Health Insurance

Senior Citizen Health Insurance Plans in India

Senior Citizen Health Insurance Plans in India

Nearly 1 out 10 people in India are senior citizens, totalling a population of more than 130 million. By 2050, the senior citizen number will double to 20% of total Indians.

Senior citizens (people who’ve attained the age of 60 years and above) are more prone to certain diseases and health conditions as compared to younger people. They might need to get hospitalised due to some age related issues, like joint replacement, heart conditions, etc. And the doctor would recommend multiple X-rays, MRI scans, and other tests to determine the illness.

The treatment of old age-related health problems is not only expensive, but also long-term. And with limited or no income, hospitalisation can be mentally and financially challenging for them.

A senior citizen health insurance plan is the best gift you can give to your parents. It is designed to offer financial aid for medical treatments in their hour of need. In short, it is a gift of health.
 

What is Senior Citizen Health Insurance?

A senior citizen health insurance plan is specifically for individuals aged 60 and above. If you're finding it difficult to include your parents in a regular health insurance plan, this could be a good option. These plans often don't require medical tests, but they do have certain restrictions and limitations such as:

  • Copay

A copay is a percentage of the approved claim amount that you must pay upfront before the insurer begins covering the rest.

  • Room Rent Limit
    The insurer can place a cap on the room rent covered by the health insurance policy in the event of hospitalisation. If you choose a room that exceeds this limit, you will be required to pay a proportionate portion of the total bill, rather than just the difference in room rent.
  • Sub-limits On Specific Treatments:
    Certain medical treatments and conditions may have specific restrictions, like cataract surgery, joint replacement surgery, etc. If the expenses for these exceed the limit set by the insurer, you will be responsible for covering the additional costs.

Calculate Your Health Insurance Premium

 

What are the Best Senior Citizen Health Insurance Plans?

Here’s an overview of some of the top senior citizen health insurance plans:
 

 

Aditya Birla Activ Care (Premier)

Manipal Cigna Prime Senior (Elite)

Niva Bupa Senior First (Platinum)

Star Red Carpet

Room Rent Limit

Covers any room except the suite (Available as an add-on)

No limit on the hospital room you can pick (Available as an add-on)

Single private room

Covers up to Rs 6,000 per day

Pre-Hospitalisation Coverage

Available for 30 days

up to the sum insured

Available for 60 days

up to the sum insured

 

Available for 60 days

up to the sum insured

 

Available for 30 Days

up to the sum insured

 

Post-Hospitalisation Coverage

Available for 60 Days

up to sum insured

 

Available for 90 days

up to sum insured

 

Available for 180 Days

up to sum insured

Available for 60 Days

up to 7% of hospitalisation expenses, maximum up to Rs 7,000 per occurrence.

Day Care Procedures

586 treatments are covered

up to sum insured

 

All  treatments are covered up to sum insured

 

All treatments are covered up to sum insured

 

All  treatments are covered up to sum insured

 

Domiciliary Treatment

Covered up to sum insured

Covered up to sum insured

Covered up to sum insured

Not available

Organ Donor Expenses

Covered up to sum insured

Covered up to sum insured

Covered up to sum insured

Not available

Modern Treatment Coverage

There is no limit

 

There is no limit

Available up to sum insured. There is a  sub-limit of Rs 1 lakhs per claim on certain robotic surgeries

Sub-limits are applicable to certain treatments

No Claim Bonus

10% of the sum insured, maximum up to 50% of the sum Insured

10% of the sum insured, maximum up to 100% of the Sum Insured

10% of the sum insured, maximum up to 100% of the sum insured

Not available

Pre-Existing Diseases waiting period

24-month waiting period

3-month waiting period (Available as an add-on)

24-month waiting period

12-month waiting period

Specified disease/procedure waiting period

24-month waiting period

24-month waiting period

 

24-month waiting period

 

24-month waiting period period

 

Note: The table was created on 04.10.2023 and displays information for a sum insured of Rs 10 lakhs.

Why Do You Need Senior Citizen Health Insurance?

  • To cover critical illnesses

    With increasing age, the human body becomes more vulnerable to several diseases, ranging from the common cold and arthritis to critical illnesses, such as cancer and cardiovascular conditions. Medical insurance for senior citizens gives financial protection against such adverse situations.

