hospitalization
Pre-HospitalizationUp to 30 days prior to the date of hospitalizationUp to 30 days prior to the date of hospitalizationUp to 60 days prior to the date of hospitalizationUp to 30 days prior to the date of hospitalization
Post-HospitalizationUp to 60 days from the date of discharge from hospitalUp to 60 days from the date of discharge from hospitalUp to 180 days from the date of discharge from hospitalUp to 60 days from the date of discharge from hospital
Co-payment30% co-pay for each and every claim in case of Non PED & 50% co-pay for each and every claim in case of PED.If age more than 61 years, company provides an option to choose co-pay of 20% the claim amount (over and above any other co-payment, if any)50% co-pay for each and every claim under the policy. 10% additional copay if treatment is taken in a higher room category than the eligible room category.Up to 20% co-pay for all inpatient hospitalization, domiciliary treatment, Ayush treatment and day care claims
Initial waiting period30 days for any illness or disease except for accidents30 days for any illness or disease except for accidents30 days for any illness or disease except for accidents30 days for any illness or disease except for accidents
Specific waiting period24 months for certain diseases or illnesses2 years of continuous coverage for certain illnesses.2 years of continuous coverage for certain illnesses.24 months of continuous coverage for certain illnesses.
Pre existing waiting period12 months for all pre existing diseases4 years of continuous coverage for certain illnesses.2 years of continuous coverage for certain illnesses.2 years of continuous coverage for certain illnesses.
Disease wise sub limitsSub limits as specified in the conditions of the policy for certain diseasesSub limits as specified in the conditions of the policy for certain diseasesNo disease wise sub limits on common health conditions such as cataract, joint replacement, cancer and more.Sub limits as specified in the conditions of the policy for certain diseases

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Susheel Agarwal

Namaste. I'm Abhinay Nedunuru, a Fellow of the Insurance Institute of India with a passion to make insurance simple and crisp. I write mostly on insurance and investment. I have a passion for teaching and training in particular to insurance. I'm currently doing my PhD from IIM in Marketing Management.