Tips for Buying the Perfect Health Insurance Policy for Senior Citizens

by SMCIB on Wednesday, 18 January 2023

Tips for Buying the Perfect Health Insurance Policy for Senior Citizens

As you grow old, you become more vulnerable to medical conditions and illnesses, right from the basic ones like the common cold, flu, etc. to potentially life-threatening ones like heart diseases, cancer, etc.

Treating these medical conditions costs money, and a lot of it sometimes - especially because of rising medical costs and new advancements in the medical sector. And, you surely do not want to burn off a huge chunk of your retirement savings or pension on this!

This is where health insurance steps in. It covers the expenses of medical treatments, without you having to stress about arranging funds or the quality of healthcare.

This article discusses some helpful tips that you can use to pick the right health insurance policy for senior citizens.


Tips for Buying Health Insurance for Senior Citizens

1. Keep in Mind to Purchase a Good Cover

If the senior citizens are older than 60, you can purchase individual coverage for them with a cover amount of at least INR 15-20 lakhs. Make sure you don't skimp on the coverage. Buy the highest level of protection possible you can if you aren’t able to afford a high level of coverage.

2. Properly Understanding the Aspects That a Plan Covers is Important

It is important to understand the coverage provided by the policy. So, always read the policy wording thoroughly before you make the purchase. Generally, health insurance plans provide coverage for -

Inpatient Hospitalisation
Inpatient hospitalization expenses are those incurred while you are admitted to a hospital. To qualify for coverage, a patient must be hospitalized continuously for at least 24 hours.

Daycare Treatments
Daycare treatments are those that are completed under general or local anaesthesia in less than 24 hours. This includes treatments like cataract surgery, chemotherapy, etc.

Pre And Post-Hospitalisation Costs
Pre and post-hospitalization costs are those expenses that are incurred before and after your hospital stay. This includes medical tests, rehabilitation, physiotherapy, etc.

Domiciliary Hospitalisation Costs
If the patient's condition is so severe that they can’t be moved to the hospital or there are no beds available at the hospital, then medical care can be provided to them at home as well. This is known as domiciliary hospitalization.

3. Keep a Track of the Aspects That The Plan Does Not Cover

Health insurance plans come with exclusions, i.e., situations they won’t cover. There are two types of exclusions - permanent and temporary.

? Permanent Exclusions
Your health insurance plan will never cover certain conditions and treatments. These are known as permanent exclusions. There are some standard exclusions set by IRDAI that won’t be covered under the health insurance plan.

And, your insurer may exclude certain diseases/illnesses as well which are known as additional permanent exclusions. For instance, if your insurer feels that some disease or illness is too risky to cover, they might exclude it from the coverage and then issue the policy to you. However, it is crucial to note that insurers can apply a permanent exclusion to only those conditions that are listed by the IRDAI.

? Temporary Exclusions (also known as waiting periods)
Most health insurance policies come with waiting periods. A waiting period is a time frame during which the insurer will not provide coverage for specific conditions or treatments.

30-day Initial Waiting Period
The insurer will impose a 30-day initial waiting period for all treatments, barring those related to accidents. Accidents are covered from day 1.

Waiting Period for a Specific Illness or Treatment
There is a 2 to 4 years waiting period before coverage for conditions like hernias, haemorrhoids, chronic kidney disease, etc. kicks in. This period is known as the Specified Disease/Treatment Waiting Period.

Pre-Existing Disease Waiting Period
A pre-existing disease (PED) is defined by the IRDAI as any medical condition that has been identified or treated within four years of purchasing health insurance. PEDs usually have a waiting period of 2-4 years.

4. Understand The Policy's Limitations and Restrictions

Health insurance policies for senior citizens may come with certain limitations and restrictions. You should stay aware of these limitations and restrictions if you want to buy a good policy.

Room Rent Limit

Room rent is the per day room expense incurred when you are hospitalised. If you opt for a room with a rent more than what you are eligible for, the insurance company will deduct the room charge difference and proportionately deduct associated medical expenses.


Insurance companies keep claims under control by setting sub-limits on certain treatments/surgeries. There may be some financial limits on cardiac treatments, or payments may be fixed for high-frequency surgeries, such as cataract surgery, hysterectomy, etc.

A copay is a portion of the approved claim amount that you are responsible for paying out of your pocket. The insurer will cover the remaining amount. Make sure that the policy you select has no copay clause or a lower copay percentage to minimize out-of-pocket costs.

5. Understand Zone-Based Copayment

Some insurers apply copayments based on zones. This generally happens if you buy health insurance from zone II cities or beyond. Depending on the city you live in, the city where you pay your premiums, and the city where you receive medical treatment - the copayment limit and premium discount may vary.

For instance, the insurer may impose, say, a 10% copay if Akash purchases a plan and pays the premiums in Zone II but wants to receive treatment in Zone I. Therefore, in this situation, Akash will be responsible for paying 10% of the approved claim amount, while the insurance provider will cover the remaining 90%.

So, always check if the policy you are planning to buy for senior citizens has such a clause. And if it has, then check the copay limit beforehand to avoid any surprises at the time of a claim.

6. Check The Network Hospitals

Always check if the insurer has a tie-up with a wide network of hospitals, especially the ones in your locality. So, in emergencies, immediate care and treatment can be received on a cashless basis. You won’t have to arrange for funds for any planned or unplanned treatment as the treatment bills will be settled between the hospital and the insurer.

7. Do Not Forget to Track the Insurer’s Record

Analyzing the insurance provider's claim history is essential as it will give you an idea of things you can expect when you file a claim in the future.  You should look at the following aspects -

  • The percentage of claims that were resolved by the insurance company out of all claims made during a given year.
  • The length of time it takes for an insurer to resolve claims.
  • Complaints that the insurance provider has received.

These specifics are available on the websites of the insurer and the IRDAI.

8. Share Your Medical Details Before Making Payment is Must

Request an underwriting evaluation based on the submission of a soft copy of the medical papers from your agent or salesman. This can be done over the phone if you have the senior citizen’s most recent medical reports and papers. Make sure you do all these before making payment. By doing so, the lengthy payment and refund process can be avoided.

9. Fill Up the Proposal Form Yourself

Complete the proposal form yourself by giving true and accurate details to the best of your knowledge. If you submit incorrect or incomplete medical documentation and if the insurer discovers it during the claim process, your claim might be at risk.

10. Give Precise Medical Declarations During Video or Telephone Calls

The senior citizen must give the insurer's representatives all pertinent information about their medical history when they contact them, without omitting anything. Make sure they respond to every inquiry from the insurer thoroughly. A recording of the call will be kept and used during both the evaluation and claim settlement processes.

We’re Done!

Ensuring the safety of senior citizens should be of utmost priority because with age, health issues might get severe. However, before buying any plan for senior citizens, always check the above-mentioned tips. We hope they will help you in taking the right health insurance decision for senior citizens.

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