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Senior Citizen Health Plan

What is Senior Citizen Health Plan?

Old age comes with more chances of contracting diseases and falling sick that may cost huge medical expenses that you have to pay from your pocket. Going for medical treatment is quite distressing, especially in the advanced ages when one does not have a regular or limited source of income.

Senior citizen health plan is a customized health plan catering to the health-related needs of elderly people. Such plans are somewhat costly as compared to regular health plans basis the plan benefits, features, inclusions, etc. You have the option to buy an individual senior citizen health plan or choose an umbrella plan that covers you and your spouse if you fall in the category of senior citizens or can take for your parents as well. It is thus a wise move to buy a Senior Citizen Health Insurance Plan for the elderly people that covers expenses incurred due to unforeseen medical emergencies.

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Why should I Buy Senior Citizen Health Plan?

There are various factors listed below which will make it imperative for people aged 60 and above to buy a Senior Citizen Health Insurance Plan.

Specialized Health Plan

Senior elderly people require frequent and urgent medical attention and a basic health plan may not be able to cater to the health care needs of the elderly. Buying a senior citizen health plan is the best option to take care of all the required medical & health care needs of people aged 60 years and above.

Rising Health Care Costs

According to recent estimates, the medical costs are rising at an alarming rate of 15% on an annual basis. When an elderly person goes for the medical treatments, it requires huge medical bills to be paid off that may disturb the financial equilibrium of a person. A senior citizen health plan pays the expenses incurred in case of medical emergencies, and the insured don’t have to pay from his/her own pocket. These health plans also pay for the long-term medical treatment treating critical illnesses.

Susceptibility to Illnesses

People in old age are more susceptible to major illnesses that may need urgent and frequent medical attention that cost them huge medical expenses. Having a senior citizen health insurance plan covers the medical expenses and provide financial back up in case of medical requirements.

Absence of Employer’s Health Policy

When a person is working, the employer must have covered him/her with an adequate group health policy. In the post-retirement life, a person might not be covered by the employer's health policy. Buying a senior citizen health insurance plan helps you to cover the medical expenses and allow a financial back up to rely on in the event of medical treatments or exigencies.

Financial Independence

People after attaining the age of 60+ years retire and there is no regular source of income for most of them. Some may become financially dependent on their heirs. With the limited or no income it becomes difficult to manage the gigantic medical costs. Going for a medical treatment would pose an additional financial burden on the family. A senior citizen health plan helps the person to pay the medical bills with ease and retain financial independence. A senior citizen health plan provides you a financial protection against medical costs and treatments of various illnesses.

What kinds of Senior Citizen Health Plans can I opt from?

Senior Citizen Health Plans are basically of two types.

Indemnity Plans

Under Indemnity based health plans, the claim or payout is paid as per the actual expenses sustained by the insured for getting the treatment done subject to the health cover taken. Indemnity plans don't pay you the total sum assured under the single event of hospitalization. The insured is indemnified to the extent of actual payout.

Fixed Benefit Plans

Fixed benefit health plans are the plans which offer you a fixed amount of benefits and are paid as lump-sum benefits under your health plan. Fixed benefit health plans pay you the complete policy sum assured on the occurrence of the insured event without taking into account the actual hospitalization or treatment expenses. Examples of such plans are Critical Illness Plans.

What are the Benefits of Buying a Senior Citizen Health Plan?

The benefits of buying a senior citizen health insurance plan offer you a vast coverage under your health plan which are:

Hospitalization Expenses

Senior citizen health insurance plan safeguards the insured by paying the hospitalization expenses which include

  • In-patient Hospitalization Expenses
  • Your senior citizen health plan will cover the medical expenses for a minimum period of 24 hours of hospitalization. Typically, your health insurer will pay for room rent, nursing, medical practitioner, anesthesia, blood, oxygen, surgical appliances, operation theater charges, medicines, drugs, consumables, and other devices required during a surgical procedure.

  • Pre Hospitalization Expenses
  • Related expenses which are covered 30 days (may vary from insurer to insurer) prior to the actual hospitalization which is related to your medical treatment under the scope of the plan which may include follow up visit charges of a doctor, medicine expenses, laboratory tests, etc.

  • Post Hospitalization Expenses
  • Related expenses for your medical treatment for 60 days post discharge from the hospital are also covered under the scope of senior citizen health plan like fees for a follow up with doctor post discharge, expenses done for diagnostic tests to ascertain the recovery of the treated medical illness, etc.

