All You Need to Know About Senior Citizen Health Insurance Policy

Considering the rapid increase of medical inflation in India, it has become extremely important for every individual to buy adequate health insurance plans for their loved ones and especially for elderly parents. With the increase in age, people are more prone to prolonged medical conditions and ailments. This can result in huge medical bills. With a senior citizen health insurance policy, all the medical expenses are covered extensively, securing the financial future of the family.

Why is Health Insurance Necessary for Senior Citizens?

You must buy health insurance even if you have a group health insurance policy from the employer that provides coverage for parents. This is because a group mediclaim policy might not be sufficient to cover the health risk of the whole family including the parents. Thus, with a senior citizen health insurance policy, you can easily provide the right coverage to your parents.  Let’s read further why you need to have health insurance for your parents.

• Increased healthcare needs: As people age, they are more likely to develop health issues and require medical care. Senior citizens often face chronic conditions like diabetes, heart disease, arthritis, and high blood pressure. Health insurance provides coverage for hospitalization, medication, diagnostic tests, and treatments, helping seniors manage their healthcare expenses effectively.
• Rising healthcare costs: Healthcare costs have been steadily increasing, and senior citizens are particularly vulnerable to high medical expenses. Health insurance helps mitigate these costs by covering a significant portion of hospital bills, doctor consultations, surgeries, and other medical services. Without insurance, seniors may struggle to afford the necessary healthcare they need.
• Limited income sources: Many senior citizens are retired or have reduced earning capacity, relying on fixed incomes such as pensions, savings, or social security benefits. These income sources may not be sufficient to cover the expenses associated with healthcare. Health insurance provides financial protection and ensures that seniors can access quality healthcare without depleting their savings or compromising their standard of living.
• Comprehensive coverage: Senior citizens often require a range of healthcare services, including preventive care, specialized treatments, and long-term care. Health insurance plans designed for seniors typically offer comprehensive coverage tailored to their specific needs. This may include coverage for prescription drugs, preventive screenings, vaccinations, physiotherapy, and nursing care.
• Peace of mind and security: Having health insurance gives senior citizens and their families peace of mind. It provides a sense of security, knowing that they are protected against unforeseen medical expenses and can receive timely and appropriate healthcare when needed. Health insurance eliminates the worry of financial burdens and allows seniors to focus on their well-being and quality of life.
• Annual Health Check-up Facility: Senior citizens can avail the facility of free health check-ups on a yearly basis as they require to undergo medical screening regularly. Thus, this facility can help to decrease the expenses incurred on the same.

Inclusions in the Senior Citizen Health Insurance Plan

Various benefits are covered under a senior citizen health insurance plan. Let’s take a look at some of them-

• Daycare Treatment- Specific daycare treatments like dialysis, chemotherapy, cataract, etc. that require hospitalization for less than 24 hours are covered under the policy.
• Hospital Expense Cover- Hospitalization costs such as nursing, room charge, doctor’s fees, ICU charges, medicine costs, fees charged by medical practitioners, anesthetists, surgeons, consultants and specialists are all covered under a health insurance policy. Moreover, the cost of blood anesthesia, surgical appliances, operation thereafter charges, medicines are also covered under the senior citizen health insurance policy.
• Other Medical Expenses- The other medical expenses that are covered under the senior citizen health insurance policy include treatments for dialysis, radiotherapy, chemotherapy, orthopedic implants, artificial limbs, vascular stents, pacemaker, etc.
• Organ Donor Expenses- Most senior citizen health insurance plans cover organ donor expenses.
• Pre and Post Hospitalization Cost- The pre and post-hospitalization expenses incurred for a specific number of days are covered under a mediclaim policy for senior citizens.
• Pre-existing Diseases- As per the terms and conditions of the policy, pre-existing illnesses are covered under the policy.
• Domiciliary Hospitalization- In case the doctor suggests home treatment then the policy also covers domiciliary hospitalization expenses.
• Ayush Treatment Cost- The senior citizen health insurance plan also covers Ayush treatment costs taken in recognized government hospitals and institutes.

Also Read: How to Renew a Health Insurance Policy?

Exclusions from a Senior Citizen Health Insurance Policy

Even though most of the health hazards are covered under a health insurance policy, there are times when the insurer denies the claim filed by the insured. Here are some of the common exclusions under senior citizen health insurance policy-

• The expense incurred due to self-inflicted injuries
• Pre-existing diseases or injuries
• Expense arising from drug abuse and related treatment
• The expense related to non-allopathic treatment
• In case of more than one medical condition diagnosed within 30 days from the date of policy initiation
• Cosmetic surgery
• AIDS treatment

Claim Settlement Process for Senior Citizen Health Insurance

The claim settlement process for senior citizen health insurance typically involves the following steps:

• Informing the insurance provider: When a senior citizen requires medical treatment or hospitalization, the first step is to inform the health insurance provider about the claim. This can usually be done through a phone call or by submitting a claim intimation form, which is available on the insurer’s website or can be obtained from their office.
• Submission of documents: The insured person or their family members need to submit the necessary documents to support the claim. These documents may include the claim form, medical reports, prescriptions, bills, discharge summary, and any other relevant documents requested by the insurance provider. It’s important to carefully review the list of required documents provided by the insurer to ensure all necessary paperwork is included.
• Verification and assessment: Once the documents are submitted, the insurance provider will review and verify the claim. They may assess the medical records, bills, and other supporting documents to ensure they comply with the policy terms and conditions. The insurer may also conduct investigations or request additional information if needed.
• Claim approval or rejection: Based on the verification and assessment, the insurance provider will decide whether to approve or reject the claim. If approved, the insurer will provide the policyholder with a claim settlement letter outlining the approved amount and any deductions, if applicable. If rejected, the insurer will communicate the reasons for the rejection to the policyholder.
• Reimbursement or cashless settlement: Depending on the type of policy and the hospital chosen, there are two possible ways to settle the claim. In the case of reimbursement, the insured person pays the medical bills upfront and then submits the bills and relevant documents to the insurer for reimbursement of the approved amount. Alternatively, if the policy has a cashless facility, the insured person can avail treatment at a network hospital where the insurer settles the bills directly with the hospital, subject to policy terms and conditions.
• Claim settlement payment: Once the claim is approved, the insurance provider will initiate the payment process. In the case of reimbursement, the insured person will receive the approved amount as reimbursement. If cashless settlement was availed, the insurance provider will directly settle the bills with the hospital, and the insured person will not be required to make any payment.

Also Read: Know About Critical Illness Insurance