Once you cross the age of 60, health issues tend to come up. It is best to plan for future health issues and plan for funds for such illnesses. A health insurance plan which covers most age-related illnesses is a prudent choice for such adversities. However, Health Insurance plans for senior citizens are too few and scarce.
The United India Senior Citizen Plan has an entry age from 61 years to 80 years. The sum Insured ranges from Rs. 100,000 to Rs. 300,000. The plan is generally issued through a TPA (Third Party Administrator) and requires a 20% co-pay on the admissible claim for major illnesses. At the time of taking this policy, a pre-policy medical check-up of the applicant is required. In case the proposal is accepted by the insurer, 50% of the costs of these tests are reimbursed to the insured.
Listed below are the basic default benefits available under the United India Health Insurance Senior Citizen Plan.
In Patient expenses: The plan covers medical expenses due to illnesses/ events which require continuous hospitalization of more than 24 hours. Apart from the common expenses on Room, ICU, Medical Practitioners, implants, etc., the policy does cover procedures like chemotherapy, radiotherapy, and dialysis. It also covers the hospitalization expenses of the donor in respect to an organ transplant to the insured.
Day Care Treatments: It also covers day care treatments which include specific procedures that do not require 24 hours hospitalization like appendectomy, coronary angiography, coronary angioplasty, dental surgery, endoscopies, eye surgery, radiotherapy, etc.
Pre & Post Hospitalization expenses: The Policy covers Pre-hospitalization expenses for up to 30 days immediately before hospitalization. Post-hospitalization expenses are covered for 60 days immediately after the discharge from the hospital. However, these expenses should be directly related to the illness for which the insured was hospitalized.
Domiciliary expenses: Domiciliary expenses are covered in cases where either the patient cannot be moved to the hospital or there are no available rooms in a hospital. Certain illnesses like Asthma, Bronchitis, Epilepsy, Hypertension, etc are not permitted under domiciliary expenses.
Ayurvedic Treatment: The policy allows for hospitalization expenses under Ayurvedic treatment only in case the hospital is a Government recognised institute or a Government hospital. Institutes accredited by the Quality Council of India or the National Accreditation Board on Health are also permissible for Ayurvedic treatment.
Health Check-up: The policy covers the expenses of a health check-up at the end of every 3-year block if the policy is continued. Expenses upto a maximum of 1% of the sum insured are reimbursable.
Being specifically designed for Senior Citizens, this Policy aims to keep the premium as low as possible and hence does not allow for any optional coverage items like Ambulance services or daily hospitalization allowance.
Since covering Senior citizens, the policy has a few exclusions/waiting periods. The applicant should take great care to go through them exhaustively before going in for the policy
Waiting periods: The illnesses/ conditions where the expenses are covered under the policy only after the expiry of the waiting period are
Exclusions: The Policy does not cover expenses in the following conditions
For a speedy claim settlement, the Insured should adhere to the timelines as defined in the policy. The TPA should be informed about a scheduled hospitalization as soon as it is finalized. In case of emergency hospitalization, the TPA should be informed within 24 hours of hospitalization. Timelines for Domiciliary hospitalization are the same as that of normal hospitalization. The notice should necessarily include the following information.
United India Health Insurance company provides an option of both cashless and reimbursement of Policy related claims.
Cashless: This facility can be availed at network hospitals only through the company’s service providers.
2. Reimbursement: A cashless claim facility may not be available in certain cases where the hospital is a non-network hospital, and details of the procedure/treatment are not available or for any other reason. In such cases, the insured should opt for the reimbursement option for a claim.
The Insured can opt for a change in the sum insured at the time of renewal of the policy. All claims are settled as per the Sum Insured during the claim period. There is no limitation on the number of times the Sum Insured can be changed. The 3-yearly Health check-up reimbursement amount is calculated on the basis of the average Sum Insured during the previous 3 years.
In case the Insured opts to switch to any other Insurance provider, the insured person must apply for porting with policy details and claims (if any) at least 45 days prior to the expiry of the policy.
In the adverse case where the Insured person opts for cancellation of the policy, United India allows for a refund of the premium, and the refund is processed only in cases where there has been no claim up to the date of cancellation.
With waiting periods on quite a few conditions, it is advised that you take this policy as early as possible. Moreover, an early entry also reduces the premium for the policy.
Clearly mention your pre-existing conditions at the time of taking the policy.
Read the policy document thoroughly, specifically the exclusions and the waiting periods
Take note that the policy has a 20% co-pay clause
The maximum Sum Insured of Rs. 300,000 may not suffice for most of the major procedures so plan for backup
Adhere to time limitations for claim submission
The United India Senior Citizen Plan is one of the few policies which cater to senior citizens’ needs beyond the age of 60. It is specifically beneficial for Senior citizens who do not have any co-morbidities and have just crossed 61 years of age. It covers most of the age-related illnesses and covers domiciliary hospitalization too. Do go through the policy exclusions and wait periods before finalizing the policy purchase.