  • To tackle hefty medical costs

    Medical inflation is prevalent across the globe. From doctor's consultation to the cost of hospitalisation - any kind of medical treatment can have a big impact on your finances. With the help of a senior citizen health policy, a majority of such expenses can be covered.

  • To shield your savings

    The amount in your bank account that you have meticulously saved should not get spent on the treatment of critical illnesses. A senior citizen health policy helps you protect your savings, and live a comfortable post-retirement life.

One important question you might have in your mind…

"My parents are covered through my employer; Wouldn't that be enough?"

Well, not in the long run!

Your cover is linked to your employment. So, it will stop as soon as you leave the organisation.

It has limited coverage. In case your health expenses are higher than your coverage limit, you may have to cover the rest of the amount out of your own pocket.

Portability, promised by your insurance broker or HR, is subject to underwriting (medical evaluation) of the case. Insurers may reject your portability application.

Group insurance schemes are one year policies, and the policy, its terms, its benefits, its pricing - everything can be withdrawn/changed at the time of renewal.

A corporate policy is designed considering the budget limitations your company might allocate - so you wouldn’t really have any control over it.

However, a corporate health insurance plan in India may not have any waiting period or exclusions on pre-existing diseases. So suppose, your parents have some pre-existing conditions, like diabetes, and you are being offered a company health insurance plan for free. Leverage that plan for the short term financial risk, while staying invested in a personal health plan - for long-term needs.

Buying health insurance starts with making multiple declarations regarding your parents’ health. Any mistake you make in providing information can result in rejections at the time of claim. Yes, insurers can reject your claim if they are able to prove that you had misinformed them about your parents’ medical history.

 

Get Free Quotes to Secure Your Health Now

 

What are the Benefits of a Senior Citizen Mediclaim Policy?

Here are some reasons why a senior citizen mediclaim policy is a good choice:

  • Offers Financial Protection
    As you age, your health becomes more vulnerable to illnesses, requiring increased medical care. This can lead to higher healthcare costs. Having health insurance is essential to help manage these expenses, especially if you are a senior citizen.

  • Protects Your Retirement Savings
    A senior citizen mediclaim policy offers peace of mind and valuable financial security by covering a significant portion of medical expenses. It can help you safeguard your savings and retirement funds from being depleted due to healthcare costs.

     
  • Provides Comprehensive Coverage
    It provides coverage for a wide range of healthcare expenses including hospitalisation, surgical procedures, pre and post-hospitalisation expenses, and other related costs. Certain policies include coverage for regular health checkups, which can help identify health problems early on and encourage preventive care.

     
  • Offers Customisation Options
    With various customisation options, you can tailor your coverage to fit your healthcare needs and budget. For example, you can include add-ons to reduce the waiting period for pre-existing conditions, waive the room rent limit, etc.

     
  • Access To Network Hospitals
    Insurance providers have tie-ups with hospitals to provide you the convenience of cashless hospitalisation. Meaning, you can get your desired treatment without paying upfront at these network hospitals.

     
  • Enjoy Tax Benefits
    Premiums for senior citizen health insurance policies in India are eligible for tax deductions under Section 80D of the Income Tax Act.

     

What is Covered  by a Health Insurance Plan for Senior Citizens?

Let’s look at the expenses that are covered under a senior citizen health insurance plan -

  • Hospitalisation Expenses
    These are costs associated with being admitted to a hospital for over 24 hours, including room and board, nursing charges, medical practitioner fees, prescribed medication, ICU charges, and other related expenses.

     
  • Pre and Post-Hospitalisation Expenses
    These are costs incurred before and after you get discharged from the hospital including consultations, tests, checkups, lab reports before admission, as well as medical check-ups, rehabilitation sessions, physiotherapy after discharge, and more.

     
  • Day Care Procedures
    Day care procedures like cataract surgery, dialysis, etc. that don't require 24-hour hospitalisation are covered.

     
  • Domiciliary Treatment  
    These are medical treatments provided at home if you are  too sick or injured to be moved to the hospital or hospital beds are not available nearby. Certain senior citizen health insurance plans may cover the costs of domiciliary treatment.

     
  • Organ Donor Expenses
    Certain senior citizen health insurance may cover organ transplantation expenses, including the cost of harvesting the organ from the donor, where the insured person is the organ recipient.

     
  • Modern Treatments
    Innovative technological breakthroughs in healthcare have brought about a revolution, enabling the availability of advanced treatments such as balloon sinuplasty, stem cell therapy, etc. that were once unattainable. These treatments can now cure ailments that were thought incurable in the past. Fortunately, senior citizen health insurance plans provide coverage for these modern treatments.

