Guide to Senior Citizen Health Insurance

A report by the UNFPA shows that in 2022, almost 14.9 crore people in India were over the age of 60 but 98% of older people don’t have health insurance. 

Senior citizen health insurance can be a liberating choice for the elderly. It allows them to live their post-retirement years independently with access to top-quality healthcare when needed.

If you are still unsure, read our guide on senior citizen health insurance in India to make a confident choice.

What is a senior citizen health insurance plan?

Senior citizen health insurance is a policy that covers the medical expenses and healthcare service needs of an insured senior citizen. 

The eligibility criteria for a senior citizen insurance plan may vary across insurers. Some standard eligibility criteria are:

• Age: Above 60 years of age, applicable for all genders 
• Citizenship: Must be a citizen of India (flexibility in citizenship may be available)
• Income range: Some insurance may set income limit criteria, but it is not mandatory for all 
• Pre-policy medical checkup: Some insurers may ask for medical checkups to determine pre-existing diseases

Key health complications in Indian senior citizens

Our body undergoes a lot of wear and tear with age. Some old age health issues can be treated easily, while others require long-term care.

Some common old age health issues are:

• Arthritis: It affects the joints and can lead to pain, swelling, immobility, and stiffness.
• Heart disease: Risk factors like hypertension and high cholesterol increase the chance of cardiac ailments. 
• Cognitive health: Alzheimer’s and dementia are becoming increasingly common among the elderly, and they need long-term care.

Other old-age health issues include diabetes, digestive issues, respiratory illness, eyesight problems, and dental concerns.

Senior citizen health insurance benefits

Here are some of the most prominent health insurance benefits for older people:

• Cashless treatment: Senior citizens with health insurance can get free treatment at any network hospital. The insurer settles all their hospital bills based on their coverage.
• Pre-existing disease coverage: After a waiting period, you can get covered for any pre-existing disease.
• Ambulance facility: Some insurance policies cover your ambulance charges during emergencies.
• Financial security: Comprehensive senior citizen health insurance in India protects against medical expenses. You can also opt for tax deductions for your premiums (up to ₹50,000).
• Pre and post-hospitalisation coverage: All your pre and post-hospitalisation costs, including medicines, doctor/nurse fees, tests, follow-up treatments, etc., are covered by an insurance policy for seniors. 

Things to check before buying old age insurance

Check the following before buying sr citizen health insurance in India:

• Coverage: Compare what is covered and what is excluded. Birth defects and cosmetic procedures are common exclusions.
• Premium and co-pay facility: Calculate the premium and co-payment (if applicable) where you can share the health insurance price with the provider. If the co-pay is 10%, then if the medical bill is ₹10,000, you pay ₹1,000, and the insurer covers the rest.
• Claim process: Ensure the insurance provider offers an easy claim settlement process. Also, you must see their claim settlement ratio, which is the number of claims received by the provider compared to the number of claims settled by them.
• Pre-existing conditions: Check whether the plan covers any pre-existing health conditions (blood pressure, thyroid, etc.), as it is common among senior citizens. 
• Waiting period: See how long is the waiting period for pre-existing diseases and select one with a smaller waiting period. This number varies depending on the insurer, type of policy, and other factors. But it can be as little as 30 days to as much as 3 years.

Daycare and domiciliary facility: Ask the provider whether the policy covers domiciliary (at-home hospitalisation), daycare treatments (dialysis, chemotherapy, etc.), and a ‘nearby network hospital list’, allowing them to get treatment hassle-free.

Family floater vs. separate plans for seniors

Sr citizen health insurance in India offers more coverage limits than family floater plans and has fewer waiting periods for pre-existing conditions. However, the premium for separate health insurance plans is comparatively higher than that for family floater plans.

For example, a family plan (1 adult, 1 senior citizen, 1 child) with ₹10 lakh coverage might cost around ₹46,000 per year. The same could cost around ₹40,000 per year for a senior citizen alone. Now, if you take insurance for the other adult, and child, collectively it will be much higher.

Family floater vs. separate plans for seniors

Sr citizen health insurance in India offers more coverage limits than family floater plans and has fewer waiting periods for pre-existing conditions. However, the premium for separate health insurance plans is comparatively higher than that for family floater plans.

For example, a family plan (1 adult, 1 senior citizen, 1 child) with ₹10 lakh coverage might cost around ₹46,000 per year. The same could cost around ₹40,000 per year for a senior citizen alone. Now, if you take insurance for the other adult, and child, collectively it will be much higher.

Key Takeaways

Senior citizens are prone to numerous healthcare concerns. Therefore, it is essential to get senior citizen health insurance coverage that ensures all your medical needs are covered at a minimum premium. 

Before you purchase one, consult with experts, check if you can afford the premiums, and choose the one that can cover your medical needs.With platforms like PhonePe, you can easily navigate