Senior Citizen Health Insurance Scheme by Government of India

Senior citizen medical insurance schemes are specialised insurance policies that cover medical expenses of senior citizens (aged 60 years or above). Unlike regular insurance plans, which have upper age limits for policyholders, senior citizens' health insurance covers elderly people.

Senior citizens in India can access government-sponsored health insurance schemes that provide free healthcare services and medical coverage. These schemes aim to lower out-of-pocket expenses and provide basic health coverage to vulnerable members of society. There are several active government health schemes available to senior citizens in India.

Government-provided senior citizen health insurance schemes include universal coverage plans like Ayushman Bharat Yojana and specialised plans like CGHS that cover only government staff. Many states also offer their own healthcare schemes to lower the medical costs of senior citizens in their states. These are usually basic plans covering mostly hospitalisation costs with a lower sum insured compared to private health insurance.

Here is a list of government-sponsored schemes for senior citizens in India, catering to different income groups and occupations:

Ayushman Bharat PMJAY

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY ) is India’s most ambitious and the world’s largest public healthcare scheme, covering more than 12 crore families. Until 2024, the scheme covered only low-income families. Since 11th September 2024, PMJAY covers all senior citizens in India aged 70 years and above with no restrictions. Over 86 lakh senior citizens get free health insurance under this scheme.

Who Does It Cover?

PMJAY covers poor and vulnerable families in rural and urban India identified by the Socio-Economic Caste Census (SECC) 2011, and all senior citizens.

Key Features

• Senior citizens in families previously covered by PMJAY get up to ₹5 lakh/year of additional top-up cover.

• For everyone else, the Pradhan Mantri health insurance for senior citizens provides up to ₹5 lakh per family per year of healthcare coverage.

• Senior citizens can get cashless treatments at empanelled hospitals with the PMJAY card.

• It covers a wide range of treatment procedures, services and pre-existing diseases.

• Senior citizens covered by other government schemes can choose PMJAY or their existing scheme.

Central Government Health Scheme (CGHS)

Set up in 1954, the Central Government Health Scheme, or CGHS, has been providing comprehensive medical care to Central Government employees, pensioners and dependents for over 60 years. CGHS covers extensive medical services, including hospitalisation expenses, consultations, outpatient treatments, and prevention. The Central Government Health Scheme for senior citizens provides healthcare services at empanelled hospitals, dispensaries and wellness centres at affordable costs.

Who Does It Cover?

All Central Government employees, pensioners and their families across the legislature, executive, judiciary and press branches. It covers the members and dependents of Railway Board, Delhi Police Force, Members of Parliament, Ordnance Factory and other institutions. Widows of eligible beneficiaries, freedom fighters, and military officers working in civil departments are also covered.

Key Features

• Currently, CGHS services are available in 80 Indian cities.

• CGHS covers all sorts of medical expenses, including doctors’ fees, diagnostic tests, emergency procedures, medical devices, etc.

• Cashless treatments are covered at empanelled medical facilities.

• It reimburses treatments taken in public and private hospitals for emergencies and when recommended by authorised medical officers.

• CGHS also covers family welfare, maternity care and child welfare services.

National Programme for Health Care of the Elderly (NPHCE)

The National Programme for Health Care of the Elderly is a national program run by the Ministry of Health and Family Welfare. It provides dedicated healthcare services to the elderly across states at primary, secondary and tertiary levels by coordinating with healthcare centres. The NPHCE has two components:

1. National Health Mission (NHM), which funds primary and secondary care, and

2. Tertiary healthcare services.

Who Does It Cover?

Unlike other medical insurance schemes for senior citizens, NPHCE doesn’t directly cover individuals. Instead, it funds primary and secondary care services at geriatric wards in district hospitals and geriatric clinics in community health centres and primary health centres. It also provides tertiary healthcare services through regional geriatric centres.

Key Features

• Provides preventive, promotional, curative and rehabilitative services via government-run healthcare centres.

• The programme is responsible for supervising implementation by states and union territories.

• NPHCE enables dedicated services by funding equipment, machinery, drugs, consumables, and training and providing additional human resources.

• It also funds the Longitudinal Ageing Study of India (LASI) project.

