Senior Citizen Health Insurance – 60+ Medical Plans

Did you know that medical inflation in India is the highest in Asia at 14%? This means your medical expenses will become costlier by 14% with each passing year. The higher medical costs go, the more money you could end up spending from your pocket if a medical emergency hits and you are uninsured.The possibility of a medical emergency becomes even more likely as you get older and are prone to multiple medical conditions. The expenses associated with serious chronic illnesses like diabetes, blood pressure, heart disease, arthritis etc., can set you back significantly. Hence, having the right health insurance is of paramount importance as it can help you avoid financial duress in the future.Read on to learn more about Health Insurance for senior citizens, what makes it a must-have and other important related information.

Insurance companies have a variety of insurance plans designed to suit specific age groups. These can be customised to suit individual needs. Today, insurers offer specifically tailored Health Insurance policies for senior citizens. This is because the health issues that people above the age of 60 tend to face are completely different to those faced by younger people. Health Insurance policies can provide the right coverage and financial assistance in these situations. Also Read: Link Why Buying Health Cover Is a Must for The Senior Citizens

Manage rising medical expenses

The human body tends to get weak as it ages, and after a certain point, medical assistance may be essential for survival. A weakened immune system and fragile body can make you susceptible to various problems, for which treatment is becoming increasingly expensive. Meeting these expenses from your savings or investments could significantly impact your financial standing during retirement. A Health Insurance plan can effectively offset such sizable expenses.

Avoid dipping into a retirement fund

As a senior citizen, you may not have a steady income source, and the retirement fund you built up over the years may only be able to sustain your lifestyle expenses. Hence, it is a good idea to take measures that protect your savings from sudden and unforeseen expenses. Health Insurance prevents such sporadic outflows of cash and allows you to retain your hard-earned money for a peaceful retired life.

Meet changing needs

Not all senior citizens have the same medical requirements. This is why Health Insurance plans can be customised to provide different levels of coverage. For instance, if your ailment requires you to make frequent hospital trips (e.g., dialysis), you can find a plan that provides you with adequate coverage for the kind of treatment you need. A Health Insurance plan proves to be quite beneficial during such times. Also Read: How Can Medical Bills Help Senior Citizens Save Taxes?

Ensure cover for critical illnesses

Cancer is one of the most prevalent and expensive diseases to treat today, with treatment plans costing several lakhs of rupees and sometimes lasting years. As a senior citizen, you are more prone to chronic critical illnesses that can significantly impact your savings. And this could especially become a matter of concern at such an advanced age. Health Insurance helps you manage your financial health much more efficiently when you need it the most.

Health insurance plans designed for senior citizens have some unique identifying features, such as the following.

• Only citizens between the age of 60 and 75 are eligible for these insurance plans.
• Most plans provide cashless hospitalisation facilities once 24 hours have passed since the patient has been admitted. This eliminates the financial burden of you spending from your own pocket for treatment.
• Coverage includes both pre-hospitalisation and post-hospitalisation periods.
• Generally, no pre-medical test is needed to purchase an insurance plan.
• Once the wait tenure is over, senior citizens can make claims for specific pre-existing diseases and ailments.
• In some cases, these plans offer preventive medical benefits as insured individuals can avail of health check-ups that may catch conditions well in time.
• Some insurance plans also cover ambulance charges, daycare expenses etc., further reducing the financial implications of medical conditions.
• The claim settlement process tends to be faster and hassle-free.

As your needs evolve with age, so does the coverage offered by insurers. So here are some things you should look for when choosing a Health Insurance plan to ensure optimum coverage.

Coverage amount

When you decide to get Health Insurance as a senior citizen, it is crucial to realise your present financial position. This is because rising medical expenses can empty your pockets very quickly. A high coverage amount can help you bear greater expenses with relative ease and ensures peace of mind in an overwhelming situation. While it is generally advisable to keep Health Insurance coverage between 5 to 10 times your annual income, an even higher coverage may be required in the case of senior citizens, particularly if they have been diagnosed with chronic illnesses. However, if a higher premium is a concern, it is preferable to have a sum insured that is at least equal to or greater than the annual medical expenses.