     
  • AYUSH Treatments
    Certain senior citizen insurance plans cover alternative treatments such as AYUSH, which includes Yoga, Siddha, Ayurveda, Homoeopathy, Naturopathy, and more.

Note : The terms and conditions associated with the coverage may differ between insurers.

 

What is Not Covered by a Health Insurance Plan for Senior Citizens?

Exclusions are situations that are not covered by your health insurance policy. These include -

  1. Standard Permanent Exclusions
    The IRDAI has set 'standard permanent exclusions' that all insurance companies must follow. Some of them include -
  • Obesity/weight control: Treatments or surgeries for weight control or obesity.
  • Profession in hazardous or adventure sports: Expenses incurred as a result of engaging in adventurous activities like mountaineering, surfing, paragliding, etc. as a professional.
  • Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurer.
  • Investigation and evaluation: Hospital admission for observation or monitoring purposes.
  • Rest cure, rehabilitation, and respite care: Admission to a facility for bed rest, without undergoing any active treatment.
  • Plastic/cosmetic surgery: Treatment or surgery that aims to alter your body characteristics or appearance.
  • Narcotics: Treatments related to addictive conditions such as alcohol addiction, drug usage, etc.
  • Breach of law: Expenses related to the treatment if you have committed or attempted to commit a breach of law with criminal intent.
  • Change of gender treatment: Treatment that aims to change your body's characteristics to match those of the opposite sex.
  • Dietary supplements, substances purchased without prescription: Vitamins, minerals, or other supplements that haven’t been prescribed by a medical practitioner.
  • Unproven treatments: Surgeries, medical procedures, or treatments that have not been proven to be effective.
  • Treatments in establishments arranged for domestic purposes:  Treatment received at health spas, nursing homes, or similar establishments that were arranged completely or partially for domestic reasons.
  • Maternity expenses: Pre/post-natal costs, expenses related to childbirth hospitalisation, and more.
  • Refractive error: Expenses related to correcting refractive errors of up to 7.5 diopters to improve your eyesight.
  • Expenses related to birth control, sterility, and infertility: Contraception methods, sterilisation procedures, artificial insemination techniques, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
  1. Additional Permanent Exclusions
    In addition to the standard permanent exclusions mentioned earlier, insurance providers may also have specific exclusions in your policy for particular circumstances or medical conditions. If you have certain diseases or severe medical conditions that insurers consider too risky to cover, they may choose to permanently exclude them from your policy. In India, insurers are only allowed to apply permanent exclusions to a specified list of illnesses provided by the Insurance Regulatory and Development Authority. They cannot exclude illnesses or diseases beyond this list.

  2. Temporary Exclusions or Waiting Periods:
    After purchasing a health insurance policy, certain illnesses and diseases will not be covered for a specific period of time. Once this timeframe is over, you can start making claims for these conditions. Here are some types of waiting periods:
  • Initial Waiting Period
    After purchasing the policy, there is a 30-day initial waiting period before you can make a claim for any medical condition, except accidents. This means that you cannot make a claim for any treatment during this period unless it is due to an accident.

     
  • Waiting Period For Pre-Existing Diseases
    A pre-existing disease is any medical condition you have had in the last 48 months before buying health insurance. There's generally a 2 to 4-year waiting period for pre-existing conditions. During this period, the policy won't cover any expenses related to these conditions.

     
  • Waiting Period For Specific Diseases
    Insurance providers may have waiting periods for certain medical conditions, apart from pre-existing conditions. These waiting periods apply even if you haven't had these diseases before and are not based on your current health. These are solely determined by the insurer. Generally, there is a 2-4 year waiting period for specific diseases.


How To Choose The Right Health Policy For Senior Citizens?

Option 1: Comprehensive plans open to relatively healthy Senior Citizens

First, look for comprehensive plans that do not have an age limit.

There are good health insurance plans available in the market with -

  • No entry age limit
  • Best possible benefits
  • Lowest limits, exclusions, and financial conditions like Copay (the share in the claim that you would be required to pay each time there is a claim)While these plans are expensive, if your parents are relatively healthy, you can apply to them before going for Senior Citizen specific plans.

Option 2: Senior Citizen Health Insurance Plans that may not require medical tests

Fill in any blanks you might have left with the information they give you. But that won’t do the trick. You need to dig deeper.