Pradhan Mantri Suraksha Bima Yojana (PMSBY)

This government health insurance scheme for senior citizens provides personal accident insurance coverage for partial disability, total disability and death. It charges a nominal premium of ₹20/year per person and provides yearly coverage from 1st June to 31st May following the payment. The accident cover terminates when the person reaches 70 years or has insufficient balance in their bank/post office account.

Who Does It Cover?

Any Indian between 18 and 70 years with an individual bank account can enrol for PMSBY by giving consent to auto-debit the premium amount.

Key Features

• It provides an accidental death benefit of ₹2 lakhs to the nominee.

• Pays ₹2 lakhs to the subscribers in case of an accident that results in the total loss of two eyes, two limbs and one eye and one limb.

• Pays ₹1 lakh for loss of any one limb and one eye.

Employees' State Insurance Scheme (ESI)

Launched in 1952, the Employees’ State Insurance Scheme provides health insurance and social security benefits to employees and their dependents. Employees must pay 0.75% of their monthly salary to ESI, while employers bear 3.25% of the costs. The beneficiaries are entitled to full medical care at empanelled hospitals and cash benefits during sickness, disablement and death arising from workplace injuries.

Who Does It Cover?

Under the Employees’ State Insurance Act, 1948, factories and businesses employing more than 10 people are mandatorily included under the ESI scheme. Shops, restaurants, transportation service providers, and other select businesses that employ more than 20 people must also offer ESI cover. This doesn’t apply to employees earning more than ₹21,000 per month.

Key Features

• ESI works as a medical insurance scheme for senior citizen employees, providing comprehensive medical coverage from day one.

• It also covers retired and permanently disabled insured persons and their spouses upon payment of ₹120 per year.

• The government scheme covers inpatient treatments, specialist consultations, imaging services, and artificial limbs.

• Reimbursement for first-aid and transportation in case of an accident.

• Additional benefits, such as unemployment allowance, confinement expenses, vocational rehabilitation, physical rehabilitation, funeral expenses, etc.

Ex-Servicemen Contributory Health Scheme (ECHS)

The ECHS is a medical insurance scheme for senior citizens who are ex-servicemen of the Indian armed forces. It is a medicare scheme providing cashless and capless coverage for ex-servicemen and their eligible dependents in empanelled hospitals and established medical institutions. Recruits and officers eligible under ECHS must pay a one-time contribution, while war widows, pre-1996 retirees, and soldiers injured in battles are exempted.

Who Does It Cover?

The scheme covers all ex-servicemen drawing pensions from the Controller of Defence Accounts. This includes pensioners and dependents of the Defence Security Corps, Territorial Army, Special Frontier Force, Assam Rifles, Indian Coast Guard, Short Service Commissioned Officers, Emergency Commissioned Officers, WW2 veterans, and other ex-defence personnel. ECHS membership is optional for early retirees.

Key Features

• The scheme provides comprehensive medical coverage, including hospital bills, drugs and medicines, diagnostic tests and specialist consultations.

• Members can get full reimbursements for treatments at a government hospital.

• ECHS also covers treatments at non-empanelled hospitals, room rent, implants, knee and hip replacement, and hearing aid devices at prevailing CGHS rates.

• Parents of ECHS members are entitled to the scheme benefits if they have a combined monthly income of less than ₹9000.

Rashtriya Swasthya Bima Yojana (RSBY)

Introduced by the Ministry of Labour and Employment in 2008, the Rashtriya Swasthya Bima Yojana (RSBY) is the GOI’s scheme covering the healthcare needs of BPL (below poverty line) families. It provides guaranteed medical treatment to economically weaker sections at government-listed hospitals for free. There are no restrictions regarding age and pre-existing conditions. In 2018, the scheme was subsumed under the Ayushman Bharat Yojana.

Who Does It Cover?

This government health assurance scheme covered unorganised sector workers and families with a valid BPL card. Each enrolled family can choose up to five members to cover under RSBY. All RSBY beneficiaries are now included under the PMJAY scheme.

Key Features

• RSBY is a government medical scheme for senior citizens and underprivileged families, providing free essential medical coverage.

• RSBY covers hospitalisation expenses, including ICU charges, room rent, consultation fees, surgical expenses, etc.

• It covers pre-hospitalisation expenses for one day and post-hospitalisation expenses up to five days.