Waiting period

Most insurers mandate a specific waiting period of a couple of years before the coverage for a particular illness gets included in the insurance plan. If you are in immediate need of medical assistance, you should opt for the Health Insurance policy that requires the least amount of waiting time.

Renewal policy

As you get older, it might be challenging to remember specific dates, especially insurance renewal. Moreover, many insurers have a cut-off period, which can make it worse. It can become tedious to keep track of renewal dates and follow through. To avoid such situations, it may be prudent to choose a lifetime renewal option when purchasing a Health Insurance plan.Secondly, you must also note the entry age and the age up to which your policy is valid. As the severity of medical conditions increases with age, many insurers cap the validity at 55 to 60 years of age. You should carefully check these terms and choose a policy which goes up to 80 years of age.

Pre-existing illnesses

At an advanced age, you may already have a specific pre-existing illness which requires medical care. When you buy Health Insurance, remember to check if the policy offers adequate coverage for such pre-existing illnesses . Sometimes, insurers are known to reject claims for certain ailments, which is why it is a good idea to make them a part of your plan right from the start.

Cashless hospitalisation benefit

Insurance companies usually have tie-ups with various hospitals that form a part of their network hospitals. Availing of medical treatment from these hospitals ensures you do not have to pay for the treatment from your pocket, as the hospital settles the bill directly with the insurer. This facility, called cashless hospitalisation benefit, helps in the hassle-free settlement of your medical bills.

Preventive health check-up

Some insurers provide an additional benefit that covers the cost of regular health check-ups and screenings. This benefit is known as preventive health check-ups, and the same helps in the early detection of any potential health issues. Selecting policies that offer this benefit can help you cut down on costs associated with such check-ups. Usually, policyholders become eligible for preventive health check-ups after completing a specific waiting period.

Availability of different riders

Riders are add-on options that increase the scope of coverage of your Health Insurance plan. For instance, some policies offer an OPD rider that covers expenses related to outpatient consultations, diagnostics, and pharmacy bills. Another example is a Critical Illness rider, which covers critical illnesses, such as cancer (at certain stages), kidney failure, strokes, etc. These riders can be valuable, especially as you age and become prone to developing certain health conditions. However, the availability of riders can vary among insurers and also means higher premiums. Also Read: Choosing the Right Health Insurance for Senior Citizens

Here’s a list of features that are commonly included in Senior Citizen’s Medical Insurance policies.

• Hospitalisation expenses Financial cover for inpatient hospitalisation expenses, including room charges, doctor's fees, nursing charges, and other medical expenses incurred during hospitalisation.
• Pre-existing diseases Some policies may cover pre-existing diseases after a waiting period.
• Daycare procedures Coverage for specified daycare treatments that do not require 24-hour hospitalisation.
• Ambulance charges Reimbursement of ambulance charges incurred during an emergency.
• Pre and post-hospitalisation expenses Coverage for medical expenses incurred immediately before and after hospitalisation (for up to 30 days and post-hospitalisation for up to 60 days).
• Domiciliary hospitalisation Coverage for medical treatment taken at home when hospitalisation is not possible.
• Annual preventive health check-up Costs associated with full-body health check-ups that are done to detect any potential future ailments.

It is equally important to know the different conditions that are not covered under a senior citizen Health Insurance policy. Here are some of the most common ones.

Injuries from adventure sports

Injuries from activities that involve any untoward risk are commonly excluded from a plan’s coverage by insurers. Although treatment may be expensive, these are considered products of unwarranted risk.

Injuries from war

Wars and military operations can be devastating to a great extent and are therefore not a part of senior citizens’ Health Insurance coverage.

Injuries from substance abuse

Substance abuse can cause long-lasting harm, and injuries arising out of it are considered self-inflicted. These are not covered under your insurance policy.

Venereal diseases

The treatments for such diseases are usually expensive, crucial, and sometimes impossible. Thus, these diseases are not covered by insurers in any Health Insurance policy.

Cosmetic corrections

Cosmetic surgeries do not constitute any form of medical necessity and are therefore excluded from Health Insurance policies.

Here are some things you need to remember when buying Senior Citizen Health Insurance.

