Senior Citizen Health Insurance

A senior citizen plan is a type of health insurance plan specifically designed to offer financial assistance to people over the age of 60. It covers medical treatments and procedures commonly prescribed to senior citizens.

According to the IRDAI, insurance providers can not reject health insurance applications and renewals from senior citizens without valid reasons such as:

• Fraud.

• Misrepresentation.

• Moral Hazard (The intention to claim money from the insurance provider on death by committing fraud).

While you may think that the savings you have accumulated throughout your life will be enough to tide you over in your retirement years. The corpus may run out earlier than you think.

Here are some reasons why you should consider getting senior citizen health insurance.

- Rising Medical Costs: Factors like rising medical costs, inflation, and medical emergencies due to unforeseen accidents or injuries can quickly deplete your savings. Investing in health insurance for senior citizens can be your way of shielding your savings.

Some of the best mediclaim policies for senior citizens will cover your hospitalisation costs and medical emergencies, so you do not have to worry about paying out of pocket for these expenses.

- Critical Illness Cover: With old age, the possibility of injuries and critical illness diagnosis increases significantly. If this is the case, your policy will provide the necessary coverage for treatment, or you can add a critical illness cover to your senior health insurance plans to increase coverage.

- Annual Health Checkups: Physical health becomes an increasingly important factor as you age, significantly affecting your quality of life. Under most plans, senior citizens can avail free annual health checkups to undergo medical screenings regularly.

A benefit to doing this is that diseases are detected in their earlier stages, making them easier to treat, and it reduces out-of-pocket expenses.

- Stress-Free Retirement: Medical expenses can be distressing for anyone to pay off, but they can be especially distressing in your retirement years as they can deplete your savings.

Having medical insurance for senior citizens can help alleviate this stress and give you peace of mind by securing your savings, as there is less risk of prematurely depleting your savings.

- Comprehensive Health Coverage for Senior Citizens

A key feature of Tata AIG's senior citizen health insurance is the extensive coverage it provides. You can get a sum insured starting from ₹2 lakhs up to a maximum of ₹20 lakhs under our MediCare policy.

Our MediCare plans for senior citizens also provide extensive base covers that cover medical expenses for pre and post-hospitalisation, a global cover for planned hospitalisations, day care procedures and much more.

- AYUSH Benefits

Under this feature, our senior citizen medical insurance plan will cover expenses incurred for treatments in AYUSH hospitals. As a result, you are insured not only for modern medical procedures but also for treatments under Ayurveda, Yoga and Naturopathy Unani, Siddha, and Homeopathy as a part of our AYUSH benefit.

- Preventative Health Checkups

Our medical insurance for senior citizens offers preventative health checkups for policyholders. This benefit can be used by multiple people insured under the policy up to a maximum amount of ₹10,000.

Availing this benefit will also not affect your accrued cumulative bonus in any way, as it has a separate limit.

- Restore Benefits

In cases where your sum insured has been exhausted during the policy's term, we offer a restoration benefit up to the basic sum insured amount and your accrued cumulative bonus.

This benefit can be availed once during the policy period and is especially useful when the sum insured amount has been exhausted due to accidents or medical emergencies.

- No Co-Pay and Sub Limit on Hospital Room Rent

With Tata AIG's senior citizen mediclaim policy, you no longer have to worry about room rent limits when hospitalised. You can have the upper limit on your hospital rent expenses removed as long as it falls under your sum insured.

In short, you can pick the best hospital room to receive treatment in, and the amount will be covered under your sum insured. You do not have to worry about any out-of-pocket expenses on your part, allowing for stress-free hospitalisations.

- Cashless Facilities

With our senior citizen medical insurance plan, you can opt for cashless claims at network hospitals for planned and unplanned (emergency) hospitalisations. We have tied up with over 8,000+ hospitals pan-India to ensure you have access to quality healthcare services no matter where you are.

The ambulance cost also gets covered under the sum insured in your policy, so you do not have to worry about any out-of-pocket expenses being incurred after emergency hospitalisations. You simply need to notify us of any hospitalisations, and we will take care of the rest.

Use our network hospital locator to find out the addresses of the closest network hospitals in your city or region.

