Senior Citizen Health Insurance: A to Z Answers | Government | Private

Senior Citizen Health Insurance:Do's & Don'ts before buying 2020-21

What is senior citizen health insurance scheme (schis)?

Senior citizen health insurance schemes are designed to meet the need of medical expenses during exigencies.
Because of age related issue, senior people require health insurance to live healthy life without stress.
This health insurance is designed specially for individuals 60 and above,
As they are already retired from their professional work front so rely on their pensions and interest drawn from the saving to meet their regular expenses.
In case of any medical emergency they can use this plan to avoid financial stress for them and we should not seek any help during our difficult time.

Our responsibility


In Indian society, parents still stays with kids or in some cases at their native, but as a child one should undertake the responsibility of our parents as they did when we were used to be kids. As a child, we should opt for our senior citizen health insurance plan so that in case we encounter with any medical emergency so we should not run pillar to post for arranging money in times of need, instead when our parents need us emotionally And physically present with them, we should be next to them and your insurance company is there to support you to meet this financial burden.

Primary factor before buying

In this section we will focus on the factors that one should consider before buying Senior Citizen health insurance scheme.

AgeAge is the vital factor before buying the health insurance scheme, One should always opt for the plan that provide coverage up-to the longest period.
To get the new insurance is quite difficult than renewing the older one or transferring to the insurer and always a wise option.
Insured amountOne should assess the need of insurance amount that may require in case of emergency.
In case you are buying additional cover, One can also opt for super top-up.
This way plan will become more affordable with a deductible clause as compared to base health insurance plans with high coverage.
Room rentEnsure you have read the terms and condition pertaining to the room rent defined in your plan.
In case, You opt for room for which the rentals are higher the limit specified or category of the system is on higher end,
so all the medical expenses during the complete hospitalization in proportionate to the excess of the room rental insured has to pay at the time of discharge,
so generally room rents are defined on the basis of sum insured you opt for.
At the time of hospitalization ensure you opt for the room as per policy criteria otherwise not only the room difference but all medical expenses during the tenure will be calculated proportionally which may burn a bigger hole in your pocket.
PremiumGenerally the premium of an insurance policy for senior citizen is quite high as compared to younger citizen.
One should not overlook the benefit for the premium.
We should opt for the plan that provide maximum benefit with lower premium.

Additional Primary factor

Pre-existing Coverage Preexisting disease is a condition, ailment or injury before applying for an insurance, depending upon the severity of the condition insurer decide whether to exclude your preexisting coverage totally or keep an initial waiting period of some time generally 4 years or not to issue the policy all together.
Opting for health insurance with lesser waiting period, thus makes sense, even if it costs you a higher premium.
Waiting PeriodThe waiting period is more like a hibernation period during which insurer does not entertain any claim pertaining to the diseases they have marked to be covered after a certain period.
This range from 2 to 4 years from companies to companies. But owing to high demand few companies offer waiting period of 1 year as well.
It will always be wise to opt for insurance with lesser waiting period as during old age one is more prone to fall ill and require hospitalization so that it meet the purpose of buying insurance as accidental injury are lesser in number than hospitalization for general illness.
Ensure before buying SCHIP one should be aware about the waiting period applicable for the pre-existing illness and there are few general illnesses for which insurer always keeps a waiting period of 2 years.
Insurance companies are very smart as they are in the business of providing financial help in return of premium, but only after they have calculated the risk, they can take to offer you the insurance policy.
Alternative TreatmentDoes your plan provide coverage other than allopathy treatment likewise homeopathy or Ayurvedic.
Co-PayCo-payment clause comes generally with a senior citizen plan in which insured has to pay a certain percentage of the claimed amount.
Generally, it varies 5% to 30%.

Secondary factor

Sub-limitIt’s always best that you understood, this clause before buying so that there should not any hassle at the last moment.
Generally the company specifies certain limit for treating /illness.
For instance, for cataract surgery only 20K per eye.
It’s always best to buy a policy without sub limit, but comes with higher premiums.
No claim bonusIn the event of no hospitalization during one policy period, how much your insurance company is providing bonus in lieu of premium paid.
This bonus will start adding on sum insured till the time.
You are associated with the insurer and one does not have to pay extra premium for the same.
Network hospitalBefore buying senior citizen plan,
One should always the look for the hospital which is near to their resident so in case of any emergency insured can be transferred to the network hospital in the minimum time – frame,
and as cashless hospitalization has been easier than claiming same expenses during reimbursement hence always try and opt for cashless hospitalization.
As senior citizen largely depends on their pension fund in case, they have taken treatment in non-network hospital, then they must pay from their pocket initially,
which may lead to financial problem for them till the recovery of claim happen.
During reimbursement process, claim team require so much documentation and medical documents which at times result in delay of processing.

How to buy SCHIS?

