Health Insurance for Senior Citizens in India – General Guidelines

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As life expectancy increases, so does the need for comprehensive healthcare, especially for senior citizens above 60 years of age. Health insurance for seniors in India has become a critical tool in managing medical expenses and ensuring access to quality healthcare as they age(1^✔ ✔Trusted Source
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Health insurance policies for senior citizens provide various benefits, including:

• Cashless Hospitalization: Senior citizens can avail cashless hospitalization at network hospitals.
• Pre-hospitalization and Post-hospitalization Expenses: Policies cover pre-hospitalization and post-hospitalization expenses, including doctor's fees, diagnostic tests, and medication.
• Day Care Procedures: Policies cover day care procedures, including cataract surgery, dialysis, and chemotherapy.
• Ambulance Charges: Policies cover ambulance charges for transportation to and from the hospital.

The premium for health insurance policies for senior citizens varies depending on factors such as age, health condition, and sum insured. Generally, the premium increases with age. There is a waiting period for pre-existing diseases, which can range from 1-4 years, depending on the policy.

The claim process for health insurance policies for senior citizens is similar to that for other health insurance policies. The policyholder needs to intimate the insurer, submit the required documents, and the insurer will process the claim.

Health insurance premiums for senior citizens are eligible for tax benefits under Section 80D of the Income Tax Act.

Prerequisites For Senior Health Insurance

Pre-screening requisites for Government Health Insurance Schemes

The general prerequisites for government health insurance schemes for senior citizens in India are as follows:

• Age: The applicant must be 60 years or older to qualify for most government health insurance schemes.
• Residency: The applicant must be a resident of India.
• Income: Some government schemes have income eligibility criteria, requiring the applicant's income to be below a specified threshold.
• Medical Screening: Certain schemes may require medical screening tests to assess the applicant's health status and eligibility.
• Pre-Existing Conditions: Specific schemes might have requirements or restrictions related to pre-existing medical conditions.

Pre-screening requisites for Private Senior Health Indian Insurance Companies

Pre-screening requirements for health insurance for senior citizens in India can vary among insurers. Generally, most insurance companies require senior citizens to undergo medical tests to determine their health status and assess the risk of coverage.

Common mandatory medical tests include:

1. Blood Pressure Test
2. Blood Sugar Test
3. Lipid Profile Test
4. Complete Blood Count (CBC) Test
5. Electrocardiogram (ECG) Test
6. Urine Routine Test

Pre-Screening Process:

• Medical Questionnaire: The insurer will ask the senior citizen to complete a medical questionnaire detailing their medical history, lifestyle, and health habits.
• Medical Check-Up: The senior citizen may need to undergo a medical examination conducted by a doctor or medical professional appointed by the insurer.
• Medical Reports: The senior citizen might be required to submit medical reports from their doctor or hospital, including any relevant previous medical records.

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Indian Government Senior Health Insurance Schemes

1. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) Scheme

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) Scheme is a flagship scheme of the Indian government that provides a cashless cover of up to ₹5 lakh annually for secondary and tertiary care hospitalization to all senior citizens above 70 years of age, regardless of their income(2^✔ ✔Trusted Source
Ayushman Bharat

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• Cashless cover of up to ₹5 lakh annually for secondary and tertiary care hospitalization
• Covers all senior citizens above 70 years of age, regardless of their income
• Covers pre-existing diseases
• No cap on family size and age
• All pre-existing diseases are covered from day one
• No need for medical check-up before enrollment

Eligibility:

• All senior citizens above 70 years of age
• No income limit
• No cap on family size and age

How to Apply:

• Visit the official website of AB PM-JAY: www.pmjay.gov.in
• Click on "Am I Eligible" and enter your mobile number and ration card number
• If you are eligible, you will receive a SMS with a link to download your e-card
• Download your e-card and take a printout
• Visit any empaneled hospital with your e-card and ID proof to receive treatment

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2. Rashtriya Swasthya Bima Yojana (RSBY) Scheme

