6 Best Government Mediclaim Insurance and Health Insurance Scheme for Senior Citizens

Government Mediclaim for Senior Citizens – Pradhan Mantri Health Insurance for Senior Citizens

The primary and most important requirement during old age is your overall health. Unfortunately, it’s a fact that as we age, we experience deterioration of health and age-related diseases crop up. To combat the health issues at this stage of your life, two essential things are to be done – taking care of your overall health and purchasing a suitable and comprehensive health insurance policy. As healthcare costs are increasing and frequent hospitalization is more likely for older adults, it’s required to look specifically at health insurance for senior citizens. This will not only help policyholders pay for costly healthcare expenses, but it will make sure that seniors are assured that they’ll have sufficient financial assistance if there is any need.

Let’s Understand More About the Government Health Insurance for Senior Citizens with an Example

Mr. & Mrs. Sharma are in their 60’s and retired from their respective job a couple of years ago. Their employer’s mediclaim policy took care of their healthcare needs during their service. After retirement, they are still looking for the best health insurance for senior citizens, and the search has only gotten aggressive, especially after the covid19 pandemic. Although many health insurers in India have strict terms and conditions to provide coverage for senior citizens, making it difficult for them to choose and buy. Mr. Sharma’s friend suggested that the government health insurance for senior citizens in India offered optimal health coverage for the couple. And thankfully, the premium was also on the lower side than the other plans. Mr. Sharma immediately bought it to cover himself and his wife, adding more mental peace to their family.

Indian government health insurance for senior citizens offers adequate health coverage for older people and other benefits provided by private health insurance companies. While some of these plans are supplied by state-run insurers, few are directly within the control of the government.

Also Read: Best Health Insurance For Senior Citizens in India 2022

Why is a Health Insurance Plan Important for Senior Citizens?

A health insurance plan is crucial for every individual.  However, since senior citizens are prone to illness and severe health conditions, they need better and more comprehensive health coverage. Here are some important reasons why senior citizens must be covered under a health insurance plan:

You get coverage against greater health issues

The elderly are prone to greater health conditions even if they follow healthy ways of life. Hence, as people grow old their health concerns become severe. To tackle such health issues, it is important to have the support of health insurance. Even if you are not covered under a health insurance plan during your youth, it is very important to avail of a plan when you reach your 40s. This is because 40 to 60 years is the period when people are more prone to health deteriorations and this is the age when you must stay covered under a health plan. 

Provides financial security against health conditions

When you are covered under a health insurance plan, it allows you peace of mind. You know that if any health emergency appears, your Mediclaim policy will support you with the expenses incurred for treatment.      

Your savings are intact – You may have enough savings accumulated over the years using investment policies. However, rather than letting the money drain on your medical expenses, you better use it on other important things and let your health care policy take care of your medical needs.

6 Best Government Health Insurance for Senior Citizens

1.) Pradhan Mantri Ayushman Bharat Yojana or PMABY

Ayushman Bharat is a flagship program of the Government of India which was created in conformity to the National Health Policy 2017 to achieve the aim of universal healthcare coverage. PMABY is the most comprehensive government health card for senior citizens, including children and women. Some of its significant characteristics are:

• Pradhan Mantri health insurance worth 5 lakh rupees for each family per year in both public and private hospitals across India
• Families with incomes less than the poverty level can receive these benefits.
• It covers upto three days of hospitalization and 15 days of post-hospitalization expenses like diagnostics, medication, etc.,
• All current medical conditions of the insured will be covered starting on the first day of the insurance coverage.
• The participant in this scheme can visit any impaneled private and government hospital within India to receive cash-free treatment. The benefits of this scheme can be transferred across the country.

2) United India Senior Citizen Health Insurance

This medical insurance for senior citizens is offered by United India Insurance Company, a public sector insurance enterprise. Here are its features:

• The entry age to this health insurance policy is 61 years to 80 years.
• You may choose a sum insured from 1 lakh to 3 lakh.
• This policy will cover the medical costs for treatments and surgeries when the duration of hospitalization stays exceeds 24 hours.
• Hospitalization costs are reimbursable only if the treatment takes place at a government hospital or any other institution recognized by the government.
• A family discount of 5% on the total premium will be granted, which includes the insured and any of the following dependent children, spouse, or dependent parents.

Also Read: Cheapest Health Insurance in India

3) Varistha Mediclaim Policy For Senior Citizens

This Indian government mediclaim for senior citizens is available with National Insurance Company Ltd.

• The varistha mediclaim policy by government is available to all Indian citizens aged 60 to 80 years.
• One lakh & 2 lakh are the two sum insured options available under this policy.
• The insurance coverage applies to hospitalization expenses and treatment for critical illness costs and treatment costs.
• Additionally, it provides insurance for diabetes and hypertension that are pre-existing conditions. However, policyholders must pay an additional premium to get the extra protection.
• The policy provides the treatment of patients through cashless options at hospitals within its network. It also allows hospitals to cover treatment costs at hospitals that are not part of its network via reimbursement claims.
• The policy coverage is for 30 days of pre-hospitalization and 60 days of post-hospitalization.