- Easy Claims Process

At Tata AIG, we provide an easy claims process for reimbursements on health insurance for parents above 60. Our online facilities have allowed us to digitise this process, making it more accessible and faster.

To file a claim, you simply need to visit our website, fill out a claims form and upload the required documents. We also provide a claims tracking feature to promote transparency so you stay fully informed throughout the claims process.

- Paperless Policies

Another benefit of digitising our processes has allowed us to go fully paperless in our transactions and application processes. So when you apply for a senior citizen mediclaim policy, the application process can be done fully online and in a matter of minutes.

Similarly, for claims processes, you only need to upload the necessary documents onto our site for us to settle your claims. You can also track your claims without needing any physical documentation.

- Tax Benefits

This is one of the key benefits of health insurance. Like any other health insurance plan, our senior citizen mediclaim policy makes you eligible for health insurance tax deductions under Section 80D of the Income Tax Law.

As a senior citizen, you are eligible for deductions up to ₹50,000 if you pay the premiums yourself and an additional ₹25,000 if a family member (under 60) insured under the same plan pays the premium instead.

- Cumulative bonus

On policy years where you do not make any claims, you are entitled to a Cumulative Bonus or a No-Claim Bonus. Essentially, we will increase your sum insured by a certain percentage without increasing your health insurance premium. This way, you can enjoy higher coverage without paying any extra premiums.

This benefit is applied on renewal for every claim-free year on consecutive renewals with us at Tata AIG. Under your senior citizen health insurance, you can get a maximum cumulative bonus of up to 100% of the sum insured.

- Benefits With Separate Limits (Over and Above the Sum Insured Amount) That Do not Affect the Cumulative Bonus:

Health Checkup: Covers expenses for preventive health checkups for 1% of the previous sum insured, subject to a maximum of ₹10,000 per policy.

More than one insured person can utilise this amount. This is payable once after every two continuous claim-free policy years.

- Compassionate Travel: Covers travel expenses for a round trip economy class air ticket or first-class railway ticket to an immediate family member if the insured person is hospitalised for more than five consecutive days in a place where no adult member of their immediate family is present.

This is payable if we have accepted an in-patient hospitalisation claim for the insured person. The expense shall not exceed ₹20,000 during a policy year.

- In-patient Hospitalisation: This cover offers financial assistance for the hospitalisation of the senior citizen as an in-patient due to disease/illness/injury during the policy period. This also covers dental treatment under anaesthesia due to the same causes.

- Pre and Post-Hospitalisation: Coverage for pre-hospitalisation expenses like consultations, investigations, and medication up to 60 days before hospitalisation and 90 days after discharge from the hospital for post-hospitalisation expenses.

This benefit is payable if you have administered claims under in-patient treatment/daycare procedures/domiciliary treatment under your senior citizen mediclaim policy.

- Day Care Procedures: Coverage for expenses for listed daycare treatments due to disease/illness/injury during the policy term taken at a hospital or a daycare centre.

You check our list of daycare procedures covered for all our MediCare variants to see what procedures are covered.

- Organ Donor: Coverage for medical and surgical expenses of the organ donor for harvesting the organ where the insured person is the recipient. These expenses will be covered if the organ donation is in accordance and compliant with The Transplantation of Human Organs Bill (Amended), 2011.

To be eligible, the insured person must submit an in-patient hospitalisation claim under the in-patient hospitalisation treatment cover, which then must be approved.

- AYUSH Treatment: We cover medical expenses on an in-patient basis at AYUSH hospitals.

- Domiciliary Treatment: For cases where the senior citizen can not be moved to a hospital, coverage for expenses related to at-home treatments of the insured person is granted if the treatment exceeds three days for illness management. This does not cover end-of-life care or enteral feedings.

- Ambulance Cover: Ambulance expenses of the insured person on registered ambulances for emergencies or transportation from one hospital to another for better facilities and treatment.

This cover is payable up to ₹3000 per hospitalisation and is admissible for claims filed under in-patient treatment and daycare procedures.

- Global Cover: In-patient expenses of the insured person are covered outside India if the diagnosis was made in India and the insured person has to travel overseas for treatment.

Only the base sum insured and cumulative bonus can be used for this cover, not the restored sum insured.

