Mediclaim For Senior Citizens

For the elderly, healthcare coverage is no longer a luxury, but a necessity. This is especially valid since they are more likely to face health concerns at this stage of their lives. To address this need, senior citizen mediclaim policies provide a safety net. These plans cater to older individuals by covering hospitalisation expenses during medical treatment.

 

The table below gives you a quick insight into the important terms of the senior citizen mediclaim policy:

Read More: Senior Citizen Health Insurance Plans

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

 

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

When you shortlist the best mediclaim for senior citizens, make sure you thoroughly read all the clauses. One of the most important is the coverage. It clarifies to you all the claims you can make if the need occurs:

• Hospitalisation Expenses

At the time of the policy purchase, a sum assured is guaranteed to the insured. If any medical help arises, the insured can make a claim for hospitalisation expenses up to the sum insured. The following covers are added under it: 

1. Room charges

2. ICU charges

3. Nursing fees

4. Charges of the anaesthetist, surgeon, practitioner, consultant, etc. 

5. OT charges

6. Medicine and drug expenses

7. Blood, surgical appliances, oxygen, anaesthesia, X-ray

8. Artificial limbs, stents, implants, pacemakers, dialysis, chemotherapy, and radiotherapy 

9. Diagnostics

10. Pre and Post-hospitalisation expenses are covered to a certain extent only (not included by some insurers)

11. You may also be provided AYUSH treatment cover

12. Ambulance charges can also be claimed

13. The insurance company also covers the charges and expenses of the donor

The exclusion clause lists what a senior citizen mediclaim policy does not cover for hospitalisation. This includes: 

• Existing diseases

• Cosmetic surgery

• STDs and inherent disease

• Alcoholism

• Self-harm 

• Harm due to illegal activity

The premium asked by your insurance provider must be affordable and within your budget. Also, you must get sufficient coverage in return for a premium. Check out the premium charged to the different age groups for the senior citizen mediclaim policy:

Raising a claim is the main component of any insurance policy, including the best mediclaim for senior citizens. The claim process includes: 

• Cashless Treatment

For cashless treatment, the insured must be admitted to one of the impanelled hospitals as specified by the insurance company. Once the disease is diagnosed, the insured must inform the insurance company or TPA (Third Party Administrator) about the same. 

 

After being hospitalised, the bills will be settled between the insurance company and the hospital. The insured is only charged in case the expenses exceed the sum insured or for inadmissible expenses.

• Reimbursement Claim

If the insured gets admitted to any other hospital than the network hospital, the following is the process for this claim:

1. Inform your insurance providers once the disease is diagnosed

2. Submit all the necessary documents to your insurance provider within the time limit given, after discharge

3. Your insurance provider will assess all the details and approve the claim

Once approved, all admissible expenses will be disbursed to your bank account.