Senior Citizen Health Insurance Plans: Premium, features, benefits – Explained

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February 11, 2021 10:57 AM

For senior citizens, the premium of the policy is mostly at the higher-end as the premium increase with age and medical conditions.

However, if it does not allow migration, you will have to opt for a fresh retail policy and serve the applicable waiting periods.It is important you stay sufficiently covered for unforeseen exigencies and protect your hard earned savings.

After the outbreak of Coronavirus pandemic, the demand of health insurance seems to have gone up. With the cost of hospitalisation due to Covid-19 running into a few lakhs, the need to have adequate coverage has become the need of the hour. Also, senior citizens were found to be more vulnerable than those at a young age. So, how is the preparation by those above age 60 in meeting the hospital bills? According to Amit Chhabra, Head – Health insurance,, “From April 20-Dec 20 when the entire world was fighting against the pandemic and people were concerned about their health the most. The share of policies bought by the senior citizen category of age-group 60-80 years stands at only 15%, whereas the share for the younger lot in the age bracket of 18-40 years was found to be 45%.”

While most health insurance plans allow anyone below 60-65 to get insured, those above that age may have to buy senior citizen health insurance plans. “The minimum age for someone who is looking to buy a senior citizen health insurance plan is 60 years,” Informs Amit. Both of them can be renewed for lifetime and hence buying as early as possible help. “Senior citizens must be adequately covered with at least Rs 10 lakh per person sum insured and ideally should buy comprehensive plans with no limitations like co-pay or sub-limits. However, if a cheaper option is needed, then they could look at senior citizen specific plans which a come with some limitations like co-pay,” says Amit.

A typical senior citizen health insurance plan will have two major differentiating feature. One, most of them will have co-payment feature and secondly, there will be sub-limits and caps for treatment of various ailments. Under co-payment, the policyholder will have to bear a certain amount for example 20 per cent of hospital bill before the balance is re-reimbursed by the insurer. Also, several ailments such as cataract, Renal Diseases etc have an upper cap.

“Around 20% of the claims made by senior citizens are for Eye and Adnexal treatment, while 15% belong to Circulatory and Heart Disease and 8% are of Malignant Neoplasms. The Average claim amount made for cardiovascular disease is around Rs 75,000 and for a musculoskeletal disorder, it is around Rs 1,06,000 which accounts for 8% of the claims made by senior citizens,” informs Amit.


The premium to be paid by senior citizens will be higher than those at a younger age. “For senior citizens, the premium of the policy is mostly on a higher-end as the premium increase with age and medical conditions. So, you should compare the policies before buying and while comparing do not look out for lower premiums, but buy a policy that provides maximum benefits and comprehensive coverage,” adds Amit.

What to look for

It is extremely important for senior citizens to carefully go through the policy document and look at such sub-limits, inclusions and exclusions before buying. “There are few things like Pre & Post Hospitalization, day-care treatment and PED coverage that you should consider before buying a policy. You should also look out for waiting period, co-payment clause, sub-limits and other possible exclusions,” says Amit. Finally, ensure that you declare existing ailments and medication if any that you are taking while buying health insurance plan. Correct disclosures will help in the smooth processing of the claim if it arises.

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