- Accidental Death Benefit (Optional): If an insured person suffers an accident during the policy term and it is the sole and direct cause of their death within 12 months from the date of the accident, then we will pay 100% of the base sum insured as a death benefit.

- Medical Exclusions

- Investigation and Evaluation: Diagnostic and investigative expenses unrelated to the diagnosis of the current illness of the insured person are not covered.

- Rest Cure, Rehabilitation, and Respite Care: Admissions only related to enforced bed rest are not covered. This includes custodial care at home or in a nursing facility or non-medical treatment/services for terminally ill people.

- Obesity/Weight Control: Expenses related to surgical treatment of obesity that does not fulfil the medical insurance policy's eligibility requirements.

- Cosmetic or Plastic Surgery: Cosmetic or plastic surgery expenses purely for aesthetic reasons and not for medically necessary reconstructive surgery after an accident/injury are not covered.

- Refractive Error: Eyesight correction treatments for refractive error less than 7.5 dioptres are not covered.

- Unproven Treatments: Treatment, services, and supplies that lack valid medical documentation to support their effectiveness are not covered.

- Sterility And Infertility: Medication or treatments for sterility or infertility, like contraceptives, assisted reproduction services (IVF, ZIFT, GIFT, ICSI), surrogacy, and sterilisation reversal.

- Non-Medical Exclusions

• Any treatment or medication not medically necessary or supported by a prescription.

• Self-inflicted injuries or suicide attempts regarding mental state/sanity.

• Items for personal comfort and convenience that are not medically necessitated, like internet, foodstuffs, cosmetic and personal hygiene products, etc.

- Treatments prescribed by medical practitioners that are outside their discipline.

- Fees from medical practitioners who share the same residence as the insured or are immediate relatives.

• Fitting of hearing aids, spectacles, or contact lenses unless stated in policy terms.

• Treatment and expenses for baldness, alopecia, toupees, diabetic test strips, and other similar products.

• Injuries from war, acts of war, war-like operations, and medical complications from ionising radiation are not covered under medical insurance for senior citizens.

• Injuries from the insured person's participation in naval, military or air force operations.

• Crutches or other external appliances and/or devices used for diagnosis or treatment unless specifically covered under the policy.

• Illness or injuries where there is a change in the health status of the insured person after the date of proposal and before the commencement of the policy, which is not communicated to or accepted by us.

- Reimbursement Claims

If you file a reimbursement claim, we must be informed as soon as possible. This is because there are chances of the claim getting rejected if the treatment or procedure is not pre-approved by us. To avoid this, ensure that you check the policy terms and coverage carefully.

Lastly, after getting discharged from the hospital, you must pay their bills and raise a claim through our website. You must present all the necessary documents and submit your claim.

- Cashless Claims

This facility can be claimed only in cases of treatment and hospitalisation at network hospitals and applies to planned and emergency hospitalisations. For a global cover, the cashless facility would be available for in-patient and daycare hospitalisations only and approved on a case-by-case basis.

• To process your cashless claim under medical insurance for senior citizens, we must be informed:

• At least 48 hours before planned treatments, procedures and consultations.

• Within 24 hours after the hospitalisation or treatment for emergency medical procedures.

• Notify the TPA/us 48 hours before any planned hospitalisations/treatments. For emergency hospitalisations, we must be notified 24 hours after the treatment/hospitalisation.

• Upon notification, we will check your coverage and eligibility and send an authorisation letter to the provider.

• You have to provide the ID card issued to you along with any other information or documentation that is requested by the TPA/us to the network hospital.

• If approved, we will directly settle the bill with the network hospital.

• In case of a rejection of the cashless claim, you can still apply for a reimbursement claim, as a rejection of cashless claims in no way indicates rejection of the claim itself.

• Visit the Tata AIG official website.

• Click on 'Claims' on the top tab.

• Click 'Initiate Claim' and choose your product; in this case, it will be 'Health.'

• Log in to the site using your registered details.

• Fill out the claims form and upload the required documents.

• After submitting your claim, an insurance agent will contact you to guide you through the process.

- Maximum Age of Entry: While some individual health insurance plans provide coverage for people above 60, the minimum entry age for senior plans is 60 years and above.

Thus, before purchasing a senior citizen mediclaim policy, you must check the age of entry to ascertain if you are eligible to buy it.