  • You can buy your insurance policy through an individual agent, a corporate agent or a broker.
    Click here to read more details.
  • You can also buy your policy directly from the insurance company and
    some of them can be bought on the internet.
    An agent or a corporate agent or a broker may also sell  insurance through using tele-marketers.
  • Whatever channel you choose to buy insurance through,
    Please ensure that you are dealing with an authorized channel and ask questions, get information and clear your doubts.
  • An agent/broker must hold an IRDAI licence. Other relevant information,
    you should ask and get include details of the policy, the benefits,
    what the policy excludes or does not pay for, clarifications regarding documentation and procedures at the point of claim.
    Source: IRDAI

Best senior citizen health insurance

  1. Bajaj allianz silver health plan.
  2. Star health:senior citizen red carpet plan.
  3. Apollo munich optima senior citizen plan.
  4. Icici lombard i-health plan.
  5. National insurance varistha mediclaim.
  6. New india senior citizen insurance mediclaim.

Medical for senior citizens

Most of the health insurance plan pre-screening test are not required.However,
it would be best to disclose the medical condition such as pre existing ailment/injury or if insured is taking medicine on a regular basis so that insurers can evaluate whether medication would be required or not at the time of buying the policy to avoid any hassle at the time claim processing.
Insurance companies have the right to terminate a policy or reject a claim based on the policyholder’s misrepresented or falsified data.

Government Senior Citizen Health Insurance

In public sector only four insurance company providing cover to senior citizens.

Varistha Mediclaim This policy is launched by India most oldest insurance company National insurance and offer the excellent benefits at an affordable premium.
Entry age is 60 years and maximum one can renew up-to 80 years of age.
This plan comes under two options:
1. Coverage for hospitalization and domiciliary treatment.
2. Critical illness cover (optional).
Hope from oriental Insurance companyPolicy are more or less similar lets talk about the feature which distinct this policy from another as this provide cover to only specified illness and one can renew lifelong.
National Assurance Senior citizen The most attractive benefit of the policy is that pre-existing disease can be covered from the date of inception by paying extra 10% loading and even 10% discount is offered if insured cover his/her spouse in the policy.
Ayushman BharatThis scheme got launched by our honorable prime minister by Narendra Modi in year 2018 to provide health plan to poor and social economic lower class people across all age groups.It provides a cover of 5 Lac and portable across the country with the cashless benefit in all government and private sector hospitals.

Benefits of Senior Citizen Health Insurance

Medical coverage to senior citizen as basic health plan provide cover up-to to 60 years.
Pre screening is not required if already holding policy from another insurer previously.
No claim bonus– During claim free year insured will be entitled to bonus which range from 20 % to 100% at no additional cost.
Some private insurer provides free annual health check up for the insured to determine their health status which does not affect no claim bonus.
Tax benefit- Provide tax benefit under 80D of the IT act. The premium paid by the policyholder is tax exempted up-to 50000/- over an above 80C benefit.
Pre and post hospitalization expenses are also covered depending upon the insurance company limit put on the no. of days it would be covered.

Frequently Asked Questions

  • Senior citizen health insurance income tax benefit ?
    If you are paying health insurance for your parents who are senior citizens above the age of 60, the maximum amount that can be capped is Rs. 30,000.
    As a taxpayer, you can maximize your tax benefit up to Rs. 55,000 under section 80D you’re your age is below 60 but your parents age is above 60.
    If you are a tax payer above the age of 60 having health insurance for yourself and you are paying health insurance for parents, then you can get a maximum benefit of section 80D up to Rs. 60,000.
  • Senior citizen health insurance from government.
    In India major insurance company providing a health insurance plan to meet the need of the older aged generation to maintain their socioeconomic status in the society.
    For instance Varistha Mediclaim policy, Hope, National Assurance senior citizen Mediclaim policy and Ayushman Bharat.
  • Senior citizen health insurance premium calculator.
    To calculate senior citizen medical insurance premium,
    the main factors, that are considered are age, sum insured and pre-existing conditions.
    At times, if your insurance company may hike your insurance premium if they find out that you are suffering from some pre-existing disease.

Additional Question

  • Senior citizen health insurance without medical test.
    Generally, all the insurance company gets the pre screening test done for the insured to evaluate the risk.
    But still there is an exception in this list like HDFC ERGO General Health Insurance and Star health red carpet plan.
  • Senior citizen health insurance without copayment.
    Well, in India there is no insurance plan which comes without copay. Only ICICI LOMBARD I HEALTH PLAN and national insurance company voluntary deductible that you decide before the policy enforcement.
  • Senior citizen health insurance scheme govt of india.
    Varistha Mediclaim, Hope, Ayushman Bharat for poor senior citizen , National Assurance senior citizen plan.
  • Super top up health insurance for senior citizens.
    This top up plan comes with a deductible feature with a lesser premium and provide you the coverage.
    You have the paid the medical expenses up-to deductible over above the top up plan would be applicable.


Prevention is better than cure so if you have elderly parents even though you have group insurance cover from corporate.
However, most of the time It does not provide sufficient cover at the time of necessity so don’t depend wholly on company provided insurance as medical treatment cost rising like anything,
which may burn a big hole in your pocket if you don’t have the sufficient cover.

Even for the senior citizen individual,
it’s essential to have as they are solely dependent on pension fund,
or interest drawn from their savings would save them from financial stress.
if they are covered under SCHIS, But always look for the factors that we discussed above buying any health plan.