It is critical that one enjoy substantial health insurance coverage as old age approaches. The possibility that a person’s healthcare expenses will increase dramatically is almost for granted. In this article we search and compare the different health insurance plans available in the market for seniors. While all health insurance companies want insurance for young people (and, by definition, healthier), there are very few plans that provide health insurance to people over the age of 60. Another interesting thing to note here is that most senior health insurance plans are offered to citizens by public insurance companies in the public sector.
The health insurance plans available for seniors are:
Farista Mediclad of the National Insurance
Oriental Insurance Plan for Seniors
New India Assurance Medicare for Seniors
United India Senior Insurance Program
Star Health Insurance Red Carpet Program
Varistha Mediclaim from National Insurance: This policy can be purchased by anyone between the ages of 60 and 80. Renewals can take place up to age 90. Between ages 76-80, premiums have an additional factor of 10% and between ages 80-90, insurance premiums are charged at 20%. The amount insured under this policy for hospitalization is Rs 1 lakh. In case of serious illness, the insured amount is 2 rupees. Under cover of a serious illness, illnesses such as cancer, kidney failure, stroke, organ transplant, etc. are covered. If a person is already insured for a period of 3 years through a health insurance policy, they do not have to undergo a medical examination, otherwise a medical examination must be carried out at the expense of the potential client. For home treatment, the maximum claim is set at 20% of the insured sum. Ambulance fee of up to Rs 1,000 is covered by this policy. For Rs 1 lakhs health coverage and Rs 2 lakhs critical illness coverage, the premium ranges from Rs 6,200 (for ages 60 to 65) to Rs 9,200 (for ages 75 to 80). An interesting feature of this policy is that high blood pressure and pre-existing diabetes are covered from the very first year of the policy by paying an additional 10% premium for both diseases. Of course, preexistence is not available for the serious illness policy. Other pre-existing conditions are covered after one policy year. For pre-existing conditions, hemodialysis, chemotherapy, and radiation therapy are not covered. Claims are only paid for events that take place within India. Claims that occur within the first 30 days of the start of the policy will not be covered, except in the case of the person insured with the insurance company without interruption during the last 12 months. For the purposes of this policy, pre-existing conditions such as cataracts, hemorrhoids, fistulas, hernias, benign lumps, joint replacements, etc., will not be covered during the first 12 months. War-related medical claims, vaccinations, cost of eyeglasses, plastic surgery, corrective dental surgery, venereal disease, non-treatment vitamins and tonics, health claims related to nuclear disasters, alternative treatments like homeopathy, etc.
Opinion: We think it’s one of the best policies for seniors, except the security deposit is low. They are very generous with age-of-entry rules and pre-existing ailments.
2. Sickness plan defined for the elderly by Oriental Insurance Company: In this plan the insured has the right to choose an insured amount of 1 lakh rupees, 2 lakhs, 3 lakhs, 4 lakhs or 5 lakhs. A limiting feature of this policy is that the insured must pay 20% of the amount of any claim. Cashless payment via TPA is limited to Rs 1 lakh. This plan covers 10 specific diseases: cancer, kidney failure, heart disease, liver-related diseases, chronic obstructive pulmonary disease (lung disease), stroke, prostration, orthopedic disease, eye disease, accidental injury, and knee replacement. The amount that a person can claim for a specific disease is restricted as a percentage of the sum insured (for example, 50% of the insurance amount can be claimed for cancer, while 20% of the insurance amount can be claimed due stroke). An insured amount of Rs 1 lakh will cost Rs 4,500 for a person aged 65, while it will cost Rs 6,400 if a person is eighty years old or older. While this may seem cheaper than the Varistha National Insurance Medical Plan, it has a lesser scope. This policy contains an interesting return of the premium clause if the policy is canceled: if the insured abandons the policy during the first month, 75% of the premium is returned and if he chooses between 3 to 6 months of the policy , 25% is returned from the premium. In this policy, pre-existing conditions are not covered during the policy’s two-year period. Other exceptions are very similar to the National Varistha Medical Chart.
Opinion: Good scheme in terms of the level of sum insured and price, but the range of covered diseases is restricted. Another problem is that pre-existing ones are only covered after two years of the policy.
New India Assurance Seniors Mediclaim – This policy is available to seniors between the ages of 60 and 80, the insured amount can be Rs 1 lakh or Rs 1.5. Pre-existing conditions are covered after 18 months of continuous coverage, while diabetes and hypertension are covered, an additional premium is required. Pre-hospital treatment is covered for 30 days, while post-hospital care is covered for 60 days. Rs 1 lakh insurance for a 65-year-old will cost Rs 3,850, while for an 80-year-old it will cost Rs 5,150. Therefore, the premiums are very competitively priced. If you want to extend beyond 80 years, you must pay 10% or 20%. For diabetes or pre-existing hypertension, each must pay an additional 10% premium. One cool feature is that there is a 10% discount if the husband or wife is also covered by this policy. This policy also contains the same criteria for a partial refund for cancellation as the Oriental Disease Specific Plan. Claims will be paid only for medical treatment in India. The exclusion clauses are standard and very similar to the Varistha Mediclaim Terms of Varistha de National.
Opinion: At attractive prices. The secured ceilings are low. The product brochure does not say anything about the copayment, so it is very likely that there is no copayment requirement.
United India Insurance Defined Disease Plan: In this policy, an insured sum between Rs 50,000 and Rs 300,000 is available for people aged 60 to 80 years. The security deposit of Rs 1 lakh will cost Rs 3,715 for a 65-year-old and Rs 8,613 for an 80-year-old. So while it is cheaper for the younger age groups, it is a bit expensive for the older age groups. An interesting feature of this policy is that there are cash payments for hospitalization from the third day of hospitalization upon payment of a certain additional premium. While the other exclusion features of this policy are comparable to the three previous policies we discussed, the biggest problem with this policy is that it has a pre-existing 4-year waiting period.
Opinion: The pre-existing 4-year waiting period is restrictive
Star Health Red Carpet Plan: This plan has had good marketing success. While one hardly hears of the large-scale, well-priced schemes from the four nationalized companies, the market is very excited about Star Health’s red carpet scheme. The amount insured under this policy can be Rs 1 lakh, 2 lakh rupees, 3 lakhs, 4 lakhs or 5 lakhs. The entry age is restricted between 60 and 69 years. Pre-existing diseases are covered from the first year itself, except for pre-existing diseases for which the insured has received payment during the previous twelve months. After that, these pre-existing conditions are covered. There are sub-limits under this policy where different diseases have different limits as a percentage of the sum insured. A security deposit of Rs 1 lakh will cost Rs 4,900 on entry, while a guaranteed sum of Rs 5,000 will cost Rs 20,000. The biggest problem with this policy is that there is a 50% copayment for pre-existing conditions and 30% for other conditions! Other exceptions are very similar to those that exist for nationalized companies.
Opinion: Simple and well marketed claim. But the combined payment terms are very negative! The maximum entry age is very low (69 years), although the Guaranteed Renewal function is very positive. Also, the levels of the insured amount of Rs 5 lakh are very high and attractive in these days of rising medical costs.
In short, we believe that the Varistha National Plan is the most comprehensive. The only problem with nationalized insurer plans is that the levels of insured amounts provided may not be sufficient for today’s high health care costs. On the other hand, they at least offer health plans for seniors. It is very difficult to find beneficial senior health insurance offered by any private health insurance company, with the exception of Star Health. The only problem we see with the Star Health Red Carpet plan is the co-payment restriction issue.