The Rashtriya Swasthya Bima Yojana (RSBY) Scheme is a government-run health insurance scheme that provides health insurance coverage to senior citizens, designed to provide financial protection against medical expenses(3^✔ ✔Trusted Source
Rashtriya Swasthya Bima Yojana

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• Health insurance coverage of up to ₹30,000 per family per year
• Covers hospitalization expenses, including doctor's fees, medicines, and diagnostic tests
• Covers pre-existing diseases.
• No cap on family size and age
• All pre-existing diseases are covered from day one
• No need for medical check-up before enrollment

Eligibility:

• Below Poverty Line (BPL) families
• Unorganized sector workers
• Senior citizens
• Disabled persons

How to Apply:

• Visit the official website of RSBY: www.rsby.gov.in
• Click on "Apply Online" and fill in the application form
• Upload required documents, including ID proof, address proof, and income proof
• Pay the premium amount online
• Download your e-card and take a printout
• Visit any empaneled hospital with your e-card and ID proof to receive treatment

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3. National Programme for Health Care of the Elderly (NPHCE)

The National Programme for Health Care of the Elderly (NPHCE) is a scheme launched by the Ministry of Health and Family Welfare to provide healthcare services to elderly people, including health insurance coverage(4^✔ ✔Trusted Source
National Programme for healthcare of Elderly(NPHCE)

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• Provides healthcare services to elderly people, including health insurance coverage
• Covers hospitalization expenses, including doctor's fees, medicines, and diagnostic tests
• Covers pre-existing diseases
• No cap on family size and age
• All pre-existing diseases are covered from day one
• No need for medical check-up before enrollment

Eligibility:

• All elderly people above 60 years of age
• No income limit
• No cap on family size and age

How to Apply:

• Visit the official website of NPHCE: www.mohfw.gov.in
• Click on "NPHCE" and fill in the application form
• Upload required documents, including ID proof, address proof, and income proof
• Pay the premium amount online
• Download your e-card and take a printout
• Visit any empaneled hospital with your e-card and ID proof to receive treatment

4. Universal Health Insurance Scheme (UHIS)

The Universal Health Insurance Scheme (UHIS) is a scheme launched by the Ministry of Health and Family Welfare to provide health insurance coverage to all citizens, including senior citizens(5^✔ ✔Trusted Source
UHIS: Universal Health Insurance Scheme: Eligibility, Coverage And Benefits

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• Provides health insurance coverage to all citizens, including senior citizens
• Covers hospitalization expenses, including doctor's fees, medicines, and diagnostic tests
• Covers pre-existing diseases
• No cap on family size and age
• All pre-existing diseases are covered from day one
• No need for medical check-up before enrollment

Eligibility:

• All citizens, including senior citizens
• No income limit
• No cap on family size and age

How to Apply:

• Visit the official website of UHIS: www.mohfw.gov.in
• Click on "UHIS" and fill in the application form
• Upload required documents, including ID proof, address proof, and income proof
• Pay the premium amount online
• Download your e-card and take a printout
• Visit any empaneled hospital with your e-card and ID proof to receive treatment

5. Varishtha Pension Bima Yojana (VPBY)

Varishtha Pension Bima Yojana (VPBY) is a pension scheme for senior citizens aged 60 years and above, which provides a guaranteed return of 8% per annum for 10 years. The scheme is operated by the Life Insurance Corporation of India (LIC) on behalf of the government.

• Guaranteed return of 8% per annum for 10 years
• Pension payment options: monthly, quarterly, half-yearly, or yearly
• Loan facility available after 3 years of policy purchase
• Tax benefits under Section 80CCC of the Income Tax Act
• No medical examination required for enrollment

Eligibility:

• Age: 60 years and above
• Residency: Resident of India
• Income: No income limit

How to Apply:

• Visit the official website of LIC: www.licindia.in
• Click on "Varishtha Pension Bima Yojana" and fill in the application form
• Upload required documents, including proof of age, proof of identity, and proof of address
• Pay the premium amount online
• Download the policy document and take a printout

6. Pradhan Mantri Vaya Vandana Yojana (PMVVY)

Pradhan Mantri Vaya Vandana Yojana (PMVVY) is a pension scheme for senior citizens aged 60 years and above, which provides a guaranteed return of up to 8.3% per annum for 10 years. The scheme is operated by the Life Insurance Corporation of India (LIC) on behalf of the government.

