Senior Citizen Health Insurance:

Salient feature:

Normally the health policy offer the coverage upto 65 years. Then the necessity was to devise a policy which grants cover to person beyond the age of 65 years. Normally Insurance Companies do not encourage the higher age Insured keeping in mind the possibility of higher claim as the age progresses but there are several insurance companies which offer specially devised Senior Citizen Health Policy where the entry age between 65 years to 80 years and if there is continuous uninterrupted renewal then even after the age of 80 years the Insurance company offer the health coverage with basic Co-Pay clause of minimum 20% which means in each and every claim the Insured person need to bear 20% of the claim.
The entry age for this policy is between the age of 65 years and 80 years. An insured beyond 80 years shall continue to be covered under Senior Citizens policy provided the policies are renewed with us without any break.
Children between the age of 3 months and 18 years may be covered provided either or both parents are covered concurrently.
Sum Insured offered is comparatively less which is normally between Rs.1 lac to Rs.3 lacs in multiples of Rs.50,000/-. Some private Insurance Companies offer higher sum Insured but then the premium is much higher and so is the higher co-payment.

Coverage: Coverage of certain disease:
If at the time of taking the Insurance of any senior citizen is siferring with any disease some of the company has waiting period for 1 year, some has waiting period of 2 years, some has waiting period of 4 years and some insurance companies just excluded the pre existing disease for the life time. The Insured need to check these important details before finalising the Sr. Citizen Health Policy The Policy provides the following benefits.
I      Hospitalisation expenses

1    Room, Boarding and Nursing expenses not exceeding 1% of the Sum Insured or actuals whichever is less.  
2    ICU not exceeding 2% of the Sum Insured or actual whichever is less.
3    Expenses incurred for Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees.
4    Expenses incurred on Anaesthetic, blood, oxygen, Operation theatre charges, surgical appliances, Medicines & drugs, dialysis,          chemotherapy, radiotherapy, cost of artificial limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker, orthopaedic implants, infra cardiac valve replacements, vascular stents, relevant laboratory/diagnostic tests, x-ray and similar expenses that are medically necessary and hospitalization expenses (excluding cost of organ) incurred for donor in respect of organ transplant to the insured.
If the insured person opts for a room with rent higher than the entitled category, the charges payable above shall be limited to the charges applicable to the entitled category only.  However, this will not apply for Medicines & drugs and implants.
Pre-hospitalisation expenses incurred up to 30 days prior to date of admission and Post-hospitalisation expenses incurred up to 60 days from the date of discharge – actual expenses or 10% of the Sum Insured whichever is less.
Expenses for the following illness restricted to –
a.     Cataract, Hernia, Hysterectomy – Actual expenses or 25% of SI whichever is less.
b.    Major illness/surgeries – Actual expenses or 70% of SI whichever is less.
c.    A co-pay on 80:20 basis applicable for all Major illness charged as a total package.
For list of major illness/surgeries, please see the prospectus or policy document.
II        Day Care Treatment
Certain specified Day Care procedures which require less than 24 hours hospitalization.
III           Family discount of 5% on the total premium if policy is taken for self and any one or more family members viz. spouse or dependent children.
IV    Free Look period of 15 days shall be applicable at the inception of the first policy.
V    Free Medical check-up once at the end of every three underwriting years provided no claims reported during the block and subject to policy renewed without any break. The limit applicable is 1% of the average Sum Insured during the preceding three policy periods.
VI    Premium paid for self, spouse, dependent children and dependent parents are exempt from Income Tax under Section 80-D of the IT act as per rules in force.
For detailed terms and conditions, please see our Prospectus and Policy in our website. Medical examination:
Insurance company grants the Sr. Citizen Health Plan after obtaining the following medical examination: ECG, Fasting BSL, Urine R, Lipid profile, HbA1C, SGPT, CBC, SGOT, Sr. Creatinine, eye check-up, knee check-up etc. Many insurance companies reimburse 50% of the cost of medical reports if the proposal is accepted by the Insurance Company.
Exclusions:
1    All Pre-existing diseases up to 48 months of continuous coverage.
2    Any disease contracted during the first 30 days of inception of policy.
3    Waiting period of 2/4 years for certain specified illness/treatment.
4    Vaccination and Inoculation of any kind unless it is post-animal bite
5    General debility and Run down conditions
6    Circumcision, Cosmetic surgery, Plastic surgery.
7    HIV/AIDS
8    Psychiatric and psychosomatic disorders
9    Injury arising out of drug/alcohol abuse.
10    Pregnancy, ailments related thereto and child birth
11    War, act of foreign enemy, ionizing radiation and nuclear weapon.
12    Naturopathy
13    Experimental or unproven treatment
14    All external equipment
15    Dental treatments
Tax deduction under Income Tax Act section 80-D is available.