Health Insurance 3061 views October 9, 2020

National Senior Citizen Mediclaim Policy

Everyone knows that health risks increases as individuals enter into their sixties. The body becomes less immune and the illness caught them easily. Therefore it is better to secure your health with an insurance plan. You can go for the National Senior Citizen Mediclaim Policy that is specially introduced for the individuals having the age of 60 years and above. You can take this plan for your family members as well who are at the age of 60 and above. This plan covers hospitalization expenses and ambulance expenses as well. You have the option to add more benefits to this plan but the premium will increase. So, you must explore the main features of this health plan.

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Key Features of Senior Citizen Mediclaim Policy

  1. This plan covers the expenses related to hospitalization.
  2. Only Senior Citizens are allowed to take this plan.
  3. Expense for the Cataract Treatment is also covered in this plan.
  4. You will also get a cover for the Domiciliary Expenses.
  5. You can renew this policy throughout your life.
  6. This policy needs a pre-health check-up before you buy it.
  7. Get Tax Deductions under Section 80D of the Income Tax Act 1961.

Benefits of Senior Citizen Mediclaim Plan

The benefits of this policy are divided into two sections. In the first section, you will get all the benefits but in the second section, the benefits are optional. You can add them as per your requirement.

Benefits of Section 1

  1. Get Hospitalization and Domiciliary Hospitalization Cover with a maximum of up to Rs.1 Lac.
  2. The treatment of the cataract illness is covered up to Rs.10000.
  3. Treatment of the Benign Prostatic Hyperplasia is covered up to Rs.20000.
  4. Get Domiciliary Expenses cover of up to 20% of the Sum Assured.
  5. Ambulance charges are also covered in this health insurance plan.
  6. If you don’t make any claim in a year then the company will increase the value of the Sum Assured by 5% until it reaches 50% of the Sum Assured.
  7. You have the option to renew this policy lifelong.
  8. You will get a discount of 5% on the renewal premium if the last year is claim-free.
  9. There will be tax rebates as per the tax laws.

Exclusions in Section 1

  1. The company will pay only accidental claims during the first 30 days from the date of inception of the policy.
  2. There is a waiting period of 12 months for all the pre-existing disease.
  3. Co-payment is needed as per the policy terms for any claim except for the claim of Cataract and BHP.
  4. HIV, AIDS, STD, Infertility, Sterility, Maternity, and Assisted Conception are not covered in the National Senior Citizen Mediclaim Policy.
  5. Intentional and Self-Inflicted Injuries are not covered.
  6. Cosmetic and Plastic Surgery Expenses are not covered.
  7. There will be no reimbursement for the Out Patient Department Treatment and Dental Treatments.

Optional Benefits in Section 2

There are some optional benefits that you can add to this plan in order to increase your coverage. You can explore all of them below and you can add them to the plan as per
your requirement.

  1. Critical Illness cover for up to 8 different critical illnesses.
  2. You can have a maximum Sum Assured of up to Rs.2 Lacs only.

Exclusions in Section 2

  1. There is a waiting period of 90 days if you are availing this benefit.
  2. There is a waiting period of 90 days for pre-existing illnesses.
  3. You are allowed to make only one claim during the policy period for the critical illness.
  4. Once the payment of the claim is made to the insured, the policy will be terminated and no further reimbursement will be made for future critical illnesses.
  5. Critical illness arising due to Non-Prescribed Drugs, Drug Addiction and Smoking, Suicide, HIV, AIDS, Radioactivity, and War Groups are not covered in this option.

Pre Health Check-up

You will have to go through a Pre Medical Check-up if you are taking this policy for the first time. There is no need for any medical check-up if you are already insured with the health plan in the preceding three years. You can see the list of tests required before you are taking this plan and the terms and conditions.

  1. Physical Examination and the reports have to be signed by the doctor with a minimum of MD qualification.
  2. Blood Sugar fasting and postprandial
  3. Urine Routine Check-up and Microscopic Examination.
  4. ECHO Cardiograph
  5. Eye Check-up and it must include Retinoscopy
  6. The date of all the reports must not exceed 30 days from the date of the proposal.
  7. The company will reimburse 50% of the expenses incurred for a pre-health check-up if the proposal is accepted.

Eligibility Criteria of National Senior Citizen Mediclaim Policy

Minimum Age of Entry60 Years
Maximum Age of Entry80 Years
Expenses Covered during Hospitalization· Room’s Rent
· ICU Charges
· Medical Practitioner Fee
· Surgeon’s Fee
· Anaesthetist Fee
· Consultant Fees
· Specialist Fees
Deductions as per Tax LawsAllowed

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