• Guaranteed return of up to 8.3% per annum for 10 years
• Pension payment options: monthly, quarterly, half-yearly, or yearly
• Loan facility available after 3 years of policy purchase
• Tax benefits under Section 80CCC of the Income Tax Act
• No medical examination required for enrollment

Eligibility:

• Age: 60 years and above
• Residency: Resident of India
• Income: No income limit

How to Apply:

• Visit the official website of LIC: www.licindia.in
• Click on "Pradhan Mantri Vaya Vandana Yojana" and fill in the application form
• Upload required documents, including proof of age, proof of identity, and proof of address
• Pay the premium amount online
• Download the policy document and take a printout

7 New India Assurance Senior Health Insurance

New India Assurance Company Ltd. is a government-owned insurance company that offers a variety of health insurance plans, including those tailored for senior citizens. Their senior health insurance policies are designed to provide comprehensive coverage to meet the healthcare needs of older adults.

Click here to know more about New India Assurance Senior Health Insurance.

8. United India Insurance Company

United India Insurance Company Ltd. is a government-owned general insurance company established in 1938 and nationalized in 1972. It offers a wide range of insurance products, including health, motor, fire, marine, and personal accident insurance. United India Insurance is one of India's leading general insurers, providing financial protection through its diverse insurance offerings.

Click here to know more about United India Insurance Company.

9. National Insurance Health Insurance for Senior Citizens

National Insurance Company Ltd. offers a specialized health insurance policy for senior citizens, addressing their unique healthcare needs. The plan provides comprehensive coverage to individuals aged 60 and above. National Insurance’s health insurance for senior citizens ensures seniors have access to quality medical care without financial stress.

Click here to know more about National Insurance Health Insurance Policy for Senior Citizens.

Private Senior Health Indian Insurance Companies

Some of the Private senior health insurance companies are:

1. Star Health and Allied Insurance Company

Policy Name: Senior Citizens Red Carpet

Entry Age: 60 - 75 years

Premium: ₹18,000 - ₹35,000 (approx.)

Coverage: ₹5 lakh to ₹10 lakh

Key Features: No pre-policy medical check-up required. Coverage includes pre-existing conditions, hospitalization, and outpatient treatments.

Click here to know more about Star Health and Allied Insurance Company.

2. HDFC ERGO General Insurance Company

Policy Name: Optima Senior

Entry Age: 60 - 75 years

Premium: ₹20,000 - ₹40,000 (approx.)

Coverage: ₹5 lakh to ₹10 lakh

Key Features: Coverage for hospitalization, day care treatments, and pre/post-hospitalization expenses. Cashless treatment in over 10,000 hospitals.

3. Bajaj Allianz General Insurance Company

Policy Name: Silver Health Plan

Entry Age: 60 - 75 years

Premium: ₹15,000 - ₹30,000 (approx.)

Coverage: ₹5 lakh

Key Features: Pre/post-hospitalization coverage, cashless treatment, and coverage for pre-existing diseases after a waiting period.

4. ICICI Lombard General Insurance Company

Policy Name: Golden Shield

Entry Age: 60 - 75 years

Premium: ₹25,000 - ₹40,000 (approx.)

Coverage: ₹5 lakh to ₹10 lakh

Key Features: Includes hospitalization, day care procedures, air ambulance, and home care treatments. Cashless services at network hospitals.

5. Reliance Health Insurance Company

Policy Name: Senior Citizen Health Insurance

Entry Age: 60 - 75 years

Premium: ₹15,000 - ₹30,000 (approx.)

Coverage: ₹5 lakh

Key Features: Covers major hospitalization expenses, pre/post-hospitalization, and critical illnesses.

6. Max Bupa Health Insurance Company

Policy Name: Health Companion (Senior)

Entry Age: 60 - 75 years

Premium: ₹25,000 - ₹50,000 (approx.)