If one or both of your parents do not get covered in the earlier option, you can choose senior citizen health insurance plans. These are specifically designed for senior citizens that may not require medical tests. However, they are likely to have many financial limitations, like room rent limits, copays, limits on treatment carried out, among others.

Important conditions to understand

  • Copays

    Most senior citizen health plans will have copays. Copay is the share of the claim that you would be required to pay each time there is a claim.

  • Room Rent Limits

    Room rent limits can severely restrict your access to quality healthcare. They cap not only the room charges, but also the related medical expenses, like surgeon fees, diagnostic tests, etc. Be aware of these financial limits And choose the room closest to what you are eligible for, to avoid deductions in your health insurance claim.

  • Sub-limits on treatments for specific diseases

    Sub-limits on surgeries for frequent and major lifestyle diseases ensure the claims are under control for insurers. They usually implement financial limits on cardiac treatments, breakage of long bones, and even standardise their payments for smaller high-frequency surgeries, like cataract and hysterectomy.

    For instance, you have purchased a senior citizen plan for your mother to cover for her cataract surgery. If the policy has a sub-limit of Rs. 25,000, all expenses for the treatment above this amount will have to be borne by you.

  • Pre-existing disease waiting period

    It is the period for which you need to wait before getting the insurance benefits. To get long term financial coverage, you will have to be patient and continue the coverage through the waiting period.

  • An indicative list of people who will find it difficult to get mediclaim for Senior Citizens

    People who suffer from cancer, heart disease, or similar critical illnesses.

    People on Insulin or with Type 1 Diabetes.

    Three or more negative lifestyle markers - lifestyle diseases like Diabetes, Hypertension, or lifestyle conditions - like heavy smoking, alcohol or being overweight.

  • Group Health Insurance from Banks - if you suffer from multiple ailments

    You can explore policies offered by banks, if -

    You find the premiums of comprehensive health plans unaffordable or your parents aren’t covered by them.

    Your parents suffer from the above-mentioned critical illnesses and don't get a senior citizen health plan.

    However, bank policies are group policies that have a very different structure from a retail policy. Here are some key differences you should understand before taking a decision:

    Renewal of group policies may not happen for a lifetime. Even if they are renewed, the terms may not be in your control.

    Banks can negotiate the benefits and terms of group policies every couple of years. The bank can also move you to a different policy that may have different terms and pricing altogether.

    Banks do not really intervene in case of a service issue in a group policy. You need to take up the issue with the insurance company or the TPA (Third-Party Administrator).

    Because the pricing is tightly negotiated, the insurance company faces higher claims. Hence, the service may not be as good as retail policies.
     

Step-by-step strategy to help you get the complete medical history of Parents

Step 1: Begin with what you know

Make a list of all the diseases and ailments that you know your parents have.

Step 2: Speak to your parents

Fill in any blanks you might have left with the information they give you. But that won’t do the trick. You need to dig deeper.

Step 3: Go through the necessary documents

Get hold of their medical files, and make a note of anything they might have missed telling you.

  • Look at all the medication they take and check why they are required.
  • Look for conditions that they might not consider ‘diseases’, and might skip. For instance, most parents feel hypertension (BP) is not a disease/health condition, but it actually is.
  • Make a list of all the surgeries, hospitalizations in the past.

Step 4: Contact your family doctor and further missing details

This will give you a deeper insight into their health status, and help you cover them better. It will also ensure that there are no rooms for disputes in claims when the time comes.

Now that you are clear about the medical history of your parents, it's time to choose a health insurance plan for them.

 

Check These Things Before Getting A Senior Citizen Health Insurance Plan

  • Go for the highest cover you can afford

    If your parents are senior citizens, considering the medical inflation, an INR 15-20 lakhs individual cover should be good. Otherwise, buy the maximum protection you can afford. Do not compromise on the coverage, because you don't want medical expenses to be hard on your pocket despite having health insurance.

  • Before making the payment, share your medical details

    Ask your agent or the salesperson on the phone for an underwriting of the medical papers - before making the payment. This way you can avoid the stressful payment and refund processes.

  • Fill the proposal form all by yourself

    Ensure you fill-up the proposal form all by yourself, providing accurate and honest information about your parents’ medical health. You need to declare all that you know. Being negligent or careless about health conditions can jeopardise your claim.

