A Glance on Health Insurance for Senior Citizens

May 14, 2014 . Sridharan S

Why a health insurance policy for senior citizens

In general, health insurance can be availed as a floater plan. For example, in a family floater policy, a policyholder, his wife, his children and his parents are covered. However, the premium charges are higher if his parents are above 60 years of age. Due to this reason, insurance companies have started offering a separate health insurance policy for senior citizens, i.e., to cater to individuals above 60 years of age.

Medical tests

In most cases, to buy a senior citizen policy, it is mandatory to undergo a medical test. There are only a limited number of insurance companies that offer senior citizen policies without a medical test. The cost of this test has to be borne by the individual and the same will be refunded by the company when the policy is issued to such an individual. Also, all the pre-existing diseases of the policyholder are covered after approximately 2-3 years of acquiring the policy.

One important point to note about the senior citizen policy is ‘co-payment on hospitalization’. For example, if the policyholder is hospitalized for treatment, and the total claim is Rs. 1,00,000, then the policyholder should make a payment of 20%-30% of the claim amount. The insurance company will settle the remaining amount. The percentage of co-payment that is required to be made by the policyholder varies from one company to the other.

This is charged because insurance companies offer additional facilities to them. Some companies offer 24 X 7 call centres to cater to their individual emergency medical needs and queries. Also, some companies might also cover health conditions like head ache and leg pain, if the claim is higher.

Health insurance plans for senior citizens are available only as individual policies, and not as family floater plans. This is due to the risk of a higher claim and higher charges for the insurance company that may arise from the floater policy.

A comparison of the different senior citizen policies

Note: For all the policies, the waiting period is 30 days from the day of issuance.

Things to remember

Policyholders must keep an eye out for the following points after taking the policy:

  1. It is very important to know the TPA (Third Party Administrator) of your policy as insurance companies will transfer your claim process to them. The TPA will be responsible for all claim processes and settlements.
  2. It is advisable to call the TPA and understand the insurance coverage, and to acquire the list of network hospitals and exclusions. By going for treatment at a network hospital, you can take advantage of the cashless claim feature of your policy. Otherwise, you will have to make payments to the hospital and then claim the same from the insurance company.
  3. To avoid any hassles during a health emergency, it is advisable to note the list of hospitals that are nearer to your residence. Then, you can easily find out if they are a part of your insurance company’s network list.
  4. It is always better to know the co-payment limit for the policy which will help you prepare the differential amount when you are hospitalized.
  5. It is always advisable to make a note of the date of your policy renewal so that you can pay the premium well in advance to avoid losing out on the cool-off period for pre-existing diseases.
  6. It is always advisable to use the policy very efficiently by not claiming smaller amounts. This will help you accumulate your sum insured, saving it for a rainy day.

It is also recommended that you save for medical emergencies, besides taking a health insurance policy as this will help you when you have more medical needs in a year.

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