Coverage: ₹10 lakh

Key Features: Offers comprehensive hospitalization coverage, day care procedures, and no maximum renewal age limit.

7. Tata AIG General Insurance Company

Policy Name: MediSenior

Entry Age: 60 - 75 years

Premium: ₹18,000 - ₹35,000 (approx.)

Coverage: ₹5 lakh

Key Features: Covers in-patient treatments, pre/post-hospitalization, and day care procedures. Lifelong renewability option available.

8. Oriental Insurance Company Ltd

Policy Name: Health of Privileged Elders (HOPE)

Entry Age: 60 years and above

Premium: ₹15,000 - ₹25,000 (approx.)

Coverage: ₹2 lakh to ₹5 lakh

Key Features: Specifically designed for senior citizens, covering hospital charges, ICU fees, and certain specified diseases.

Click here to know more about Oriental Insurance Company Ltd.

Note: Not all private health insurance companies in India cover full hospital or health charges. It's important to carefully review the coverage and exclusions of each policy before purchasing the insurance.

Exclusion Charges in Health Insurance Policies for Senior Citizens in India

Certain charges are typically excluded from coverage by private health insurance companies for senior citizens in India. These exclusions often include:

Cosmetic surgery: Most private health insurance companies in India exclude cosmetic surgery from their coverage.

Fertility treatments: Fertility treatments, such as IVF, are typically excluded from coverage by private health insurance companies in India.

Experimental treatments: Experimental treatments, such as those that are still in the trial phase, are usually excluded from coverage by private health insurance companies in India.

Pre-existing conditions: Many private health insurance companies in India exclude pre-existing conditions from their coverage, or may have a waiting period before coverage begins.

Pregnancy and childbirth: Pregnancy and childbirth are typically excluded from coverage by private health insurance companies in India, unless a separate maternity policy is purchased.

Dental, vision, and hearing: Dental, vision, and hearing procedures are usually excluded from coverage by private health insurance companies in India, unless a separate policy is purchased.

Alternative treatments: Alternative treatments, such as acupuncture and homeopathy, are often excluded from coverage by private health insurance companies in India.

Self-inflicted injuries: Self-inflicted injuries, such as those resulting from suicide attempts, are typically excluded from coverage by private health insurance companies in India.

War and nuclear risks: War and nuclear risks are usually excluded from coverage by private health insurance companies in India.

Congenital diseases: Congenital diseases, such as those present at birth, are often excluded from coverage by private health insurance companies in India.

Hormone replacement therapy: Hormone replacement therapy is typically excluded from coverage by private health insurance companies in India.

Sleep disorders: Sleep disorders, such as sleep apnea, are often excluded from coverage by private health insurance companies in India.

Treatment outside India: Treatment outside India is usually excluded from coverage by private health insurance companies in India.

Unrecognized physician/hospital: Treatment by an unrecognized physician or hospital is typically excluded from coverage by private health insurance companies in India.

Artificial life maintenance: Artificial life maintenance, such as life support, is often excluded from coverage by private health insurance companies in India.

Tips for Buying Insurance

When buying a health insurance policy, senior citizens should:

• Compare Policies: Compare policies from different insurers to find the best one that suits their needs.
• Check the Network Hospitals: Ensure that the insurer’s network hospitals are convenient and accessible to you.
• Read the Policy Document: Read the policy document carefully to understand the terms and conditions.
• Consult a Doctor: Consult a healthcare professional to understand the implications of the policy and how it aligns with your health needs.
• Check the Claim Settlement Ratio: Verify the insurer’s claim settlement ratio to ensure they have a reliable track record of settling claims efficiently.
• Review the Policy Exclusions: Understand the exclusions in the policy to be aware of what is not covered.
• Verify the Policy Renewability: Confirm that the policy can be renewed without complications or restrictions.
• Assess the Customer Service: Check the customer service of the insurer to ensure that they provide good support in case of any issues.

Health insurance for senior citizens in India is essential to ensure that they receive quality medical care without financial burden. By understanding the general guidelines and benefits of health insurance policies, senior citizens can make informed decisions and choose the best policy that suits their needs.