Assessment of Health Insurance Schemes regarding Senior Citizens


It is absolutely vital that as one approaches old age, one has a substantial health insurance cover. The probability that one’s health care expenses would increase substantially is almost a given. In this piece we look and compare the various health insurance plans that are available searching for senior citizens. While every medical insurance company wants to insure the young (and almost by definition, more healthy), there are very few plans which provide health insurance to people beyond 60. Another interesting thing to note here is that most of the health insurance plans for senior citizens is offered by the public sector general insurance companies.

The health insurance policies available for senior citizens are:

Varistha Mediclaim by National Insurance
Senior Citizen plan by Oriental Insurance
Mediclaim for Senior Citizens by New India Assurance
Senior Citizen Plan by United India Insurance
Red Carpet Plan by Star Medical insurance
Varistha Mediclaim by National Insurance: This policy can be bought by anyone between 60 and 80 years of age. Renewals can be done upto the age of 90. Between the age bands of 76-80, premiums have an added factor of 10% and between 80 to 90 years of age, premiums are grossed up by 20%. The sum insured under this policy for hospitalization is Rs 1 lakh. For critical illness, the sum insured is Rs 2 lakhs. Under the critical illness cover, diseases such as cancer, renal failure, stroke, organ transplants etc are covered. If the person has already been insured for 3 years through a medical insurance policy, then he or she does not have to undergo a medical test, else there has to be a medical test under the prospective customer’s costs. For domiciliary treatment, the maximum claim is fixed at 20% of the sum insured. Ambulance charges upto Rs 1000 are covered under this policy. For a mediclaim cover of Rs 1 lakh and a critical infection cover of Rs 2 lakhs, the premium varies between Rs 6200 (for a 60-65 year old) to Rs 9200 (for a 75-80 year old). One interesting feature of this policy is that pre pre-existing hypertension and diabetes will be covered from the 1st season itself of the policy by simply paying 10% additional high quality for each of the two diseases. Pre existing is of study course not available for the critical illness policy. Other pre established diseases are covered soon after 1 policy year. Dialysis, chemotherapy and radiotherapy for preexisting ailment is never protected. Claims are paid just for events that occur inside India. Claims which happen within the first 30 days in the commencement of the policy will never be covered, unless in the case of the individual being insured with an Insurance broker without break for the past 12 months. For the purpose of this policy, before existing diseases such as cataract, piles, fistula, hernia, benign lumps, joint replacement etc will not be covered in the primary 12 months. War related medical claims, vaccination, spectacles charge, plastic surgery, corrective dental medical procedures, venereal disease, vitamins and even tonics which are not area of the treatment, nuclear disaster related health claims, alternative therapy like homeopathy etc are excluded.

Opinion: We think it is one of the best policies for older persons, except that the sum insured is low. They are very generous as far as the best practice norms for entry age plus pre existing diseases have concerns.

2 . Senior Citizen Specified Condition Plan by Oriental Insurance coverage: In this plan, the policyholder has the option to choose quantity insured of Rs you lakh, 2 lakhs, 3 or more lakhs, 4 lakhs or even 5 lakhs. One hard to stick to feature of this policy is that 20% of any claim amount has to be co-paid by the insured. Cashless payment by means of TPA is restricted to Rs 1 lakh. This plan addresses 10 specified diseases: malignancy, renal failure, heart conditions, liver related diseases, COPD (lung ailment), stroke, prostrate, orthopaedic disease, ophthalmic disease, accidental injury and knees replacement. The amount that one can lay claim for a particular disease is restricted to be a percentage of the sum insured (for e. g., fifty percent of the sum insured is usually claimed for cancer, while 20% of the sum insured can be claimed for stroke). A sum insured connected with Rs 1 lakh will surely cost Rs 4500 for a 65 year old, while it will cost Rs 6400 if one is 70 years old or beyond. Could may seem cheaper than State Insurance’s Varistha medical plan, it is less wide inside scope. This policy posseses an interesting refund of premium clause if one withdraws from the policy: if the policyholder gets out of the policy from the first month, 75% of the premium is returned in case he opts out in between 3 to 6 months of the policy, 25% of the superior is returned. In this coverage, pre-existing diseases are not included for a period of 2 policy yrs. Other exclusions are very similar to those of National’s Varistha medical scheme.

Opinion: a good program in terms of the level of sum covered by insurance and price, but the extent of diseases covered is usually restrictive. Another issue is that pre-existing is covered only after 2 policy years.

Mediclaim for Senior Citizens by New India Assurance: This policy is available for senior citizens between 60 and 80 years, and the sum insured can be Rs 1 lakh or Rs 1 . 5 lakhs. Pre existing diseases are covered after 18 continuous months of coverage, while for diabetes and hypertension to be covered, additional premium needs to be paid. Pre hospitalization is covered for 30 days, while post hospitalization is covered for 60 days. An insurance of Rs 1 lakh for a 65 year old will cost Rs 3850 although it will cost Rs 5150 for an 80 year old. Thus, premiums are very competitively priced. If one really wants to extend beyond 80 years, then loading of 10% or 20% has to be paid. For pre existing diabetes or hypertension, an additional premium of 10% each has to be paid. One interesting feature is that there’s a 10% discount if one’s spouse is also covered under this policy. This policy also has the same partial refund norms on cancellation as Oriental’s Specified Disease Plan. Claims would be paid only for medical treatment in India. The exclusion conditions are standard, and are very similar to National’s Varistha Mediclaim.

Opinion: Attractively priced. Sum insured ceilings are low. The product brochure is silent on co-pay, and thus there is no co-pay requirement in all probability.
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United India Insurance’s Specified Disease Plan: In this policy, sum insured of Rs 50, 000 to Rs 300, 000 is available to people between 60 to 80 years old. Sum insured of Rs 1 lakh will cost Rs 3715 for a 65 yr old, and Rs 8613 to have an 80 year old. So while it is cheaper for the younger age bands, it is a bit costly for the older age groups. An interesting feature of this policy is the fact there is a hospitalization cash repayment from the 3rd day regarding hospitalization on payment of any particular additional premium. While other exclusion features of that policy are comparable to that of the previous 3 policies that we get discussed, the biggest problem in this policy is that this has a pre-existing waiting period of 4 decades.

Opinion: Pre -existing longing period of 4 years is definitely restrictive

Star Health’s Green Carpet Plan: This plan has been a good marketing success. Whilst one barely gets to hear the reasonably broad, well priced schemes of the 4 nationalised companies, the market is quite pumped up about Star Health’s Red Floor covering scheme. The sum covered under this policy may be for Rs 1 lakh, Rs 2 lakhs, Rs 3 lakhs, Rs five lakhs or Rs 5 various lakhs. Age of entry is fixed between 60 and 69 years. Pre existing diseases are covered from the very first year itself, except for all those preexisting diseases for which often the insured received payment inside preceding 12 months. Subsequently, these pre-existing diseases are included. There are sub limits under this policy wherein various diseases have different limits being a percentage of the sum covered. Sum insured of Rs 1 lakh will cost Rs 4900 at entry, when a sum insured involving Rs 5 lakhs will set you back Rs 20000.. The biggest get in this policy is that there exists a 50% co-payment for pre existing diseases and thirty co-payment for other illnesses!! Other exclusions are very comparable to what is there for the nationalized companies.

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