  • Make clear declarations on video/telephonic call

    Provide the insurer with a summary of the health assessment you carried out. Give clear and detailed answers to all the questions the insurer has. The call is recorded and will be used not only for evaluation, but also in case there is any dispute at the time of claims.

  • Ensure you understand the plan well

    You need to accept the fact that these plans would have coverage restrictions. Check the pre-existing illnesses’ waiting period. If your parents are afflicted with any pre-existing conditions, like diabetes or high-blood pressure, opt for plans with a low waiting period. This way you can get covered, at the earliest.

  • Do not depend on your employer policy alone

    Yes, your corporate health policy might cover for your parents, without a waiting period. But remember that such a policy is controlled by your employer. There are factors you cannot control, like -

    Yearly renewals

    Modifications

    Termination

    In the worst situation, the premiums might even become unaffordable or unreasonable. Also, if you leave the company, you will lose the coverage. And there’s no guarantee that your next employer will provide health insurance. So it's always better to take a health insurance cover for your parents, separately.

  • Ensure you invest in a healthcare savings fund

    Senior citizen health plans have various kinds of restrictions, like copays, room-rent limits, etc. Hence, it is important to separately save in a healthcare fund for your parents. This is all the more relevant for people who suffer from multiple diseases and thus, aren’t able to get a good plan.

As your parents age, their risk of getting diagnosed with serious illnesses increases. The treatment costs for these illnesses are very expensive and could leave your family financially exhausted. Senior Citizen Health Insurance makes sure old-age doesn't come with huge medical expenses. Carefully check all your options, and choose the one that fits your parents the best.
 

Get Free Quotes to Secure Your Health Now

 

Step-by-Step Guide to Buying Senior Citizens Health Insurance Plans

Here are the steps you need to bear in mind while buying senior citizen health insurance -

  1. Assess your Needs

First, you need to evaluate your parents’ current health conditions, expected medical costs, budget, and healthcare preferences. By understanding their individual healthcare requirements and financial limitations, you can make an informed choice when choosing the right health insurance plan. This ensures that the plan you select adequately covers your specific circumstances.

  1. Conduct Research

The next step is to research reliable insurance companies offering health insurance plans for them. Look for insurers with a strong history of settling claims and an extensive network of hospitals. Make sure the insurance provider has a network of hospitals and healthcare providers in your area that offer cashless hospitalisation.

  1. Compare The Plans

To obtain quotes and compare senior citizen health insurance policies, consider factors such as coverage limits, premiums, waiting periods, inclusions, exclusions, and any additional benefits like consumables coverage, etc. It is crucial to thoroughly read the policy documents, terms, and conditions, including any waiting periods, sub-limits, and exclusions. This will help you understand what is covered and what is not.

  1. Select the Plan of your Choice

Choose the policy that suits your parents’ needs and budget based on factors such as the sum insured, co-payment requirements, riders, etc.

  1. Fill out the Application Form
    Complete the application form and include all the necessary information and documents. It is important to be truthful about your parents’ personal, medical, and other details during the application process. Ensure you disclose all relevant information regarding their health to avoid any potential risks to your claim.
  2. Policy Review Stage
    Once you have paid the premium for the chosen policy and submitted the application, allow some time for the insurance company to review the same.
  3. Review Approved Policy Document
    If approved, you'll receive the policy documents. Take the time to review them carefully and ensure that all details are accurate. If you find any errors, contact your insurer to have them corrected.

     

Claim Settlement Process for Senior Citizen Health Insurance

There are 2 types of Claim Settlement processes; Cashless & Reimbursement. Let’s discuss each one of them as below:

Senior citizen health insurance: Cashless Claim Settlement Process

Here are the steps you need to follow to submit a cashless claim -

  1. Verify your claim eligibility
    It is of utmost importance to ascertain whether you meet the criteria for a claim, particularly when it comes to medical conditions that typically require a waiting period of 2 to 4 years before coverage becomes effective.
  2. Check for cashless availability
    Next, confirm if your insurance provider offers cashless services at your preferred hospital.
  3. Verify whether the hospital is an excluded provider
    If your hospital is excluded, your claim won't be paid. If it's not excluded, ask if they accept cashless payment from your insurer.
  4. Understand the policy’s limits and conditions
    It's important to be familiar with your policy's limits and conditions and fully understand the coverage it provides. Take the time to check if there are any financial restrictions, such as a limit on room rent, ICU charges, or sub-limits on certain diseases and treatments (especially for planned procedures). Additionally, verify if your policy covers non-consumable items and if there is a specific list of items it does not cover. By doing so, you can estimate the costs you might have to pay yourself.
  5. Keep the necessary documents at hand
    Make sure you have all the necessary documents to avoid your cashless claim being rejected. Otherwise, you may have to pay upfront and then apply for reimbursement. Having everything ready will help prevent any inconvenience during the claim process.

