TOP 5 Health Insurance Plans for Senior Citizens

1). Star Health Red Carpet

Star Health was one of the first insurers in India to design and introduce a health insurance plan pertaining to the selective needs of senior citizens. It was also the first plan that increased the maximum entry cap from 69 years to 75 years. Star Health Red Carpet has made it to our list because of the extensive coverage it offers.

Coverage:

In-patient hospitalization expenses covered including ICU expenses, nursing expenses, surgeon's fees, consultant's fees, anesthetist's and specialist's fees, cost of blood, oxygen, pacemaker, cost of drugs and diagnostic tests.

Pre and post hospitalization expenses covered (up to a maximum of 7% of the hospitalization expenses) 

Emergency ambulance charges covered

Domiciliary treatment covered

Daycare procedures covered

Treatment at network hospitals only

Pros:

Pre-existing disease starts getting covered right from the first year (except those for which treatment was received/recommended during the preceding 12 months from proposal date)

No medical screening required.

10% discount if certain documents are provided related to stress thallium, BP report, sugar, blood urea, and creatinine. The discount is also applicable if the insured submits a self-declaration mentioning that any surgery related to brain, heart or cancer has not been done in the past

No TPA involved. Direct in-house claim settlement

Cashless hospitalization at +5400 network hospitals across the nation

24x7 toll-free helpline

Free telephonic consultation with general physician

Cons:

Waiting periods - 30 days initial waiting period, before which no coverage is given. 

2 years waiting period for specific diseases like cataract, knee replacement surgery, etc. 

1 year waiting period for specific diseases like hernia, piles, etc.

Exclusions – Expenses incurred on naturopathy treatment, cosmetic surgery, and diagnostic tests. treatments currently availed or availed during the preceding 12 months from the proposal date

Treatment can be availed at network hospitals only

50% co-payment of the claim amount, for pre-existing diseases

30% co-payment of the claim amount, for all other claims

2). National Insurance Varistha Mediclaim

National Insurance is the oldest and one of the biggest players in the insurance sector. The name holds repute among customers and the insurance fraternity for its innovative plans and hassle-free claim settlement. Varistha Mediclaim is one of the best health plans available for senior citizens in terms of coverage as well as premium.

Coverage:

Hospitalization expenses including room and boarding expenses, nursing expenses, ICU expenses, surgeon's fees, anesthetist’s fees, consultant's fees, cost of drugs and diagnostic tests, cost of blood, oxygen, pacemaker, etc.

Pre and post-hospitalization expenses

Domiciliary hospitalization

Optional critical illness cover

Organ's donor expenses

Ambulance charges

Pros:

Diabetes and hypertension, even pre-existing diseases are covered right from the inception of the policy (at a 10% additional premium)

Sum insured increased by 5% for each claim-free year

Reimbursement of cost of health check-up once in every 3 years

Rock bottom premium

Cons:

Waiting periods - Pre-existing diseases are covered after 1 claim-free year. 

Cost of dialysis, chemotherapy & radiotherapy done relevant to pre-existing diseases are not covered even after 1 year. 30 days initial waiting period, before which no coverage is given and for critical illness, it is 90 days.

Exclusions – Expenses incurred on cosmetic surgery, dental expenses, visual aid, hearing aid, vaccination, HIV/AIDS, diagnostic tests not directly relevant to any disease, vitamins and tonics, pregnancy-related expenses, and naturopathy.

76-80 age band will have to bear 10% loading charges up to 85 years.

20% loading charges for renewal at 85-90 age bracket.

Pre acceptance medical checkup for fresh entrants (no medical checkup required if the insured was covered under any health insurance policy continuously for the preceding 3 years).

Insured has to make a 10% co-payment in all claims. Plus, if it's a case of pre-existing disease, an additional 10% co-pay has to be borne by the insured

Cover is not substantial from a monetary perspective.

3). Oriental Insurance HOPE (Health of Privileged Elder)

HOPE comes from Oriental Insurance, is the most popular health insurer among customers not just for its products but also for its high claim settlement and high incurred claim ratios. HOPE offers coverage for specified diseases at an optimum premium.

Coverage:

Hospitalization expenses including room, boarding and nursing expenses, ICU expenses, surgeon fees, medical practitioner fees, specialists fees, anesthesiology, blood, oxygen, operation theatre charges, surgical appliances, medicines & drugs, dialysis, chemotherapy, radiotherapy, artificial limbs, prosthetic devices implanted during surgical procedure like a pacemaker, relevant diagnostic test, x-ray, etc.

