What’s the difference between a
senior citizen health plan and a
regular one?
As your parents grow older, you start to realise two main things. The first is that time truly flies by quickly, and the second is that the dynamics between you and your parents are starting to shift subtly. Years ago, they were your caretakers – every move they made was centred on your well-being and happiness. Now, it is you who is worried about their future.
While the future is often unpredictable and terrifying, there are certain elements that are in your control. For instance, health insurance. Understanding the difference between senior citizen health insurance and regular plans can help you pick the most ideal policy for your parents’ needs.
What is a senior citizen health insurance plan?
As the name suggests, senior citizen health insurance plans are catered to those who are over the age of 60. These plans are often quite comprehensive in nature, meaning they cover a vast number of possibilities. Typically, you’d gain access to cover for:
1. Certain pre-existing diseases (this makes the policy particularly useful for senior citizens are they are likely to have a few lifestyle conditions owing to their age)
2. Pre and post hospitalisation costs
3. Preventative health check-ups
4. Cashless hospitalisation and treatments
Senior citizen health plans vs. family plans – what’s the better option for your parents?
Now, most of us have family floater plans that accommodate dependant parents, ensuring that their medical needs are taken care of. If you have a family floater plan, you’re probably wondering which makes more sense – should you keep your parents on the same plan or get them a separate senior citizen health plan?
The table below shows how the offerings of a family floater plan compare against a senior citizen plan so that you can make an informed decision regarding your parents’ needs!
| Factor | Senior citizen health insurance | Family floater health insurance |
| Waiting period | Most senior citizen health insurance plans offer a lower waiting period, as these plans have been designed for the elderly, keeping in mind that they are prone to falling sick. | A family floater health insurance policy has a standard waiting period of 90 days (though this may vary from plan to plan). Such a long waiting period may not be a viable option for elderly folk with many pre-existing conditions. |
| Pre-existing conditions | Many pre-existing conditions are covered by such policies. The list of the conditions covered is detailed in the policy document and you must check the same before picking a policy. | Pre-existing conditions are not covered in a general health insurance plan. |
| Premiums | Premiums are generally lower to accommodate the needs of seniors who live on a limited pension. | Premiums are higher when compared to senior citizen health insurance. |
| Co-Pay | Due to the lower premiums, these policies generally have a co-pay clause. This means that it will be prudent to keep aside an emergency fund for expenses. | You can get a policy that does not have a co-pay clause. This means that the insurance provider will shoulder the claim. |
| Sum insured | The sum insured for senior citizen health insurance plans can range from 10-20 lakhs. | The sum insured for family floater plans are generally higher. They can be anywhere between 10 lakhs – 1 Crore. |
To understand what these differences can mean, consider these examples.
Shagun’s parents are a part of her family-floater plan, and she has a total sum insured of Rs. 20 Lakhs. Shagun’s mother develops diabetic retinopathy and requires eye surgery for the same. However, since her diabetes was a pre-existing condition, the insurance company rejected the claim and Shagun had to pay for the treatment from her savings.
Raima, on the other hand, bought her parents a senior citizen health insurance policy. The policy she chose covered diabetes, even though it was a pre-existing condition. Though her sum insured was lesser than what you would find in a family floater plan, the amount was enough to cover the treatment for her mother’s diabetic retinopathy. Even with a co-pay of 20%, Raima’s expenses were far lesser than Shagun’s. In the long-term, the senior citizen health insurance plan proved to be more helpful.
What expenses are covered under a senior citizen health insurance plan?
A senior citizen health insurance plan can cover the following:
1. In-patient hospitalisation
2. Day care treatments and procedures
3. Free medical check-ups (generally, there is one free medical check-up per year, but this can depend on the policy you’ve chosen)
4. Critical illnesses (if the corresponding rider is bought)
5. Cashless treatments
6. Organ donor expenses
7. Sum insured rebound (this means that you can re-charge your policy once the sum insured is exhausted)
8. AYUSH treatments (however, some policies may require you to buy the corresponding rider for the same)
9. Ambulance and room rent
10. Domiciliary expenses
What expenses are not covered under a senior citizen health insurance plan?
A typical senior citizen health insurance plan does not cover the following:
1. Cosmetic surgeries
2. Mental disorders
3. Conditions caused due to alcohol or drug misuse
4. Non-allopathic, weight-control treatments
5. Treatment of HIV/AIDs, other STDs
6. Self-inflicted injuries
7. Conditions caused to participation in extreme sports
8. Conditions caused due to participation in the military
Comparing the top senior citizen health insurance plans!
| Senior citizen HEALTH INSURANCE PLANS | SUM INSURED | CO-PAY amount |
| ICICI Lombard’s iHealth Plan | 3 Lakh to 50 Lakh | NA |
| New India’s Senior Citizen Mediclaim Policy | 1 lakh & 1.5 lakhs | 10% |
| Star Health – Senior Citizen Red Carpet Policy | 1 Lakh to 25 Lakhs | 30% – 50% |
| Bajaj Allianz Silver Health Plan | 50K to 5 Lakh | 20% |
| National Insurance Varistha Mediclaim | 1 Lakh & 2 Lakhs | 10% – 20% |
| Apollo Munich’s Optima Senior Health Plan | 2 Lakh to 5 Lakhs | 15% – 30% |
Final Thoughts
Facing important decisions can sometimes have a crippling effect – we freeze out of fear and decide to handle important tasks at a later date. However, no matter how scary it may seem to be in charge of your parents’ health and well-being, you must take firm steps to ensure you’re doing everything you can. Buying senior citizen health insurance may prove to be one of the best decisions you’ve ever made as far as your parents are concerned!
Frequently Asked Questions
1. Do my parents need to go through a medical test before I buy them insurance?
If you are planning on purchasing senior citizen health insurance, then you do not have to worry about this as pre-existing diseases are covered. Just be honest about the existing conditions so that you can get the best cover possible.
2. My parents are over 65. Can I still get them a health insurance policy?
Yes. The eligibility criteria for senior citizen health insurance is a minimum age of 60. This means that parents above the age can get it.
3. What is a co-pay amount?
A co-pay percentage refers to the portion of the expense that you will have to pay on your own. For instance, the New India’s Senior Citizen Red Mediclaim Policy has a co-pay of 10%. Assuming the treatment cost was INR 1 Lakh, the insurance provider would pay INR 90,000 while you would have to pay INR 10,000.
Conclusion
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