Are Senior Citizen Health Insurance Policies Restrictive?


The average life span of an Indian citizen has risen to 71 years today against 51 years about two decades back. Simultaneously, the cost of medical expenses is growing at an average of about 20% per year that is almost twice the rate of inflation. It has made the need for a medical health insurance policy across ages and especially for senior citizens a must.

It’s a known fact that senior citizens are more prone to diseases and chances of getting hospitalized. A health policy can prove a boon at those times in preventing a financial drain and elimination the possibility of not getting treated for lack of money.

There was a time when there were very few policies for senior citizens, but the scenario is fast changing.  You have quite a few choices available today. There are several policies available for people from 60+ age. But these policies have a some restrictions that you may not find in health policies for people in the younger age group. Few of the noteworthy restrictions that you must be aware of are:

  • High premiums

Foremost, the premium amount for Senior Health Plans is considerably higher than the other health plans. Hence, you must look for affordable plans that can meet your requirements. On a general note, taking an Rs.5 lakh plan is ideal for a senior citizen and then save a corpus that would help you cover all those that are not covered by the policy. Another smart move is to take a top-up plan which becomes available to you at marginal cost and help meets your needs comfortably.

  • Co-Payment

This is a mandatory feature with almost all senior health plans. It means that the insured needs to share a certain percentage of the medical bills with the insurance company at the time of payment. It may be applicable for specified ailments, specified hospital expenses or the whole treatment cost. Hence, you must go through the co-payment clause carefully and opt for a percentage that is comfortable for you. Few also offer you the waiver of the co-payment for a higher premium. This option is best if affordable and available to you.

  • Sub-limits

Sub-limit is another common feature found in senior health insurance plans. It is usually a percentage of the sum insurance till which the insurance company would pay for different hospital expenses. It means that the claim for room rent, doctor’s fees, medicine cost, nursing cost, etc. would only be paid to a certain extent. This cap limits your claim amount for any expense irrespective of the sum insured. For instance, there could be a sub-limit clause of room rent to be only two percent of the sum insured. Any extra room rent will need to be paid by you. Hence, it is critical to go over this clause. Of late, you are also witnessing few plans with a more liberal sub-limit. It’s best to look over it microscopically before selecting one.

  • Waiting Period

It’s a restriction for which all should be cautious about at all age-groups. Generally, no illness is covered for the first thirty days since the inception of a policy other than accidental hospitalization. This initial waiting period can extend to 90 days. Apart from it, you will also find a waiting period for certain diseases like ENT, tumour, etc. The period of this can vary from one to three years.

Another important waiting period to look into is for pre-existing diseases. The waiting period for this may vary from one to four years. Moreover, they might be covered only till a certain percentage like 50% of the sum insured.

  • Medical tests

Regarding health policies for senior citizens; most insurance providers insist on it before issuing the policy. Most of them do not charge anything for it if you get it done in their network hospitals. But it is best to verify with the insurance company if they would be bearing the cost or you would need to foot the bill.

  • Additional features

There are certain other features that one must look into while reviewing a policy like:

  • Domiciliary treatment- It may or may not be included in the plan. It means the treatment of diseases at home that would generally require hospitalization.
  • Organ donation transplant- You can usually avail of this benefit at an extra premium so that the insurance company bears the cost during organ transplantation and organ donation.
  • Ambulance service- It is generally included in the plan but few might ask for an extra premium amount for it.
  • Second opinion- it is best to have this feature of consulting another doctor included in the plan.

Wrapping up

Despite all restrictive features, a senior health insurance plan proves a boon at the time of crisis. One should merely critically evaluate all before buying the most appropriate health policy.