Also Read: Health Insurance for Senior Citizens Above 70 Years in India

4) Health of Privileged Elders (HOPE)

This is a senior-citizen-friendly insurance scheme offered by Oriental Insurance Company. A brief outline of the project is as follows:

• The policy is open to all Indian citizens aged 60 and over for receiving hospitalization in India.
• The policy can be purchased for a sum insured of Rs 1 lakh to 5 lakhs, with only coverage for specific diseases.
• 20% of co-payment from the admissible claim must be paid at the time of hospitalization.
• Policyholders can benefit from a considerable discount in premium when opting for voluntary co-payment.
• While cashless claims are processed via TPA (third-party administrator), it is restricted only upto 1 lakh rupees.
• The program includes Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy treatment system if conducted in any of AYUSH Hospitals.

5) The New India Assurance Senior Citizen Mediclaim Policy:

This insurance scheme for senior citizens is open for people aged 60 to 80 years old.

• The maximum amount insured for each person under this plan is Rs.1 lakh or 1.5 lakh.
• A 10% discount is available when the policyholder’s spouse is also covered under the same plan.
• It offers limited coverage for hospitalization in government Ayurveda/homeopathic and Unani hospitals.
• Hypertension and pre-existing medical conditions such as diabetes mellitus, hypertension, and complications are covered for up to 18 months of continuous coverage, but only upon payment of additional premiums.

6) National Senior Citizen Mediclaim Policy

This plan is available with a greater sum assured of up to INR 10 Lakh. Individuals within the age bracket of 60- to 80-years can avail of this plan. The insured has the facility to cover his/her spouse under this plan on a family floater basis. 

Here are some features of the plan:

• The plan pays for the fees charged by surgeons, physicians, and anesthetists 
• The plan incurs expenses of room charges, injection charges, transfusion, etc.
• Organ donor expenses and ambulance charges are also covered under the plan
• The plan comes with a 24-month waiting period for PEDs or pre-existing conditions
• Mental illness and HIV coverage is also offered
• Ayurveda and homeopathy treatments are covered 
• The plan offers cashless treatment facilities at network hospitals
• Tax benefits are available u/s 80D 

Advantages of Senior Citizens Health Insurance Plans

Health plans for senior citizens are comprehensive and cover a range of illnesses. They come with many interesting benefits as mentioned below:

• Annual Health Check-ups – This is an important benefit of the Senior citizens’ health insurance plans. The feature of annual health check-ups keeps the well-being of the elderly intact as they become eligible for cashless check-ups every year with their health insurance plan. 
• Covers diverse expenses – Health insurance policies of senior citizens cover treatment costs for diseases, injuries, accidents, and so on. They allow the elderly to avail the facility of cashless treatment at network hospitals. 
• Pre-existing diseases (PEDs) coverage – The health insurance plans of the elderly cover the PEDs after the completion of their waiting period depending on the terms and conditions of an insurance company.
• Covers daycare treatments – Daycare procedures that do not take hospitalization of more than 24 hours are also covered as part of the elderly health insurance plans.
• Tax Deductions – Senior citizens can also avail of tax benefits on premiums paid on their health insurance u/s 80D up to INR 50,000.
• Free Look Period – These policies are available with a free look period ranging from 15 to 30 days. During this period, a policyholder can decide to terminate the plan if they are not satisfied with the terms and conditions of the policy.
• Special Equipment Expenses – The health plans for the elderly cover equipment costs used for chemotherapy and dialysis, which are quite substantial. A Government health insurance scheme covers such expenses for senior citizens

Further, there are other costs such as ambulance charges, hospital room rent coverage, free medical check-ups once a year (In the case of some insurers), domiciliary expenses, Ayush treatment, organ donor expenses, and pre-and post-hospitalization expenses are covered under these plans.

Features of Senior Citizens’ Health Insurance Plans Offered by the Government? 

Below are the key features of a government health insurance plan for the elderly:

• Cost of Hospitalisation – These include consultation fees of the physician, room rent, doctor’s fees, and treatment charges for senior citizens
• Ambulance Charges – Ambulances used for emergency purposes are also covered by Government health insurance plans for the elderly
• Daycare Treatments – Treatments that do not need more than 24 hours of hospitalization like dialysis are also covered under these schemes

Facilities Offered for Senior Citizens under Government Health Insurance Plans

Retired senior citizens working in the government sector can benefit from the health plans provided by the government. However, they need to contribute a certain amount from their salary during their job tenure to avail of this facility. This contribution can be either a one-time lump sum pay or maybe annual payment. 

Let’s take a look at the health coverage that can be availed as per premium paid under some government health insurance policies for pensioners.

