IRDA Guidelines for Health Insurance for Senior Citizens

IRDA's directive

The regulator for insurance industry in India - Insurance Regulatory Development Authority has addressed all problems relating to insurance industry in India including its policyholders with special emphasis on senior citizens. No insurer or insurance company in India can refuse or deny an senior citizens with a health insurance cover or load him/her with extra premium without providing valid reasons. All such reasons can be scrutinized by regulatory bodies like IRDA., important as it may be, the current scenario of health insurance markets across India is arbitrary in nature. For example, while some insurers reimburse the cost of medical tests to be undergone by a customer above the age of 45 years, few others insurers do not reimburse the costs incurred on medical test whereas some others reimburse only a part of it.

A recent amendments made to IRDA Act, makes it mandatory for all insurance companies to reimburse 50 percent of the total cost incurred on tests, if they agree to provide insurance coverage to the clients after medical examination. This means that a senior citizen can make a claim once the insurance coverage is approved. The new rules and regulation from IRDA ensures that the insurance sector across India practices more transparency and follows uniform standards. With the entry age being extended up to 65 years, the prospective customers would have greater flexibility in choosing a plan that suits their requirements. It has become mandatory for all insurance companies to see that disclosures are explained upfront so that an insured individual or the policyholder knows what is in stock for them.

Most insurance providers pass the discount they may provide to senior citizens to other categories by increasing their premium by a small amount. Health insurance policies for senior citizens have been introduced in India keeping the factor of cross-subsidization in mind. Such insurance policies have a lower ‘Sum Insured’ with ‘Greater Premium’ and are therefore to some extent designed to be self-sustainable.

Illustrative Policies-

1. Star Health and Allied Insurance ‘Senior Citizen Red Carpet Policy’ offers to insure people in the age group of 60-69 years (or senior citizens) without undergoing a medical test. It also covers pre-existing diseases from the first year itself.

2. National Insurance's Varistha Mediclaim Policy- medical tests for enrollment of senior citizens are not made mandatory, gives no-claim benefits and incorporates the coverage of pre-existing diseases after one claim-free year.

However, it must be noted that while Senior Citizen Red Carpet gives a Sum Insured of up to Rs 2 lakhs, Varistha Mediclaim policy by National Insurance offers a maximum sum insured of only Rs 1 lakh.

Entry age limits

Based on the latest regulations in health insurance sector, it has become mandatory that the maximum entry age for a standard health insurance policy offered by General (or non-life) Insurance Companies across India should be at least 65 years. The prevailing scenario regarding maximum entry age by general insurers offer at present is enlisted below:

General Insurance Companies	Maximum Entry Age (Yrs)
Oriental Insurance	No Limit
New India Assurance	80
Reliance General Insurance	80
Star Health and Allied Insurance	80
IFFCO Tokio General Insurance	70
Cholamandalam General Insurance	65*
ICICI Lombard General Insurance	60
Tata AIG General Insurance	60
Apollo DKV	60
National Insurance	59
Bajaj Allianz General Insurance	55
HDFC Ergo General Insurance	55
Universal Sompo General Insurance	55
Royal Sundaram General Insurance	50*
United India Insurance	50