- Sum Insured: Your senior citizen health insurance plan must have an adequate sum insured. It should cover all your health-related expenses, like preventive health checkups, medications, and hospitalisations, and medical emergencies.

When deciding your sum insured amount, always make sure you account for all your medical expenses and for medical emergencies to ensure adequate coverage.

- Enhancement of Sum Insured: Your senior citizen mediclaim policy must be flexible enough to provide coverage enhancement. This can be available through:

• Enhancing the sum insured amount on policy renewal,

• By an increase in the sum insured through a cumulative bonus, or both.

- Waiting Period: Several covers in your senior citizen health insurance plan have specific waiting periods attached. You must read the policy wordings carefully to know when you can get coverage for each cover.

- Policy Inclusions and Exclusions: This is the most important part of any medical insurance policy. When comparing your senior citizen mediclaim policy with other senior citizen health policies, always make sure to check the policy inclusions and exclusions to know what is covered under the plan.

- Policy Renewability: Not all senior health insurance plans have lifetime renewability. This feature, in particular, can save you a lot of money as it is more cost-effective to renew your plan than it is to purchase a new senior citizen mediclaim policy every year.

-** The Tata AIG Claim Form:** Can be downloaded from our website. It must be filled and signed on behalf of the insured person.

- Original bills, receipts (pharmacy purchase bill, consultation bill, diagnostic bill), and any attachments like receipts or prescriptions supporting any amount claimed.

- Regulatory Requirements: KYC documents (recent ID/Address proof and recent photograph) and NEFT (to enable direct credit of claim amount in your bank account for cashless claims).

• All medical reports, case histories, investigation reports, indoor case papers/ treatment papers (in reimbursement cases, if available), and discharge summaries. These include:

-Medication prescriptions that name the insured person, their price, and a payment receipt. For pre/post-hospitalisation claims, the prescription must be submitted with the corresponding doctor/hospital invoice.

• All pre and post-investigation, treatment, and follow-up/consultation recordsabout the patient's present ailment.

• Treating doctor's certificate regarding any missing information in case histories. For example, the circumstance of injury and alcohol or drug influence at the time of the accident, if available.

• Copy of settlement letter from the other insurance company or TPA.

• Stickers and the invoices of implants used during surgery.

• In Case the Hospital Bill is not Available: A detailed list of the individual medical services and treatments provided with all of their individual prices.

• For Claims of the Same Event Covered by Another Insurer:Attested copies of the above-mentioned documents and a declaration from the other insurer detailing the availability of the original copies of the treatment documents.

• *Additional Documents: *

• Legal heir/succession certificate, if required.

• PM report (wherever applicable and conducted).

• For Compassionate Travel: Boarding Pass, railway ticket, or any other document to show proof of travel.

• For Global Cover: Proof of diagnosis in India and the insured's passport and visa.

- There is No Need for Senior Health Insurance if You Are Healthy

Ageing brings with it more health issues and makes people more susceptible to injuries and other illnesses they would otherwise not be prone to in their younger years.

So even if you or your parents seem healthy now, it is always best to consider future scenarios and sudden medical emergencies.

- A Family Health Insurance Plan Provides Enough Coverage

While family floater plans do provide extensive coverage, the sum insured is shared among all insured family members. This means any time someone gets sick, the coverage amount gets lessened.

Senior citizens may need regular refills on their medication or undergo treatments to manage their health conditions. Hence, the sum insured under a family health policy may not be enough to cover these expenses, and you may have to pay out of pocket.

In these cases, getting separate health insurance for parents above 60 is always best.

- Senior Citizens With Pre-Existing Conditions Can not Get Coverage

This will depend on the insurance company. While some may not provide this benefit, there are insurance providers that offer coverage for pre-existing conditions under their senior citizen health insurance plans.

It is up to you to conduct thorough research on your part about the insurers and the plans they offer to find the best mediclaim policy for senior citizens.

- Purchasing Health Insurance Online is not Safe

Buying health insurance online is now more safe than ever. It is also more convenient and affordable as you can get lower premium rates.

Always check if the company is an IRDAI-approved insurance provider on the IRDAI's website to mitigate the chances of fraudulent purchases.