Aam Aadmi Bina Yojana

• Premium amount paid = INR 200 (per year)
• Coverage received = INR 30,000 

Ayushman Bharat 

• Premium amount paid = INR 30 (per year)
• Coverage received = INR 5 lakh per family

Pradhan Mantri Suraksha Bima Yojana

• Premium amount paid = INR 12 (per year)
• Coverage received = INR 1 lakh/year for partial disability, and
•  INR 2 lakh/year for total disability

Besides these government plans, you can also avail of all-inclusive health insurance plans from reputed insurers in India for comprehensive health coverage.

What are the Criteria for Eligibility Under Government Health Insurance Plans for the Elderly?

IRDAI has set some criteria for senior citizen insurance schemes as mentioned below:

• The age limit to be eligible for a senior citizen health scheme is 60 years and above
• Insurers must pay reimbursements to senior citizens for a minimum of 50% of the cost of pre-insurance medical check-ups 
• Insurance companies rejecting the plea of senior citizens to obtain health insurance must offer a valid reason in writing for the same to the applicant
• Insurance companies can however decline to renew the health insurance of a senior citizen if it involves any fraud

Key Documents Required to Buy Senior Citizen Mediclaim Policy

Below are the documents required:

• ID and address proof
• Income proof
• Age Proof
• Report of any medical check-up (if applicable)
• Two passport-size photographs 
• Duly filled application form

Procedure to Avail Senior Citizens of government Health Insurance plans

Here are the steps to avail senior citizens health insurance:

• Go to the official website of the insurance scheme/provider
• Submit the basic information as required 
• Select the plan type
• Select the premium amount to be paid
• Make online payment for the plan

Regulations by IRDAI for Senior Citizens Government Health Insurance Schemes

Here are some rules set by IRDAI regarding health insurance for senior citizens offered by the government:

• An individual must be 65 years and above to obtain a senior citizen health insurance plan
• Insurers must pay the senior citizen a minimum of 50% of the pre-insurance medical check-up cost if his/her claim is accepted 
• Insurance companies rejecting the plea of senior citizens to obtain health insurance must offer a valid reason in writing for the same to the policy seeker
• Insurance companies can however decline to renew the health insurance of a senior citizen if it involves any fraud
• Individual applications are eligible to change their TPA or third-party administrator as per their wish

Claim Process of Senior Citizens’ Government Health Insurance Plans

There are two ways of filing a claim for a senior citizen health insurance plan if the insured is hospitalized or if there is an emergency healthcare need. They are:

• Cashless Claim
• Reimbursed Claim 

Cashless Claim– Under the cashless procedure, the insured should get admitted at a network hospital of the insurer. They must duly fill out the form of pre-authorization and submit it. The TPA will verify the form and accept the request. Once the insurer approves the claim, cashless treatment will start. The insured can go through the treatment, and at the time of discharge, the insurance company will clear the bill with the hospital directly.

Reimbursement Claim – Here, the insured individual is required to inform the insurance company while getting hospitalized. The individual must pay the bill including all the expenses incurred. They are expected to keep the bills, prescriptions, health reports, receipts of medicines, etc., safe. Once discharged, the insured can file a reimbursement claim after going through the terms and conditions of the insurance policy. Once the insured applies for the claim by submitting the required documents, it gets approved and signed by the TPA. And finally, the reimbursement amount is paid after the claim is accepted by the insurer. 

Things that are not covered under Senior Citizens’ Government Health Insurance Plans

• The claim will not be accepted if the insured is suffering from an uninformed disease before receiving the claim
• The claim will be rejected if it is a case of suicide or self-inflicted injury 
• It will be rejected if the case is of drug or alcohol abuse
• Apart from accidental cases, any other medical condition will not be accepted within 30 days of obtaining the policy

States/Cities Where Senior Citizens’ Government Health Insurance Schemes are Available 

Most of the plans for senior citizens initiated by the central government are available across India. However, there are some specific plans available in certain states/cities. The Central Government Health Scheme is one such plan that is available in Delhi, Kolkata, Mumbai, Pune, Nagpur, and Lucknow. 

Alternatively, the Chief Minister’s health insurance plans of specific state governments such as the one initiated by the state of Tamil Nadu allow benefits to be received by the residents of the state only.  

Karnataka also offers the Yeshasvini Health Insurance Scheme that allows farmers and peasants in the state to avail of healthcare facilities 

Things to Note Before Buying Senior Citizens’ Government Health Insurance Plans

• Make sure that the plan offers coverage for PEDs or Pre-existing Diseases
• Also, one should check if the plan covers critical illnesses
• You may note that dental surgeries and hereditary conditions are among some of the treatments that are not covered under such plans
• Another factor to take note of is the sum insured. You should assess your needs and purchase a plan that fulfills your needs at a reasonable premium
• The number of network hospitals is another important factor to consider. You may choose a plan offering a wide network of hospitals in your vicinity

Also Read: OPD Full Form in Medical

Government health insurance for senior citizens can be advantageous in many ways, as it promises financial freedom without worries about finances during older age. Moreover, the collected savings through this method will add to their retirement savings pool, leading to a fulfilling life. To ascertain whether a government health insurance scheme might be the right one to suit your needs refer to PayBima’s expert advice and get all information on the right products that suits your need.

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