Government Health Insurance for Senior Citizens (2023) – Benefits & How to Claim 

The Government has introduced several health insurance policies, taking the healthcare requirements of senior citizens into consideration. Government health insurance for senior citizens can be exclusively availed by individuals above 60 years of age which offer special benefits. These are curated to cover the additional healthcare expenses of senior citizen individuals.

This article discusses the benefits, coverage, components, costs, eligibility criteria, etc., of Government health insurance for senior citizens. Keep reading to get the details!

The Government has introduced several health insurance policies, taking the healthcare requirements of senior citizens into consideration. Government health insurance for senior citizens can be exclusively availed by individuals above 60 years of age which offer special benefits. These are curated to cover the additional healthcare expenses of senior citizen individuals.

This article discusses the benefits, coverage, components, costs, eligibility criteria, etc., of Government health insurance for senior citizens. Keep reading to get the details!

Importance of a Government Health Insurance Plan for Senior Citizens

Government health insurance plans provide free or cheap medical insurance that covers regular health checkups or emergency situations for adults over 60 years of age. Users can even choose the plan of their choice to avail health benefits from clinics or hospitals around. This health insurance plan also helps senior citizens to preserve their savings and get treatment during an emergency situation.  

Benefits of Health Insurance for Senior Citizens

The primary benefit of obtaining a health insurance policy for senior citizens is reducing the burden of their medical expenses. However, there are a host of other benefits, as mentioned below:

1. Covers Multiple Expenses

The health insurance policies provide coverage on a number of occasions, such as the following:

1. Treatment of injury or diseases or accidents during in-patient hospitalisation 
2. Cashless treatments at network hospitals
3. Pre-existing illnesses after the waiting period 
4. Daycare treatments 
5. Cost of ambulance and hospital room rent 
6. Free medical check-ups once a year (In the case of some insurers)
7. Domiciliary expenses
8. Pre and post-hospitalisation expenses 
9. AYUSH 
10. Organ donor expenses 

2. Tax Deductions on Premiums Paid

Individuals paying premiums on a Government health insurance for senior citizens are eligible for tax deductions. Policyholders can enjoy deductions of up to Rs.50,000 under Section 80D of the Income Tax Act, 1961.

3. Free Look Period

Government health insurance policies for senior citizens offer a free look period of 15 to 30 days. In this period, policyholders can go through the terms and conditions of the plan and decide whether to terminate it or not.

4. Costs of Special Equipment

During daycare treatment procedures like dialysis and chemotherapy, the costs of special equipment are substantial. A Government senior citizen health insurance scheme covers such expenses.

5. Annual Health Check-ups

Senior citizens might require annual health check-ups for their well-being. By availing of a health insurance plan, they can get cashless check-ups every year.

What does Government Health Insurance for Senior Citizens Cover?

Generally, Mediclaim policies for senior citizens cover three main expenses:

• Ambulance Costs
  Any emergency ambulance charges fall under the coverage of Government health insurance for senior citizens. 
• Daycare Treatments
  Daycare treatments that do not require hospitalisation for more than 24 hours, such as dialysis, are covered under these schemes. 
• Hospitalisation Costs
  A number of expenses such as physician consultant fees, treatments, room rent, doctor’s fees and more are included under government medical insurance for senior citizens.

Cost of Facilities under  Government Health Insurance for Senior Citizens

Pensioner senior citizens can avail of facilities under Government health insurance schemes by making a contribution based on their pay grade while they are in service. They can either make an annual contribution or a one-time payment towards their health plan. 

Here is a table showing coverage offered based on the amount of premium for a few Government health insurances for senior citizens. 

Other than this, one may opt to avail of comprehensive health benefits coverage for his/her entire family within 5 minutes from Navi. Download the Navi app and enjoy cashless claims in under 20 minutes.

Eligibility Criteria for Government Health Insurance for Senior Citizens

Individuals aged 60 years or more are eligible to purchase senior citizen insurance schemes. In line with this, the Insurance Regulatory and Development Authority of India (IRDAI) has issued the following regulations:

• If insurance providers decide to reject or accept a senior citizen insurance scheme, they will need to provide the reasons for the same in writing to the senior citizens. 
• Senior citizens are eligible to get reimbursements for at least 50% of the pre-insurance medical examination costs from an insurer. 
• An insurer can refuse a senior citizen’s health insurance renewal in case of fraud, moral hazard, or misinterpretation. 

