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Ref. No. KLI/22-23/E-BB/492
Health Insurance for senior citizens is specially designed to cover people aged over 60 years. Here is how you can choose the best health insurance plan for seniors.
As we journey through life, the sands of time continue to trickle down, leading us to a phase where health becomes a paramount concern. In our golden years, a time when we should be enjoying the fruits of our labor and the company of loved ones, health issues can often cast a shadow over this period.
With age, health complications start knocking at the door. Therefore, senior citizens over the age of 60 years may have frequent needs for medical assistance. But regular salaries stop at the standard retirement age of 60 years.
Health insurance plans for senior citizens are crucial for senior citizen health insurance schemes to safeguard retirement funds.
Senior citizen health insurance is a specialized insurance product designed to cater to the healthcare needs of individuals aged 60 and above. It offers a wide range of medical coverage, including hospitalization expenses, medical tests, doctor consultations, pre- and post-hospitalization costs, and even some preventive healthcare services.
Unlike regular health insurance policies, senior citizen plans are tailored to address the unique health challenges and requirements associated with ageing. These plans recognize that senior citizens are more likely to face chronic illnesses, age-related conditions, and a higher risk of hospitalization.
The long-term advantages make purchasing health insurance coverage a clear objective in your yearly financial strategy.
Growing older necessitates comprehensive medical care, which raises costs. Seniors’ financial burden from regular medical bills is lessened by having health insurance.
Medical expenses can be overwhelming, especially for senior citizens who may not have a regular income source. Senior citizen health insurance provides financial security by covering various medical costs, ensuring that healthcare needs are met without burdening the individual or their family.
As individuals age, the likelihood of needing specialized medical attention increases. SCHI offers comprehensive coverage that includes hospital stays, surgeries, ambulance services, diagnostic tests, and more, ensuring that no aspect of healthcare is neglected.
Many SCHI policies include coverage for preventive health check-ups and screenings. Regular health check-ups can help identify potential health issues early, allowing for timely intervention and better management of conditions.
Some insurance providers offer a No Claim Bonus, which rewards policyholders with a reduction in premium or an increase in coverage for each year without making a claim. This incentivizes individuals to maintain a healthy lifestyle and make the most of the insurance when needed.
Senior citizen health insurance often provides the convenience of cashless hospitalization. This means that policyholders can avail of medical services at network hospitals without making any upfront payments. The insurance company settles the bill directly with the hospital.
If you consider such parameters, critical illness insurance is the ideal health insurance solution for senior citizens. Here are the most common life-threatening ailments covered:
As a senior citizen, if you are looking for health coverage, here are some factors to consider:
Look for plans with a broad minimum age at the entry range to buy the policy after turning 60.
In 2020, the life expectancy of 60-year-old Indians stood at 18.02 years. Thus, you will need renewable health coverage after retirement, even in your 70s, to access quality healthcare whenever you need it.
The risk of contracting infections, injury, or critical illnesses increases at an advanced age. But some treatment procedures like chemotherapy may not need overnight hospital stays. Also, domiciliary treatments at home might be essential when the senior patient is not in a condition to be shifted to a hospital. However, many policies limit the treatment procedures covered.
Mediclaim policies provide cashless treatments only on admission to a hospital having tie-ups with your insurer. Hence, you will need to look for hospitals under your insurer’s network to overcome any shortage of funds without your salary in an emergency. Therefore, a vast network is crucial.
Copayment clauses require you to bear a part of the medical bill yourself. Sub-limits cap the amount you can claim for specific illnesses or procedures, regardless of the total sum insured. Look for minimal copayments and sub-limits to reduce out-of-pocket spending.
To ensure that senior citizens can age gracefully while managing their healthcare needs, Senior citizen mediclaim policies have emerged as a crucial safeguard.
While health insurance plans for senior citizens offer a comprehensive range of coverage, it is essential to understand that not all medical expenses are covered.
pre-existing condition refers to a health issue that an individual has been diagnosed with before obtaining a health insurance policy. Insurance providers often impose waiting periods before such conditions are covered, and even then, the coverage might be limited.
Long-term care encompasses assistance with daily activities such as bathing, dressing, eating, and medication management, which are often required by seniors who experience chronic illnesses or disabilities. This type of care is usually provided in nursing homes, assisted living facilities, or at home by professional caregivers.
While some plans may offer limited coverage for these services, such as preventive dental check-ups or basic vision exams, comprehensive coverage for dental procedures (like crowns, dentures, and root canals) and vision treatments (such as eyeglasses and contact lenses) is usually excluded.
