'As we get older, our health risks increase, and this makes health insurance significantly more expensive for seniors.'
Galaxy Health Insurance has launched Galaxy Privilege, a senior citizen plan that covers pre-existing diseases (PEDs) within a year of purchasing the policy.
Even as health insurance policies for seniors evolve, elders need to carefully select a policy that offers adequate coverage while fitting into their budgets.
Challenges for seniors
Age-related health risks make purchasing a policy a challenge for senior citizens.
Insurers may reject proposals or load premiums heavily after medical tests reveal health issues.
Policies also become costlier.
"As we get older, our health risks increase, and this makes health insurance significantly more expensive for seniors," says G. Srinivasan, MD & CEO, Galaxy Health Insurance.
"As the age bracket changes, the premium rate increase can be quite high, raising afford ability issues," says Hari Radhakrishnan, expert, Insurance Brokers Association of India.
Policies for seniors also come with several types of waiting periods, of which the most significant is the one for pre-existing diseases (PEDs). It can range from one to three years.
What to go for
Experts suggest at least a Rs 10 lakh sum insured with the restore benefit.
"Later on, as the person contracts more ailments, the insurance company may not enhance the sum insured," says Radhakrishnan.
OPD (outpatient department) coverage and annual health checkups have become available.
"Many new plans offer at-home doctor visits and even ICU setups. It's wise to look for plans that cover modern treatments like robotic surgeries without restrictive limits," says Siddharth Singhal, head of health insurance, Policybazaar.
Radhakrishnan cautions that such features can raise the premium for seniors.
Features that need scrutiny
When selecting a policy, the focus should be on avoiding overly restrictive conditions while keeping the premium at a manageable level.
Room rent: Some policies have fixed (e.g., Rs 4,000/day) or percentage (of sum insured) based caps.
Those who opt for a higher-grade room than the one allowed face proportionate deductions (actual payout is cost of treatment multiplied by the following ratio: Permitted room rent/actual room rent).
Disease-wise caps: These restrict claim amounts for specific conditions, regardless of the sum insured.
Co-pay and deductible: Co-pay means that the insured has to pay a certain percentage of the bill, which could be 10 to 30 per cent or higher.
A deductible is a fixed threshold amount up to which the insured pays. Beyond it, the policy pays.
"Prefer deductible over co-pay as it is predictable," says Anita Upadhyay, CEO, Lord's Mark Insurance Broking Services.
A deductible increases out-of-pocket expenses but also makes the policy more affordable.
"Do the cost-benefit analysis of economising on premium versus coverage," says Radhakrishnan.
Managing high premiums
Pairing a base policy with a super top-up can help bring down costs.
"Buy a base policy with a sum insured of Rs 3 lakh and a super top-up of Rs 50 lakh," says Shilpa Arora, co-founder and chief operating officer, Insurance Samadhan.
(The base policy sum insured can be higher, say, Rs 5 lakh or Rs 10 lakh, while super-top-up coverage can go up to Rs 90 lakh to Rs 95 lakh, depending on affordability.)
The former can handle smaller expenses while the latter can take care of major bills.
"Super top-up is better than a regular top-up because the threshold is calculated cumulatively across claims in a year," says Upadhyay.
"Opting for a preferred network can fetch up to 15 per cent discount. "One can also save by downgrading the room category and removing non-essential add-ons," says Singhal.
Mistakes seniors must avoid
- Not declaring pre-existing conditions
- Purchasing a family policy that includes younger family members (it raises costs)
- Not checking for clauses in ported policies that restrict coverage of PEDs beyond reasonable waiting periods
- Not checking for low sub-limits on room rent, ICU charges, specific diseases
- You can post your health insurance related questions HERE
Disclaimer: This article is meant for information purposes only. This article and information do not constitute a distribution, an endorsement, an investment advice, an offer to buy or sell or the solicitation of an offer to buy or sell any securities/schemes or any other financial products/investment products mentioned in this article to influence the opinion or behaviour of the investors/recipients.
Any use of the information/any investment and investment related decisions of the investors/recipients are at their sole discretion and risk. Any advice herein is made on a general basis and does not take into account the specific investment objectives of the specific person or group of persons. Opinions expressed herein are subject to change without notice.
Feature Presentation: Ashish Narsale/Rediff
© 2025