List of Documents to Buy Senior Citizen Mediclaim Policy

List of documents required are as follows:

• Identity and address proof
• Income proof
• Proof of age
• Medical check-up report if applicable
• Passport-size photographs (two)
• Application form

By following the above eligibility rules, senior citizens can successfully apply for senior citizen health insurance schemes. 

How to Apply for Government Health Insurance for Senior Citizens

Steps to apply for a government health insurance scheme are:

1. Open the official website for the insurance provider.
2. Enter basic information such as personal details.
3. Choose the type of plan.
4. Choose the amount of premium and payment plan
5. Confirm your choice.

IRDAI Rules and Regulations for Government Health Insurance for Senior Citizens

The Insurance Regulatory and Development Authority (IRDAI) had laid down certain rules and regulations regarding providing and accepting health insurance. 

• To avail of a senior citizen health insurance, the individual should be 65 years of age or above.
• The insurer should pay 50% of the pre-insurance medical check-up cost if the insurance application is accepted. 
• Insurance providers must provide a valid reason for rejecting the insurance applications of senior citizens. 
• Individual applications can change their Third party administrator as they wish. 
• Unless found guilty of misinterpretation or fraud, insurance companies cannot reject applications for senior citizen health insurance.

How to Claim a Government Health Insurance for Senior Citizens

Policyholders must file a health insurance claim for cases of hospitalisation or emergency medical assistance. They can either obtain a cashless treatment or get reimbursed for the expenses. Let’s check the two processes below:

1. Reimbursement Claim Procedure

• Informing the insurance company when hospitalized. 
• Getting all the medical insurance documents during discharge
• Reading the conditions and filling up the application form. 
• Submission of the signed form to the Third-Party Administrator (TPA) with the required documents. Documents may include prescriptions, health reports, chemist and medicine bills, etc
• After careful review and approval by the claims team, policyholders can obtain the reimbursement. 

2. Cashless Claim Procedure

• Getting hospitalized at a network hospital.
• Filling up the pre-authorisation form and submitting it.
• The Third-Party Administrator (TPA) will accept the pre-authorisation request and cashless hospitalisation will only be initiated after the insurance company approves the claim. 
• Undergo the treatment process after receiving approval.
• The approved application will be insured by the insurance company with the hospital directly. 

Exclusions under Government Health Insurance for Senior Citizen

Insurance plans are devoid of legality in situations of

• Uninformed disease or illness prior to receiving the claim.
• Cases of Self-inflicted injuries or suicide. 
• Cases of alcohol or drug abuse
• Incidence of a medical condition within 30 days of purchasing policy (apart from accidental injuries). 

Cities Covered under Government Health Insurance Schemes for Senior Citizens

Mostly, all the Government health schemes are available for citizens across India. However, some schemes are operational in only a few cities. For instance, the Central Government Health Scheme is available in cities such as Pune, Kolkata, Nagpur, Delhi, Mumbai and Lucknow. 

On the other hand, the Chief Minister’s Comprehensive Insurance Scheme, launched by the Government of Tamil Nadu, offers perks and benefits only to the state’s residents. Similarly, Yeshasvini Health Insurance Scheme, promoted by the Karnataka State Government, covers peasants’ and farmers’ expenses in and around Karnataka.

Factors to Consider before Purchasing a Government Health Insurance for Senior Citizens

1. Checking Pre-existing Conditions

Before applying for an insurance plan, one should check for pre-existing medical conditions. A health plan with a minimum waiting period helps avail the benefits quickly.

2. Coverage

Since the probability of being susceptible to life-threatening illnesses is rising in senior citizens, one should check his/her medical insurance plans to look for illness types covered by the plan. Dental surgeries, hospitalisation expenses and hereditary conditions etc. are not covered by the insurance plan.

3. Insured Amount

Making a decision to purchase a health policy is dependent on the mutually agreed insured amount. One should pre-assess their requirements and purchase that policy which provides a personalised feature-rich policy at a low premium.

4. Network Hospitals

Mediclaim policies contain a list of their network hospitals which accept the insurance claim launched by the company. Users should choose a policy that covers a wide range of hospitals in nearby areas or other locations. 

Final Word

Since senior citizens are exposed to a higher risk of ailments, it is imperative for them to have a comprehensive health insurance policy in place. Government health insurance for senior citizens can prove to be the most cost-effective choice in this regard.

If you are looking for a higher coverage amount and added benefits, check out Navi Health Insurance.  Download the Navi app today!

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This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.