Healthcare needs often increase with age because of a combination of physiological, medical, and social factors that arise from cumulative effects of ageing. As a result, routine medical treatment costs can place a significant financial burden on retirees and their families.
To counter this situation, senior citizens’ healthcare insurance plans are designed to address medical aspects by offering coverage that accounts for hospitalisation and the recovery period. But there are certain things that you should know before selecting such healthcare plans. In this context, we’ll explain features, common limits and exclusions of senior citizen health insurance.
Policy Inclusions
There are a few aspects that make a mediclaim policy suitable for senior citizens. Let’s have a look at a few of them:
- Sum Insured: Coverage limits differ for multiple slabs. They range from mid-level to high-level amounts that align with the expected healthcare costs of older adults.
- Eligibility and Renewability: Many senior citizen health insurance plans allow people aged 60 years or above to select this healthcare insurance option.
- Renewal incentives: Some insurance policies increase the available sum insured year on year if no claims are made.
- Cashless Hospital Network: Access to a wide range of hospitals allows you to get treatment without the hassle of making payments upfront. This availability makes medical insurance the most feasible option to buy health insurance.
Primary Features of Senior Citizen Health Insurance Plans
While the exact features may differ between policies, here are common ones listed:
1. In-Patient Hospitalisation Cover
This fundamental advantage covers the costs of medical fees incurred during official hospital stays. Such medical insurance plans usually include room charges, nursing care, ICU charges, diagnostic tests, and specialists’ consultations.
2. Day-Care Procedures
Some procedures do not entail a complete stay of 24 hours but require medical care. Some of the best health insurance plans can also include chemotherapy, dialysis, cataract surgery, and other similar treatments.
3. Pre- and Post-Hospitalisation Expenses
The costs incurred right before hospitalisation and in follow-up treatment after discharge are normally reimbursed or paid in cash within given periods. For example, insurers like HDFC ERGO offer 60 days prior to hospitalisation and up to 180 days after on their senior citizens’ health insurance plans.
4. AYUSH Treatment
Traditional treatments like Ayurveda, Yoga, Unani, Siddha, and Homoeopathy are usually incorporated if they include inpatient care.
5. Organ Donor and Ambulance Cover
Costs associated with organ donor processes and ambulance care to the hospital can be reimbursed on some plans.
Typical Limits of Senior Citizen Insurance Plans
Besides attractive benefits, senior citizen health insurance plans also come with some limitations. Here are a few of them:
| Feature | Limits | Notes/buyer action |
| Sum insured choices | Some insurers provide ₹5 lakh up to ₹1 crore. | Make your choice based on expected healthcare costs and family history. |
| Pre-hospitalisation | Up to 60 days | Verify the exact number in the policy schedule. |
| Post-hospitalisation | Up to 180 days | Confirm limits for follow-up care and diagnostics. |
| Day-care procedures | Identify whether the amount has a limit on daycare treatments | Ensure the procedure you need is listed as covered. |
| Restoration benefit | Check the amount of restoration of the sum insured after the first claim offered on the plans. | Restoration can be crucial to ensure financial backing for future medical coverage. |
*The above factors are a generic overview and actual coverage may differ based on the policy you choose.
Common Exclusions to Review
Exclusions list the situations in which claims would not be payable, even if hospitalisation occurs. In senior citizen medical insurance, here are a few exclusions to be aware of:
1. Waiting Period
Any illness or medical condition diagnosed within the first waiting period is not covered, except claims brought about because of an accident. This is usually the initial 30 days of policy commencement.
2. Pre-Existing Conditions
Pre-existing medical conditions not stated or found after policy purchase are not covered until the pre-existing disease waiting period is over. This is usually until 36 months of continuous coverage.
3. Specific Treatment and Procedure Exclusions
Some treatments are not pre-existing but excluded over a specified period of time. These usually involve cataract surgery, joint replacement, hernia, piles, sinusitis and stones in the gall bladder. Coverage is provided after the relevant specific disease waiting period, which is usually about 24 months.
4. Penal Exclusions
Claims due to intentional self-injury or similar events are not covered. Costs associated with alcohol or substance abuse are not payable as well, even if hospitalisation is required.
Final Thoughts
Senior citizen health insurance plans work best once you know their features, limits and exclusions. These three terms define the capabilities of your chosen healthcare plan and allow you to compare plans and select the appropriate health insurance. To get more details on these areas, read the policy wordings of insurance plans, as they give more clarity about the offerings.