Senior citizen health insurance is a type of health insurance policy designed specifically for individuals who are above a certain age, usually 60-65 years. These policies provide coverage for medical expenses incurred due to hospitalization, surgeries, critical illnesses, and other medical treatments.
Senior citizen health insurance policies in India usually come with a higher premium compared to regular health insurance policies due to the increased health risks associated with old age. However, these policies offer several medical benefits and tax benefits under Section 80D of the Income Tax Act.
When choosing a senior citizen health insurance policy in India, it is important to consider various factors. We have explained 8 important factors in this article.
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1) Age limit: In India, senior citizen health insurance is a specialized health insurance policy that is designed to provide comprehensive health coverage to individuals who are above a certain age, typically 60 years or more. The age limit for senior citizen health insurance policies varies from insurer to insurer, but generally, it ranges from 60 years to 80 years.
2) Pre existing diseases: Pre-existing diseases refer to any health condition or ailment that an individual has before taking a health insurance policy. In the case of senior citizens, pre-existing diseases are more common due to age-related health issues. When it comes to senior citizen health insurance in India, coverage for pre-existing diseases may vary depending on the policy and the insurer.
Most senior citizen health insurance policies in India cover pre-existing diseases after a waiting period of 2-4 years, depending on the insurer. During this waiting period, the policyholder will not be able to make a claim for any pre-existing diseases. However, after the waiting period, the policyholder can make a claim for treatment related to pre-existing diseases.
It is important to note that the coverage for pre-existing diseases may come with certain limitations and exclusions. For instance, the policy may have a sub-limit on the amount of coverage for pre-existing diseases, or may not cover certain pre-existing diseases. Therefore, it is important to carefully read the policy documents and understand the coverage, exclusions, and limitations before purchasing a senior citizen health insurance policy.
In addition to the waiting period, insurers may also ask for a medical check-up before issuing a policy to senior citizens, especially if they have pre-existing diseases. The medical check-up helps the insurer assess the risk associated with the policyholder and determine the premium for the policy.
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3) Sum Insured: The sum insured in senior citizen health insurance policies in India is the maximum amount of money that an insurer will pay to the policyholder in case of hospitalization or medical treatment. The sum insured in senior citizen health insurance policies is usually higher than regular health insurance policies, as senior citizens are more prone to age-related health issues and may require expensive medical treatments.
The sum insured in senior citizen health insurance policies in India may vary from insurer to insurer and may range from a few lakhs to several lakhs of rupees. Some insurers also offer policies with no upper limit on the sum insured, although these policies may come with higher premiums.
It is important to note that the sum insured should be selected based on the individual’s medical history, age, and lifestyle. While a higher sum insured may provide better coverage, it may also come with a higher premium. On the other hand, a lower sum insured may result in insufficient coverage and may not cover all medical expenses.
4) Co-Pay: Co-pay is a cost-sharing feature in senior citizen health insurance policies in India, where the policyholder is required to pay a certain percentage of the medical expenses incurred, while the remaining amount is paid by the insurer. Co-pay is usually expressed as a percentage of the claim amount and varies from policy to policy.
Senior citizen health insurance policies in India may have co-pay clauses to limit the insurer’s financial liability in case of high medical expenses. Co-pay clauses may be applicable to specific medical treatments, hospitalization expenses, or for all medical expenses incurred.
For instance, a policy may have a 20% co-pay clause, which means that the policyholder will have to pay 20% of the medical expenses, while the insurer will pay the remaining 80%. In some cases, insurers may offer policies with a higher co-pay option, which can help lower the premium for the policy.
While co-pay clauses can help lower the premium for senior citizen health insurance policies in India, it is important to carefully consider the impact of co-pay on the policyholder’s finances, especially in case of high medical expenses. It is also important to compare policies from different insurers and read the policy documents carefully to understand the co-pay clauses, as well as other terms and conditions of the policy, before making a purchase decision.
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5) Waiting period: The waiting period is a period during which the senior citizen health insurance policyholder will not be able to make a claim for certain medical treatments or health conditions. The waiting period is usually specified in the policy documents and may vary depending on the insurer and the policy.
In senior citizen health insurance policies in India, waiting periods are common, especially for pre-existing diseases and certain medical treatments. This is because senior citizens are more prone to age-related health issues, and insurers may want to limit their financial risk by imposing waiting periods.
The waiting period for senior citizen health insurance policies in India may vary from 2-4 years, depending on the insurer and the policy. For instance, a policy may have a waiting period of 2 years for pre-existing diseases, while another policy may have a waiting period of 4 years for the same.
It is important to note that the waiting period may not apply to all medical treatments or health conditions. For instance, waiting periods may not apply to accidental injuries, hospitalization due to accidents, or medical treatments for certain diseases.
6) Network Hospitals: Network hospitals are a group of hospitals that have a tie-up with the senior citizen health insurance provider to provide cashless treatment to policyholders. These hospitals have a pre-agreed tariff with the insurer, and the policyholder can avail of medical treatment without having to pay cash at the time of admission or discharge.
Senior citizen health insurance policies in India usually have a list of network hospitals that the policyholder can visit in case of a medical emergency or planned hospitalization. The list of network hospitals may vary depending on the insurer and the policy, and it is important to check the list before purchasing a policy.
7) Premium: Consider the premium amount and whether it is affordable in the long term. Compare the premiums of different insurers and choose a policy that provides the best value for money.
8) Renewal Age: Check the renewal age of the policy, which can range from 75-90 years. Choose a policy with a higher renewal age to ensure continued coverage in old age.
Conclusion: In summary, when buying a senior citizen health insurance plan in India, consider factors such as age limit, pre-existing diseases coverage, sum insured, co-pay, waiting period, network hospitals, premium, and renewal age. It is advisable to compare policies from different insurers and read the policy documents carefully to make an informed decision.
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