    Here's a list of the necessary documents you may need -
    • Policy copy or cashless card
    • Patient’s past medical records associated with hospitalisation such as consultation papers and follow-ups for any kind of medication or condition
    • Patient’s ID proof
    • Police FIR in the event of an accident.
    • KYC documents of the proposer such as PAN card, Aadhar card, passport-size photo), etc.

 

  1. Inform the hospital
    For planned hospitalisation, submit a claim request 3-4 days before admission. For emergency hospitalisation, it is essential to submit the request within 24 hours of admission. The hospital needs specific details and documents to start a pre-authorisation request with your insurer for cashless claim approval.

    Here's a list of the information and documents you'll need to provide:
  • Health card
  • KYC documents of the proposer such as PAN card, Aadhar card, passport-size photo, etc.
  • KYC of the policyholder
  • Policy number
  • Policyholder’s name
  • Patient’s ID proof
  • Name and address of the insured for whom the claim is made
  • Type of Illness/injury and recommended treatment/surgery
  • Name of the medical practitioner and their residential address
  • Admission date
  • Honest declaration of your previous medical history, whether related or unrelated to the current condition. If you fail to provide this information during the policy purchase, it could lead to your claim being denied.

Please keep a copy of all original documents you submit for future reference.

  1. Pay an advance deposit
    Pre-authorisation can take 6-24 hours, depending on the insurance company. They may also ask questions that you need to respond to promptly. During this period, the hospital might request an advance deposit, which will be refunded by your insurer later. To avoid any financial burden, it's wise to have an emergency fund for such payments.

Please remember that any medical expenses before hospitalisation should be claimed separately from your insurer. To ensure a smooth process, it is advisable to keep all original prescriptions, bills, receipts, and reports (including films) related to the hospitalisation.

  1. Track the claim process
    Once you're discharged, the hospital's insurance desk will notify your insurer and handle all the paperwork, including the final bill and discharge summary. Your insurer will keep you updated on your claim's progress through updates sent to your registered mobile number or email.

Sometimes hospitals may forget to inform your insurer about your discharge or neglect to send the necessary documents, which can cause delays in the approval process. To avoid any issues, make sure to stay updated on the status of your claim by checking for communication from your insurer. The approval process usually takes 2-6 hours after your insurer is informed of your discharge. They may also have questions that need to be answered promptly. To ensure a speedy settlement, it's important to stay in touch with your insurer.

  1. Review the final bill and approval letter
    Once you receive  your final bill and approval letter, review them carefully to understand what expenses have been approved and what haven't. Feel free to reach out to your insurer or advisor if you have any questions or uncertainties. Take note of the approval letter, as it may contain information about expenses that should not be charged to the patient. Review and refrain from making payments for those expenses.

In addition to these costs, there may be other expenses not covered by your insurer that need to be paid by you before leaving the hospital.

Senior citizen health insurance: Reimbursement Claim

Here are the steps to be followed to make a reimbursement claim -

  1. Verify whether the hospital is an excluded provider
    Before receiving treatment at a non-network hospital, ensure that it is not an excluded provider. If it is, your claim will not be paid, and you will need to select a different hospital. To confirm this, you can reach out to your insurance company via their toll-free number or email/SMS.
  2. Inform the insurance company
    Next, inform your insurance company within 24 hours of hospitalisation. You can find the contact information on your policy document or the insurer's website.
  3. Get the documents from the hospital
    Make sure to collect all your original documents from the hospital before you leave after receiving treatment.. These include receipts, discharge summary, claim form (a portion of which will be completed by the hospital), medical reports (including MRI/X-ray films), doctor prescriptions for all payments you made, etc. In case of any mistakes or errors, double-check the patient's name, gender, and age on each document and get the details corrected.

You can request the hospital for a detailed bill that itemises all the costs. Additionally, you should ask for a copy of the case sheet or indoor case papers and hospital's registration certificate, if the non-network hospital agrees to provide them.