Day care Procedures

Certain treatments which do not require minimum 24 hours of hospitalization and are treated in less time because of technological innovation are also part of the senior citizen health policy. Every insurer has the list of daycare treatments covered under the scope of the plan.

Domiciliary Treatment

Expenses pertaining to the medical treatment done at home are also paid under the senior citizen health policy which otherwise require hospitalization for the same. This treatment can be undertaken by the undertaking given by the medical practitioner for getting it done at home due to unavailability of space in the hospital or due to the critical condition of the insured patient, etc.

Hospital Cash Benefit

A hospital cash allowance is payable on a day to day basis. The hospital cash benefit depends on the terms of the policy. A specified minimum stay in the hospital is required to avail this facility.

Organ Donor

Expenses related to the treatment of the organ donor are also paid under your senior citizen health plan in the need of organ transplant.

Cashless Treatment

By taking a senior citizen health plan, insured may avail cashless medical treatment for his/her illness or disease if the insured chooses to get it done under the listed framework of the network hospitals of the insurer.

No Claim Bonus

You are entitled to a no claim bonus for your senior citizen health policy which is a benefit accrued in the event of claim free policy year. Your insurer will reduce your premium by the bonus amount or may enhance your health cover by the same.

Health Check-ups

Some insurers offer free health check ups on an annual basis and claim free years. With a senior citizen health plan, you can avail basic medical check ups subject to the terms specified by the insurer and plan you have opted.

Tax Benefits

Senior Citizens can avail tax benefit of up to Rs. 30,000 each year towards the premium paid for their health policy. If you are paying the premium for the health policy of your parents, you become eligible to avail this benefit. These benefits are applicable under section 80D of the Income Tax Act 1961, subject to changes in tax laws.

(Note: The benefits mentioned above may differ from one insurer to another. Read your chosen Senior Citizen Health policy wordings carefully for more details)

How is my Senior Citizen Health Plan Premium Calculated?

Following are the key determinants for computing the premium amount for your chosen Health Insurance Plan.

Sum Assured

The sum assured you opted for, determines the premium amount for the senior citizen health plan. You should select the adequate sum assured that can easily cover all your medical conditions. Choosing a higher sum assured requires you to pay higher premiums also, but an inadequate health cover will not cover your medical expenses.


The age factor plays a key role in determining the premium amount for a senior citizen health plan. These health plans are available for those with the age of 60 years and above. Insurers tend to charge the higher premium amount considering higher health risks of senior citizens. Some insurers charge different premium amount for different age brackets, such as 60-65 years, 66-70 years, 71-75 years. Extra loading is applied on higher age brackets, such as 81-85 years, 86-90 years as applicable under the policy.

Personal Health Condition

Personal health is a vital determinant that decides the cost of the premium. If you are suffering from any genetic disease, you will be charged with the higher premium amount or the disease would be excluded from the coverage, basis the terms and conditions laid by the insurance company. Also, if you are in a habit of taking drugs, chewing tobacco, or smoking, you are charged with the increased rates of premium. These unhealthy habits directly put you at a high health risk and thus affects the premium rate as well.

Pre-existing Health Condition

If you have any pre-existing health condition, your insurance company will charge a premium at a higher rate. It is recommended to inform about your pre-existing condition to the insurer while buying the health plan, so you can easily get the claim afterward.

Claim Free Years

Getting a claim free year may result to discount on the premium rates on the next policy renewal or an increase in the sum assured. No claim bonus earned by you under the health plan may reduce your premium amount in the subsequent years.

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What are Some Smart Buying Tips?

Following are some of the key buying tips you can follow to buy the Senior Citizen Health Insurance Policy.

Buy an Adequate Health Cover: When buying a plan, apart from judging its benefits, you also need to select the sum assured (health cover) that can easily cover the medical expenses and is adequate for health treatment expenses. If you are under-covered, you need to pay bills from your pocket, and if over-covered, you need to pay high premiums to get a health cover that you don't require at the current moment. So, be prudent in choosing the sum assured amount. Opt the right amount of health cover considering medical inflation, treatment and surgery costs, hospital room rents cost, your health condition, etc.

Check on the List of Illnesses Covered: You should ascertain the number of illnesses covered under the health plan. It would be a prudent decision to choose a health policy that covers a wide range of illnesses. As with advance age, the elderly person is more prone to illnesses and other kinds of treatments. The health plans also include some illnesses which are not covered under the senior citizen health plan which needs to be reviewed before buying. You can buy a plan that covers the maximum number of illnesses including critical illnesses.

