Written by Hannah Punitha, PG , Lyju Kuruvilla | 
Medically Reviewed by Dr. Sunil Shroff, MBBS, MS, FRCS (UK), D. Urol (Lond) on Nov 21, 2016

IRDA Guidelines for Health Insurance for Senior Citizens

IRDA's directive

The regulator for insurance industry in India - Insurance Regulatory Development Authority has addressed all problems relating to insurance industry in India including its policyholders with special emphasis on senior citizens. No insurer or insurance company in India can refuse or deny an senior citizens with a health insurance cover or load him/her with extra premium without providing valid reasons. All such reasons can be scrutinized by regulatory bodies like IRDA., important as it may be, the current scenario of health insurance markets across India is arbitrary in nature. For example, while some insurers reimburse the cost of medical tests to be undergone by a customer above the age of 45 years, few others insurers do not reimburse the costs incurred on medical test whereas some others reimburse only a part of it.

A recent amendments made to IRDA Act, makes it mandatory for all insurance companies to reimburse 50 percent of the total cost incurred on tests, if they agree to provide insurance coverage to the clients after medical examination. This means that a senior citizen can make a claim once the insurance coverage is approved. The new rules and regulation from IRDA ensures that the insurance sector across India practices more transparency and follows uniform standards. With the entry age being extended up to 65 years, the prospective customers would have greater flexibility in choosing a plan that suits their requirements. It has become mandatory for all insurance companies to see that disclosures are explained upfront so that an insured individual or the policyholder knows what is in stock for them.

Most insurance providers pass the discount they may provide to senior citizens to other categories by increasing their premium by a small amount. Health insurance policies for senior citizens have been introduced in India keeping the factor of cross-subsidization in mind. Such insurance policies have a lower ‘Sum Insured’ with ‘Greater Premium’ and are therefore to some extent designed to be self-sustainable.

Illustrative Policies-

1. Star Health and Allied Insurance ‘Senior Citizen Red Carpet Policy’ offers to insure people in the age group of 60-69 years (or senior citizens) without undergoing a medical test. It also covers pre-existing diseases from the first year itself.

2. National Insurance's Varistha Mediclaim Policy- medical tests for enrollment of senior citizens are not made mandatory, gives no-claim benefits and incorporates the coverage of pre-existing diseases after one claim-free year.

However, it must be noted that while Senior Citizen Red Carpet gives a Sum Insured of up to Rs 2 lakhs, Varistha Mediclaim policy by National Insurance offers a maximum sum insured of only Rs 1 lakh.

Entry age limits

Based on the latest regulations in health insurance sector, it has become mandatory that the maximum entry age for a standard health insurance policy offered by General (or non-life) Insurance Companies across India should be at least 65 years. The prevailing scenario regarding maximum entry age by general insurers offer at present is enlisted below:

General Insurance Companies Maximum Entry Age (Yrs)
Oriental Insurance No Limit
New India Assurance 80
Reliance General Insurance 80
Star Health and Allied Insurance 80
IFFCO Tokio General Insurance 70
Cholamandalam General Insurance 65*
ICICI Lombard General Insurance 60
Tata AIG General Insurance 60
Apollo DKV 60
National Insurance 59
Bajaj Allianz General Insurance 55
HDFC Ergo General Insurance 55
Universal Sompo General Insurance 55
Royal Sundaram General Insurance 50*
United India Insurance 50

*For dependants of the policyholder

Comments

vinode Thursday, January 24, 2013

apollo munich health insurance, india should not be trusted. they have duped and taken us, sr. citizen, for aride. they have refused to reimberse charges as promised by their medical centre and manager. only 5 medical tests were done on us but apollo munich health insurance has given us reports for 19 tests. where did they get reports for 14 tests when they were not done on us? do not trustapollo munich health insurance

vinode Thursday, January 24, 2013

apollo munich health insurance, india should not be trusted. they have duped and taken us, sr. citizen, for aride. they have refused to reimberse charges as promised by their medical centre and manager. only 5 medical tests were done on us but apollo munich health insurance has given us reports for 19 tests. where did they get reports for 14 tests when they were not done on us? do not trust apollo munich health insurance

kkat466 Thursday, February 2, 2012

new in india assurance in TIE UP WITH CITIBANK have a policy for their credit card holders called good health policy, there is a provision to apply for senior citizens [parents].I submitted all relevent documents after a confirmation from them they have declined the insurance ,-THEY DONT WANT OLD PEOPLE .they are lying now saying some excuse or the other how do we deal with such cheats,in this CITIBANK AND NEW INDIA ASSURANCE BOTH have to be blamed for cheating me.

chandaniel Saturday, January 7, 2012

I like the valuable info you provide in your articles about health insurance. I’ll bookmark your weblog and check again here frequently. I’m quite sure I’ll learn many new stuff right here! Best of luck for the next!

Indian_Citizen Saturday, October 29, 2011

The National Insurance company at Kolkata have dared to refuse to sell my parents the insurance, advising them that they should not waste their money on Insurance , rather save it and use it when they are sick....Can you believe this ???? And this is told by the Branch Manager... They have kept my father waiting for an entire day and at the end have told these words after offering him tea in his cabin. These thugs try to bypass the law by this method...Harassing Senior Citizens till they get frustrated.....

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