Everything You Need To Know | Senior Citizen Insurance Plan

As one grows older, income reduces, immunity goes down, vulnerability to various diseases increases, and the bills pile up.

Ageing brings along a wide range of medical expenses. As one grows older, income reduces, immunity goes down, vulnerability to various diseases increases, and the bills pile up. Needless to say, having good health coverage for this age is a necessity that cannot be ignored. But don’t worry, there’s a lot that you can do to prepare yourself.

When to buy?

Senior Citizen plans are more restrictive in nature, so buying them after the age of 60 is not advisable. IRDAI allows people to have lifelong renewability which means that you can buy a ‘regular plan’ early and keep renewing it for life. It would help you cross the waiting period before you turn 60 and also cover pre-existing illnesses. But if you buy a Senior Citizen Plan later, you will face a number of policy constraints.

What are the most important features of a Senior Citizen Health Insurance Plans?

Senior citizen plans are designed to provide good coverage to elderlies and there are some important features that you should be aware of:

  1. Entry age – This is the age where you are eligible to buy a Senior Citizen-specific plan. Most insurers have only the minimum limit (60 years) but some of them have a cap on age. Star Health’s Red Carpet plan, for example, will not let you buy a Senior-citizen plan if you are over 75 years of age. Plans above this age bracket come under Super Senior Citizen schemes.
  2. Co-payment – Co-payment means that your total medical bill will be shared between you and your insurer in a pre-defined ratio. For instance, Religare Senior Citizen Plan has a smaller, 20% co-payment clause, for every claim which means that 20% of all the claims will be borne by the insured and 80% by the insurer.
  3. Regular Health Checkups – Religare Care Senior, for example, provides for an annual complete health check-up for all policy holders in their network hospitals regardless of your claims history. Another great benefit of this plan is that you may opt for a second opinion from another doctor, and that expense will be covered too.
  4. Personalised Care – Certain senior citizen health plans like Aditya Birla’s Active Care provide for a more personalised care. They provide unlimited health coaching sessions if the Sum Insured is more than 5 Lakh. Their health coaches provide advice and lifestyle management tips. And most importantly, they have qualified nurses in their network to care for elderlies at home.
  5. Automatic Restoration Of Sum Insured – Most Senior Citizen plans offer 100% restoration of sum insured. Tata AIG, Religare, and Aditya Birla, for instance, offer complete restoration if you exhaust your cover due to claims to ensure that you remain protected at all times.
  6. Waiting period – Apart from accidents, no disease is covered in the first 30 days of a Senior Citizen plan. Pre-existing illnesses are usually covered only after 4 years, and there can be illness-based waiting periods ranging from 2-4 years. Some insurers do cover pre-existing illnesses after 24 months but they may pay only 50% of the cover in this case.
  7. Sub-limits – Sub-limits are individual caps on individual expenses like doctor’s fee, room charges, nursing costs, operation charges, etc. For example, cataract, knee-replacement surgeries, or broken bones are some of the common ailments in the old-age. Under the sub-limits, a plan like Religare’s Care can provide upto 30,000 per eye for cataract operation, 1 Lakh for knee replacement, and 2.5 Lakh for broken bones even if the total sum insured is, say, Rs. 4 Lakh.
  8. Thorough medical test – Due to high health risks of age, some insurers insist on a thorough medical checkup before offering a policy. Usually, they do the tests in one of their network hospitals or they reimburse you for tests done in other centres. This is done to have a proper medical record of the insured senior person before they buy the policy to avoid potential disputes during the claim process.

OneAssure is a distribution platform that helps you make right decisions on matters where health and finances converge. Visit oneassure.in to know more about your health insurance choices.

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