Government Health Insurance For Senior Citizens: Facilities, Components And Eligibility Criteria
The Government has introduced several health insurance policies, taking the healthcare requirements of senior citizens into consideration. This Government health insurance for senior citizens can be exclusively availed by individuals above 60 years of age and come equipped with special benefits. These are curated to cover the additional healthcare expenses of senior citizen individuals.
Learn more about the facilities, components, costs, eligibility criteria, etc., of Government medical insurance for senior citizens below.
Facilities under Medical Schemes for Senior Citizens
The primary benefit of obtaining a health insurance policy for senior citizens is reducing the burden of their medical expenses. For that, these schemes offer a number of facilities as given below:
Covers multiple expenses
The health insurance policies provide coverage on a number of occasions, such as the following:
- Treatment of injury or diseases or accidents during in-patient hospitalisation
- Cashless treatments at network hospitals
- Pre-existing illnesses after the waiting period
- Daycare treatments
- Cost of ambulance and hospital room rent
- Free medical check-ups once a year (In the case of some insurers)
- Domiciliary expenses
- Pre and post hospitalisation expenses
- AYUSH
- Organ donor expenses
Premiums paid on a Pradhan Mantri senior citizen Mediclaim are eligible for tax deductions. Policyholders can enjoy deductions of up to Rs. 50,000 under Section 80D of the Income Tax Act, 1961.
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 settle for it or not.
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.
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.
Also read: https://navi.com/blog/health-insurance-for-senior-citizen/
Components of Government Mediclaim for Senior Citizens
Generally, Mediclaim policies for senior citizens cover three main expenses:
- Ambulance costs
- Daycare procedures
- Hospitalisation expenses
Take a look at the number of expenses covered under the given categories:
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 health insurance policies for senior citizens.
Cost of Facilities under Pradhan Mantri 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.
| Scheme Name | Premium Paid (In Rupees) | Coverage (In Rupees) |
| Ayushman Bharat | 30 per year | 5 lakhs per family |
| Aam Aadmi Bima Yojana | 200 per year | 30,000 |
| Pradhan Mantri Suraksha Bima Yojana | 12 per year | Annual cover of 1 lakh for partial disability and 2 lakhs for total disability. |
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 health insurance policy, 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.
Also Read: https://navi.com/blog/waiting-period-for-health-insurance/
Individuals also need to furnish a list of documents to buy senior citizen mediclaim policies. They 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 health insurance.
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.
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.
Those looking for a higher coverage amount and added benefits can always turn to Navi App Health insurance. Check out the benefits of our apps today!
Frequently Asked Questions
Ans: No, a Government health insurance policy for a senior citizen does not include cover for sexually transmitted diseases such as HIV/AIDS.
Ans: The Pradhan Mantri Jan Arogya Yojana (PMJAY) and National Senior Citizen Mediclaim Policy are the two renowned Government health schemes for elderly citizens in India.
Ans: This criterion varies with respect to the Government scheme you choose. To be on the safe side, one must get pre-acceptance health check-ups prior to the insurance application.
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Disclaimer: 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.
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