Health insurance plans for senior citizens typically exclude coverage for elective cosmetic procedures or surgeries, which are considered non-essential and aimed at improving appearance rather than addressing medical conditions. Procedures like facelifts, breast augmentation, and liposuction are generally not covered.
Health insurance plans often do not cover alternative or experimental treatments that are not considered mainstream medical practices. These might include alternative therapies like acupuncture, chiropractic care, naturopathy, and experimental treatments for certain conditions.
While some health insurance plans offer limited coverage for emergency medical treatment while traveling abroad, comprehensive coverage for overseas medical expenses is usually not included. Seniors who frequently travel or spend extended periods in different countries may need to consider purchasing additional travel health insurance to ensure they are adequately covered in case of medical emergencies abroad.
The claim settlement process involves several stages, from notifying the insurer about the claim to receiving the reimbursement or direct payment for the medical expenses incurred. Here Is a step-by-step guide to the claim settlement process for Senior citizen health insurance:
This should be done as soon as possible, either by contacting the insurer’s customer service helpline or through their online portal. The policyholder or their family members need to provide details such as the policy number, name of the insured, nature of illness or injury, date of hospitalization, and the name of the hospital.
The insurer will provide a list of documents required to process the claim. These typically include the claim form (duly filled and signed), medical records, hospital bills, discharge summaries, prescription copies, diagnostic test reports, and any other relevant documents.
The insurance company reviews the submitted documents and may conduct a verification process to validate the claim. This could involve contacting the hospital or medical professionals for further information. Timely and accurate submission of documents greatly expedites this stage.
Once the claim is verified and approved, the insurer will communicate the decision to the policyholder. Depending on the policy terms, the settlement can take two main forms:
If the policyholder is treated at a network hospital, the insurer may offer cashless treatment. In this case, the insurer settles the bill directly with the hospital, and the policyholder is not required to pay the medical expenses (or a specified percentage) out of pocket.
If the policyholder seeks treatment at a non-network hospital or opts for reimbursement, they need to pay the medical expenses upfront. Subsequently, they can file a reimbursement claim with the insurer by submitting all relevant bills and documents. The insurer will review the claim and reimburse the eligible amount directly to the policyholder’s bank account.
In some cases, claims may be denied due to incomplete documentation, policy exclusions, or other reasons. If a claim is denied or there are discrepancies, the policyholder has the right to appeal the decision or seek clarification from the insurer. It’s important to review the denial letter and take appropriate action carefully.
Once the claim is successfully settled, the policyholder should receive a settlement letter along with the reimbursement or a confirmation of cashless treatment. Providing feedback on the claim settlement process can help insurance companies improve their services and enhance customer experience.
A health insurance premium calculator is a free tool for figuring out the costs of different health insurance plans for senior citizens, as well as comparing and examining various medical insurance policies offered by well-known insurance providers online. You may contrast many aspects of health insurance policies, such as age, gender, occupation, the number of people covered by a policy, and others.
A modification in the health insurance premium is also possible after customizing one’s health insurance plans for senior citizens policies. Making a better purchasing selection is made possible with the use of a health insurance premium calculator.
Do not settle for limited coverage to get lower premium rates. Without sufficient financial cover, inflation can affect your retirement savings. Hence, look for a high sum insured and a wide range of benefits to prepare for medical uncertainties.
Amit Raje is an experienced marketer who has worked in various Fintechs and leading Financial companies in India. With focused experience in Digital, Amit has pioneered multiple digital commerce in India. Now, close to two decades later, he is the vice president and head of the D2C business department. He masters the skill of strategic management, also being certified in it from IIMA. He has challenged his challenges and contributed his efforts in this journey of digital transformation.
Prasad Pimple has a decade-long experience in the Life insurance sector and as EVP, Kotak Life heads Digital Business. He is responsible for developing user friendly product journeys, creating consumer awareness and helping consumers in identifying need for life insurance solutions. He has 20+ years of experience in creating and building business verticals across Insurance, Telecom and Banking sectors
Ref. No. KLI/22-23/E-BB/2435
The information herein is meant only for general reading purposes and the views being expressed only constitute opinions and therefore cannot be considered as guidelines, recommendations or as a professional guide for the readers. The content has been prepared on the basis of publicly available information, internally developed data and other sources believed to be reliable. Recipients of this information are advised to rely on their own analysis, interpretations & investigations. Readers are also advised to seek independent professional advice in order to arrive at an informed investment decision. Further customer is the advised to go through the sales brochure before conducting any sale. Above illustrations are only for understanding, it is not directly or indirectly related to the performance of any product or plans of Kotak Life.