  1. Keep the necessary documents at hand
    Speak with your insurer regarding the necessary documentation for submitting a reimbursement claim. Here is a general list of documents you can prepare with:
  • Health card or policy copy
  • KYC documents of the proposer including PAN card, Aadhar card, passport size photo, bank statement with bank name, account number, and IFSC code printed on it (or) copy of the bank passbook with the latest transaction page (or) original cancelled cheque with the policyholder’s name printed on it
  • Patient's ID proof
  • Filled and signed claim form
  • All relevant documents: test reports, films, receipts, and medical prescriptions associated with the treatment
  • Original discharge summary from the hospital
  • IOL sticker and invoice for implantation claims (e.g., knee replacement, cataract)
  1. Complete the claim form
    Next,  you need to fill in all the necessary details in the claim form and submit it along with the relevant documents to the insurer.
  2. Submit the relevant documents
    When you submit the documents, ensure you  include any pre/post-hospitalisation bills, prescriptions, and reports that you have incurred along with your hospitalisation bills. This will help ensure that you don't overlook any eligible expenses.
  3. Ask for an acknowledgement
    Ensure you keep a copy of all the documents you give to the insurance company. Get an acknowledgement from the insurance company or TPA on the original documents you submit.
  4. Track the claim process
    After submitting your claim, it's important to stay in touch with your insurer to track its progress. Once received, the claim will be thoroughly reviewed. Additional information or documents may be requested and you should promptly submit them.
  5. Review the claim settlement summary
    Once the verification process gets over, the approved amount will be transferred to the bank account you provided. You will receive a settlement summary that shows all the deductions made. Please review the deductions in the summary carefully and if you have any questions, don't hesitate to contact your insurer for clarification.


Tax Benefits of Senior Citizen Health Insurance

Senior citizens can enjoy tax benefits on their health insurance as follows -

  • Under Section 80D of the Income Tax Act, 1961, individuals aged 60 years or above can claim tax deductions of up to Rs 50,000 on annual premiums paid under the senior citizen health insurance policy. To qualify for these benefits, premiums must be paid through a bank, credit/debit cards, cheque, demand draft, etc. Cash payments are not eligible for tax exemptions under section 80D, except for preventive health check-ups.
     
  • Under Section 80D, senior citizens can claim tax deductions for payments made towards preventive health check-ups. The maximum deduction is Rs 5000, which will be within the overall maximum cap of Rs 50,000. This deduction applies even if the payment is made in cash.

FAQs

  1. Why should you purchase senior citizen health insurance?
    It protects you from the rising costs of medical treatments and healthcare services and provides access to high-quality healthcare during your later years.

  2. What key aspects to consider when evaluating a senior citizen medical insurance policy?
    Here are some of the key things to keep in mind when choosing a senior citizen medical insurance plan -
  • Sufficient sum insured
  • Minimal or no copay,
  • No financial limits on room rent,
  • No sub-limits on certain treatments,
  • Coverage for modern treatments
  • Coverage for day care treatments, and
  • Coverage for domiciliary treatment, among other benefits.
  1. What are the necessary documents needed to purchase a mediclaim policy for senior citizens?
    Although the specific documents required may vary between insurers, some common ones include proof of age, proof of identity, proof of address, any medical test reports, etc.

     
  2. Are cashless hospitalisation services provided by all health insurance companies?
    Certainly! All health insurance providers in India offer cashless hospitalisation.

     
  3. Is it necessary to undergo medical screening prior to buying senior citizen health insurance?
    Specialised plans designed for senior citizens often do not necessitate the need for medical examinations.

     
  4. Do senior citizens receive a continuity advantage if they port the senior citizen health insurance plan they own?
    When a senior citizen health insurance plan is ported from one insurer to another, your continuity benefits, such as the waiting periods you have already served, will remain in place.

     
  5. Are senior citizen health insurance plans available with individual or floater cover?
    There is a diverse selection of health insurance plans tailored specifically for senior citizens available in the market. These policies cater to both individuals and families, providing extensive coverage and ensuring a sense of security.

     
  6. Is there an increase in the cost of health insurance as you age?
    As one ages, the health insurance premiums may also increase. This can be attributed to the fact that as individuals grow older, the probability of developing health conditions and falling ill tends to rise. Consequently, insurance providers adjust the premiums accordingly, to compensate for the elevated risk.