Opt for Plan with Least Waiting Period: Health insurers usually put a waiting period after which you are covered for specific illnesses or medical treatments. When going to buy a senior citizen health plan, it is recommended to choose a plan that covers illnesses with a least waiting period.

Check for Co-Payment Clause Carefully: By opting for this clause, your premium amount may reduce, but you need to pay a specific percentage of the incurred medical claims. When it comes to health plans for people aged above 60 years when the chances of becoming ill are quite higher, you need to assess the co-payment clause prudently so that it does not put a huge financial burden on your pocket. When you go for the treatment of serious illnesses, you need to pay the huge amount from your pocket considering the expense to treat such illnesses.

Check for Renewal Age limit: Renewal age is the age limit up to which the insured can opt to renew his/her medical insurance policy. For example, if you have a health plan having a renewal age of 80 years, it means you would not be able to renew your health policy after this age limit. Some insurers offer lifetime renewability for the health plans. Different insurers offer different renewal age limit, so it’s recommended to check it before buying the plan.

Opt for Plan with Domiciliary Treatment Cover: With domiciliary treatment option, you can avail the medical treatment at home on the advice of the attending medical practitioner. There are stances when seniors or elderly people need emergency care and thus, it is quite essential for you to buy a senior citizen health plan covering expenses incurred in case of domiciliary treatment of the insured.

Check on Sub Limits: A Sub-limit clause under the health plan provides a monetary cap towards the amount of coverage available for health insurance claim. Usually, the sub-limits are available for room rent and certain illnesses or treatments. For example, if a cataract operation costs you Rs. 1 Lakh and you claim for the amount, the insurer will pay only Rs. 30,000 due to sub limit clause. For senior citizen health policies, it would be a right move to choose a policy that applies a nil or minimal sub limit.

Opt for Top & Super Top-up Health Plans to Enhance Coverage: Seniors are more susceptible to critical illnesses that may eat their sum assured under the health plan and it may result in paying huge medical bills from your pocket. Taking into consideration this scenario, it’s a right move to opt for top or super top-up health plans that cover the medical expenses over and above the basic sum assured at the cost effective premium cost.

Listed Network of Hospitals: You never know when seniors would require an urgent medical attention and emergency care and to address this concern, on needs to buy a senior citizen health policy that covers a broad network of hospitals having emergency care and hospitalization facilities, close to your location.

Check Claims Efficiency: It is important to know the claim settlement ratio and turn around time of settling the claim by the insurance company before buying the health policy. Also, it’s imperative to check the efficiency of the Third Party Administrator (TPA) involved. For medical emergencies, the need of the hour is the immediate financial support from the insurance company. Choose the insurance company with higher claim settlement ratio and fastest claim settlement turnaround time.

Read Fine Print: Prior to buying a policy, it is advisable to read through the policy terms & conditions and inclusions exclusions attached to the health plan. Read the policy wordings so you can easily assess whether the policy is a right fit for your medical needs.

Compare & Buy Online: It is important to compare the available senior citizen health plans in the market online to know about the key features, benefits, inclusions, exclusions, etc. and compare among the best ones. Also, online buying will enable you to compare the health plans from multiple insurers. Buying plans online will help you save some money as the online insurance products are cheaper than the offline ones. You can take an informed buying decision by choosing the best fit.

Is there any Add on Cover/Rider with Senior Citizen Health Plan?

Riders with senior citizen health plan may differ from plan to plan or insurer to insurer. You have the flexibility to customize the health plan while buying.

What is Not included in my Senior Citizen Health Plan?

Following are the conditions/exclusions that are not included in your Senior Citizen Health Plan.

• Pre-existing conditions: Any illness that had symptoms or received medical treatment within a stipulated period (as mentioned in the policy) of the commencement of the first policy.

• First 30 days: You can’t claim for the first 30 days from the commencement of the health policy. Accident injury claims, however, don’t require a waiting period.

• Non-allopathic treatment including.

• Medical conditions resulting from the consumption of alcohol, smoking, drugs, etc.

• Health conditions arising due to war, nuclear weapon, radiation of any kind, etc.

• Medical expenses incurred for treatment of STDs and AIDS.

• Cost of contact lenses, hearing aids, and specs.

• Convalescence, congenital external defects, intentional self-injury, general debility, expenses for diagnostic tests related to the disease for which the insured has not been hospitalized.

• Ailments such as non-infective arthritis, joint replacement, etc. are covered after completion of 2 consecutive policy years.

• Naturopathy treatment.

• Dental treatment/surgery.

(Exclusions may differ from insurer to insurer and plan to plan.)

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