• The scheme also covers daycare treatments, transportation expenses and newborn baby expenses.

National Varishtha Mediclaim Policy

The Varistha Mediclaim Policy is a dedicated health insurance policy offered by the National Insurance Company Limited. It’s a standard senior citizen plan with a tenure of 1 year and renewability till 90 years of age. The Varishtha plan provides basic financial coverage for multiple expenses, including hospitalisation, pre- and post-hospitalisation, domiciliary treatment, etc. The plan has two sum insured options- ₹1 lakh and ₹2 lakhs.

Who Does It Cover?

Anyone between the ages of 60 and 80 years who purchases the policy with the option to renew the plan till 90 years.

Key Features

• Cashless treatments in network hospitals and reimbursement for non-network hospitals.

• Hospitalisation expenses, including doctors’ fees, room rent, nursing fees, medicines, etc.

• Pre-hospitalisation cover up to 30 days and post-hospitalisation cover up to 60 days.

• Critical illness treatment cover up to ₹2 lakhs over the base sum insured.

• Pre-existing disease cover after one year.

Before looking at the various government senior citizen schemes, let us first look at the conditions under which they are presented. The Insurance Regulatory and Development Authority (IRDAI) has laid down specific rules regarding senior citizen health insurance schemes by the Government of India.

• All health insurance providers in India must cover senior citizens up to 65 years old.

• They must provide a detailed breakdown of the premium amount charged.

• No insurance company can reject an application made by a senior citizen without providing a valid reason in writing. Insurance applications can only be rejected for fraud, misrepresentations and ethical reasons.

• Insurance companies also need to provide a valid reason to reject renewal requests.

• If the insurance application is accepted, the insurer should pay 50% of the pre-insurance medical checkup cost.

• Applicants can change their third-party administrators (licensed intermediaries between policyholders and insurance companies) if they wish.

Senior citizens' health insurance schemes help cover the high health-related risks and treatment costs for senior citizens. When you buy health insurance online for your senior citizen parents, you get the following benefits:

Covers Multiple Healthcare Expenses

Policyholders can enjoy comprehensive coverage from senior citizen health insurance schemes by the Government of India. They can get coverage for:

• Pre and post-hospitalisation expenses

• Treatment of injury from accidents or illness-specific treatment during inpatient hospitalisation

• Cashless treatments at network hospitals listed under the plans

• Treatment for pre-existing illnesses after the waiting period

• Daycare treatments and the cost of medical devices

• Cost of ambulance and hospital room rent

• Free medical checkups once a year (In the case of some insurers)

• Domiciliary expenses

• AYUSH Treatments

• Organ donor expenses (within a specific limit)

Tax Deduction Of Paid Premiums

Senior citizens paying premiums for government mediclaim for senior citizens are eligible to opt for tax deductions up to ₹50,000 under Section 80D of the Income Tax Act.

Tax deductions and exemptions also happen to be a prime reason many people opt for health insurance plans, whether backed by government or private insurers. So even if you aren't suffering from serious chronic conditions, buying a health insurance plan may still be a good idea.

Annual Health Checkups

As stated, overall health maintenance is essential for senior citizens. So most government mediclaim for senior citizens offer free annual health checkups in their packages. So by purchasing a plan, policyholders can get access to cashless checkups every year at one of the network hospitals listed under their plans.

Coverage For Special Equipment

Most daycare treatment procedures, like dialysis, chemotherapy, etc., involve the use of specialised equipment, which can incur additional treatment costs. However, a government scheme or health card for senior citizens covers such additional expenses. This eases many of the financial burdens caused by the regular use of these daycare treatments.

Senior citizen health insurance schemes by the Indian Government provide free or low-cost medical coverage to vulnerable members of society. While there are many benefits of these health insurance plans, you need to fulfil stringent requirements to qualify for these government schemes.

In contrast, personal health insurance policies allow anyone to get medical insurance coverage. These plans offer higher sum insured amounts, better coverage, faster claims and coverage for domiciliary treatment and routine checkups

TATA AIG’s Senior Citizen Health Insurance is the best choice for comprehensive coverage at affordable costs. Unlike government schemes that only cover certain costs, our scheme offers high-value coverage, cashless treatments at a hospital of your choice across India and a yearly cumulative bonus. Explore our health insurance plans today!