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Early last year, IRDAI the insurance regulator notified several changes that were aimed at increasing insurance penetration amongst senior citizens. One year later there is a noticeable change in the options for senior citizens. The prospective policyholder in the silver years may have never had it better than the current marketplace to choose health insurance. Options for Value, OPD consultations, coverage, worldwide travel, and all aspects of interest to health insurance are now on offer. Rejection, which was a key concern, has also been specifically addressed with few policies advocating guaranteed coverage without hassle.
Below we list the various policies on offer for every key concern a policyholder might want addressed. For all the variants, we have considered a 64-year-old male. We have also added Diabetes and Blood pressure as pre-existing diseases (PED). A search with such parameters would have yielded few options a couple of years back and almost no response four-five years back. But now there are multiple insurers with multiple variants available as options.
₹1 crore & above coverage
One crore health insurance is offered by ICICI Lombard – Max Protect, Aditya Birla’s Active One, Niva Bupa’s Max Saver, and Manipal Cigna’s Lifetime (₹50 lakh). The average premium across the four at ₹48,000 is at a slight premium to a regular ₹5 lakh cover which comes at ₹30,000. While options exist, rejection of policy issuance was a key concern earlier. Aditya Birla mentions that guaranteed issuance of policy with low hassles which addresses that concern.
But a high cover can also be gained from restoration of cover and NCB (No claim bonus) although limited in scope. Restoration of cover is mostly limited to once a year and up to the sum insured in most policies. Manipal Cigna’s Lifetime policy or Aditya Birla’s Activ One allow several restorations in a year. HDFC Ergo’s Optima Secure policy doubles from day one and triples the sum insured in three years irrespective of claims.
A special mention goes to ICICI Lombard’s Elevate health insurance. This policy allows one claim of unlimited amount per policy life term with a rider. This is applicable to even the base ₹5 lakh policy. This ensures high coverage for one instance.
Waiting period and disease covers
The PED waiting period is 3 years and is common to all policies. But Star Health’s PED buy back policy or Niva Bupa’s Senior First Gold policy offer 1 year and 2-year PED waiting period, respectively. Again, Star Health mentions easier access to policy, but there are some limiting conditions like copay and higher premium cost (₹46,762).
As mentioned, the basic filter had included diabetes and blood pressure. But there are disease specific health insurance available in the senior category as well. Aditya Birla’s VYTL and Manipal Cigna’s Prime Advantage offer policies for diabetes, heart or blood pressure conditions. Such policies generally have a higher acceptance ratio for those conditions and lower the PED for that condition. Aditya Birla’s PTCA (Percutaneous Transluminal Coronary Angioplasty) policy for instance costs ₹88,000 and no PED for PTCA. The nil waiting period and high acceptance in those conditions are the reason for the elevated premiums.
Value policies
No frills policies with low cost of premium are also on offer. But policyholder must understand that beyond low frill’s (no restoration or NCB and twin sharing room or lower room), these policies also include either a copay or a deductible. Most other policies have zero copay compared to few years back when 10-20 per cent copay was a given in senior health insurance. But to lower premium, Star Health’s Senior Citizen Red Carpet or Niva Bupa’s Senior First Gold offer 30 and 50 per cent copay respectively. This implies that 30 or 50 per cent of the medical bill must be met by the policyholder and only then will the claim be admitted. This can be financially constraining in high value procedures which costs ₹10-20 lakh or more. ₹3-6 lakhs has to borne from out of pocket to access health insurance. A ₹2 lakh deductible option offered in Tata AIG Medicare plus is comparatively better as the amount is fixed per year. That means that on meeting ₹2 lakhs from pocket in a year, the health insurance can be accessed for any number of claims.
A copay or a deductible can be useful for a secondary policy with the contribution from the primary policy meeting the initial payment. But in other cases, the low cost of health insurance (average of ₹17,000 for the three) has to be carefully assessed.
OPD and others
Out patient consultation (OPD) cover is in high demand and most of the policies provide OPD cover only as a rider. Manipal Cigna’s Prime Advantage offers ₹20,000 OPD cover in the base policy itself. It also offers E-consultation and so do ICICI Lombard Max Protect and Niva Bupa’s Max Saver.
Worldwide cover is offered in Tata AIG Medicare base policy and as a rider in Manipal Cigna’s Lifetime policy. But the diagnosis must be made in India for treatment to be received outside of India.
These are few of the variants and services offered in senior health insurance marketplace. Prospective policyholders in the silver years without a medical cover should not be on the sidelines when the regulator and the industry have provided such enhanced features.
Key aspects
Options for value, OPD consultations, coverage, worldwide travel
No frills policies with low cost of premium are also on offer
Rejection, a key concern, specifically addressed with a few policies advocating guaranteed coverage without hassle
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Published on March 29, 2025
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