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Choosing Health Insurance for Senior Citizens

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.

  • 5,033 Views | Updated on: Dec 27, 2023

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.

What is Senior Citizen Health Insurance?

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 Benefits of a Health Insurance Plan

The long-term advantages make purchasing health insurance coverage a clear objective in your yearly financial strategy.

  • Coverage for multiple ailments under the same policy
  • Option to have your spouse under the plan to safeguard their health against age-related ailments
  • Age of entry up to 65 years, allowing you to buy the coverage as a senior citizen
  • Maturity age up to 75 years, keeping your health coverage in force even in your advanced age
  • Lump-sum payouts upfront on the diagnosis of the health problems covered, removing burdens of copayments and sub-limits
  • Payouts without the need to submit hospital bills, allowing you to seek any treatment procedure anywhere you choose
  • The sum insured amounts to ₹1 crore, letting you stay financially prepared for any health-related emergency.
  • Provision to add an extra monetary benefit of up to ₹50 lakhs for permanent disabilities due to an accident or unfortunate demise
  • Option for add-on daily hospital cash benefits to cover unforeseen expenses during a hospital stay
  • Flexible premium payments in monthly installments to suit pensioners’ limited budgets.

Why Do You Need Health Insurance Plans for Senior Citizens?

Growing older necessitates comprehensive medical care, which raises costs. Seniors’ financial burden from regular medical bills is lessened by having health insurance.

Financial Security

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.

Comprehensive Coverage

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.

Preventive Care

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.

No Claim Bonus (NCB)

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.

Cashless Hospitalization

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:

  • Cancer
  • Heart attack
  • Nerve diseases
  • Liver damage

Important Factors to Consider

As a senior citizen, if you are looking for health coverage, here are some factors to consider:

Entry Age Boundary

Look for plans with a broad minimum age at the entry range to buy the policy after turning 60.

Renewal Age Limits

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.

Diseases And Treatment Procedures Covered

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.

Hospital Network

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.

Co-payments And Sub-Limits

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.

Senior Citizen Mediclaim Policy

To ensure that senior citizens can age gracefully while managing their healthcare needs, Senior citizen mediclaim policies have emerged as a crucial safeguard.

Entry Age And Eligibility

  • If the proposer is a senior citizen, they may be eligible for an individual policy.
  • Self-only was 60 to 80 years old when it first started.
  • Self and Spouse were both between the ages of 60 and 80 when they were born.
  • If the proposer is an elderly person, a policy on a floating basis may be obtained.
  • Both the self and the spouse are present, with the self being between the ages of 60 and 80 and the spouse being between the ages of 50 and 80

Lines Of Treatment Covered

  • Allopathy, Ayurveda, and homoeopathy room rent/ICU costs, medical professionals’ fees (including anesthesiologists’ fees), consultants’ fees, and other expenditures as specified in the policy’s restrictions.
  • Funeral costs, ambulance fees, and organ donor costs are all paid to the extent specified and in accordance with the selected plan.
  • HIV & Mental illness cover Pre and Post Hospitalization for the same sickness, illness, or injury for up to 30 days and 60 days, respectively.
  • 12 The policy currently covers contemporary treatments, including robotic surgery, oral chemotherapies, immunotherapies, and others.
  • After a certain amount of time has passed, treatment for morbid obesity is now covered. (For complete information, see the policy)
  • After a set amount of waiting time, correction of refractive defects above -7.5 D is now covered.
  • Treatment associated with amateur participation in risky or adventurous sports is restricted.
  • Now covered are hospital expenses, mental illness, HIV/AIDS, and genetic abnormalities.
  • Only through TPA is a cashless facility available at Network Hospitals.
  • Pre-negotiated package prices for particular operations or procedures at participating hospitals.
  • Long-Term Renewability
  • According to IRDAI rules, portability (migration) is permitted from/to related products.

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

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 Conditions

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

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.

Dental and Vision Care

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.

Cosmetic Procedures

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.

Alternative and Experimental Treatments

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.

Overseas Medical Expenses

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.

Claim Settlement Process for Senior Citizen Health Insurance

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:

Intimation of Claim

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.

Submission of Documents

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.

Claim Verification

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.

Approval and Settlement

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:

Cashless Treatment

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.

Reimbursement

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.

Claim Denial or Discrepancies

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.

Settlement and Feedback

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.

Health Insurance Premium Calculator

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.

Conclusion

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.

Key takeaways

  • Senior citizen health insurance is a specialized insurance product designed to cater to the healthcare needs of individuals aged 60 and above.
  • Senior citizen health insurance provides financial security by covering various medical costs, ensuring that healthcare needs are met without burden.
  • SCHI offers comprehensive coverage that includes hospital stays, surgeries, and ambulance services.
  • Senior citizen health insurance often provides the convenience of cashless hospitalization.

- A Consumer Education Initiative series by Kotak Life

Amit Raje
Written By :
Amit Raje

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.

Amit Raje
Reviewed By :
Prasad Pimple

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

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