Diseases covered - Accidental injury, knee replacement, cardiovascular diseases, chronic renal failure, cancer, hepato-biliary disorders, chronic obstructive lung diseases, stroke, benign prostrate, orthopedic ailments, ophthalmic diseases.

Domiciliary hospitalization expenses

Ambulance service charges

Pros:

Discount in premium for opting voluntary co-payment.

Discount in premium for every claim-free year.

The benefit of continuity extended if already insured with any mediclaim policy of the company.

Ayurvedic/ Homeopathic/ Unani treatment covered.

Cons:

Waiting period - 30 days initial waiting period, before which no coverage is given (except in case of accidental injury). 2 years waiting period for pre-existing diseases. The same waiting period shall also be applied to the complications arising from pre-existing diseases.

Exclusions – Injury or disease arising from an act of war, cosmetic surgery, visual aids, hearing aids, HIV/AIDS, naturopathy treatment, outpatient treatment expenses, disease/injury arising from the insured's participation in hazardous activities.

Covers specified diseases only.

Compulsory co-payment of 20% on admissible claim amount.

Loading for new entrants

Pre and post hospitalization expenses are not covered

Pre-acceptance medical screening is required and expenses of which has to be borne by the insured

4). Bajaj Allianz Silver Health

Bajaj Allianz is a brand that is known to come up with customer-oriented insurance plans. Silver Health is one such plan, offering the best of health insurance to senior citizens.

Coverage:

In-patient hospitalization expenses

Pre and post hospitalization expenses covered (up to a maximum of 3% of admissible hospitalization expenses)

Emergency ambulance charges covered subject to a limit of Rs 1000/claim

Pros:

In-house health claim administration team

Fast claim settlement

Innovative packages to match individual need

5% cumulative bonus gets added to your limit of indemnity for every claim-free year

5% family discount

Cons:

Waiting periods - Pre-existing disease starts getting covered only from the 2nd year of the inception. 30 days initial waiting period, before which no coverage is given. 

Certain diseases such as hernia, piles, cataract, benign prostatic hypertrophy, hysterectomy shall be covered after a waiting period of 1 year. 

Joint replacement surgery (other than due to accidents) will have a waiting period of 4 years.

Exclusions - Non-allopathic medicines, AIDS and related disorders, cosmetic, aesthetic or related treatment, use of Intoxicating drugs and alcohol, treatment of any mental illness or psychiatric illness.

Pre-medical screening cost has to be borne by the proposer. It will only be reimbursed if the proposer is accepted.

20% co-payment, in case treatment, is taken at non-network hospital.

5). New India Senior Citizens Mediclaim Policy

Holding the zenithal 17.89% market share, New India Assurance is the leading health insurer in India. Senior Citizen Mediclaim Policy offers a standard coverage at the lowest premium among all the health insurance plans available for senior citizens in the market.

Coverage:

Hospitalization expenses incurred for the treatment of illness/injury

Pre and post hospitalization expenses up to 30 and 60 days respectively

Ambulance charges

Limited cover for hospitalizations in government and /or registered Ayurvedic/Homeopathic and Unani hospitals

Pros:

Discount on premium for voluntary excess

Family discount

Reimbursement of cost of health check-up once in every 4 claim-free years

The lowest premium among all the health plans

Cons:

Waiting periods - Pre-existing diseases covered only after 18 months from the inception of the policy. There is a 30 days initial waiting period, before which no coverage is given.

10% loading charges for renewal between age of 81-85 years

Exclusions – Expenses incurred on dental treatment, debility, AIDS, cosmetic surgery, vaccination and inoculation, pregnancy and childbirth, war, nuclear weapon, etc

20% loading charges for renewal between age of 86- 90 years

Additional premium to cover pre-existing conditions like hypertension, diabetes mellitus, from the inception of the policy.

Pre-acceptance health check-up required for new entrants. However, the health check is waived for those who are already insured with New India

There's no flexibility in the sum assured

Final words

The above-stated plans are some of the leading health plans available in the market for senior citizens. Someone who relied on employer health policy for all his life and now post-retirement left without health coverage can bank on these insurance options.

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