Premiums

Insuring a senior citizen may prove a bigger risk for insurance companies than insuring a young adult. This is because of the complications associated with age and the resulting expenses. It is always advisable to purchase a long-term insurance plan early on in life and reap its benefits later.

Entry age limit

Individual Health Insurance plans come with a hard cap on the entry age. This age limit determines whether or not you are eligible for an insurance plan. Since this is also a deterrent at an advanced age, an early purchase of Health Insurance is advised. Generally, insurance plans are offered to senior citizens between the ages of 60 and 75.

Mandatory full-body check-up

When the health risks of an individual are higher, most insurance companies prefer to either reject the insurance application or charge a higher premium. In most cases involving senior citizens, a full body check-up may be mandatory.

Waiting period

Most Health Insurance policies for senior citizens have a waiting period for pre-existing illnesses and certain other conditions. This generally is the first two to three years of the policy, during which you cannot claim against specific medical conditions. This is another reason experts advise you to buy Health Insurance as soon as possible.

Co-payment clause

As a senior citizen, you are prone to various conditions that make you a higher-risk customer. This invariably leads to the inclusion of a ‘co-payment’ clause in your policy wherein you may be required to pay a portion of your hospital bill. For example, the co-payment clause could require you to pay 25% of the bill while the insurer pays 75%. Ideally, if your premium is high, you will bear a lower co-payment burden and vice versa.

Associated services

These refer to non-hospitalisation services but those included in your medical treatment, such as ambulance charges, diagnosis costs, lab testing costs, consultations, etc. Although these costs add to your financial burden, not all insurers may cover them. This makes it essential to thoroughly read all the inclusions and exclusions mentioned in your Health Insurance policy.In fact, this is a key difference between a senior citizen Mediclaim policy and Health Insurance. A Mediclaim policy for senior citizens covers only hospitalisation charges, whereas a Health Insurance plan covers everything, including pre-and post-hospitalisation costs. Also Read: What Is the Difference Between a Mediclaim and Health Insurance?

Under Section 80D of the Income Tax Act, you can claim tax deductions of up to ₹ 50,000 for premiums paid on Health Insurance for Senior Citizens

There are two ways to apply for senior citizen Health Insurance policies – online and offline. The offline mode involves visiting the office of your preferred insurer and providing all details physically in person.

For online application, you can follow the below-mentioned steps:

Step 1: Log on to the website of the insurance provider of your choice and fill in the basic personal details, such as your name and contact details. Step 2: The insurance provider will respond with a quote, or an online calculator will give you a tentative idea of the premium you have to pay. Step 3: You will then be asked if you wish to add any ‘riders’ (additions to the basic plan) and customise it for your needs. It is advisable to go through this step carefully, evaluate your needs and select a rider that will offer better protection. Step 4: Once you have completed this process, you can make the premium payment online, after which you will receive the policy documents via e-mail and WhatsApp.The online process is quite easy and less physically tedious for senior citizens.

Follow these steps to initiate a claim under a Senior Citizen Health Insurance plan.

For cashless claims:

• Make sure to choose a network hospital for your treatment if you want to avail the cashless claim facility.
• Next, submit the claim form to your insurer’s Third-Party Administrator (TPA).
• Your insurer will then review the submitted documents and assesses the claim.
• Your insurer will determine the eligible claim amount after processing your claim. If the claim is approved, the network hospital will settle the amount with your insurer directly.

For reimbursement claims:

• Inform your insurer and apply for a reimbursement claim in case of medical treatments or hospitalisation at your preferred hospital.
• Gather the necessary documents from the hospital. These documents can include the discharge summary, hospital prescriptions and medical reports.
• Submit the documents to your insurer. This step can be done online or at your insurer’s local branch office.
• If your claim is approved, the reimbursement amount will be credited to your bank account.

• Health Insurance becomes more and more crucial as your age advances, especially because of the constantly rising medical costs in India.
• Entry age barrier, waiting period and co-payment clauses are some critical elements that can become hurdles for senior citizens who want to get an insurance policy.
• Always read all the inclusions and exclusions of the Health Insurance policy you choose to be completely aware of the level of coverage to which you are entitled.
• It is possible to get Health Insurance online, and it is much more convenient than in-person visits to the insurance provider.