10 New Health Insurance Rules for Senior Citizens

Latest Health Insurance Rules for Senior Citizens

Considering the health needs of senior citizens, the Insurance Regulatory and Development Authority of India (IRDAI) revised the existing health insurance guidelines. The new guidelines, effective from April 1, 2024, aim to make it easier for senior citizens to secure the medical coverage they need in their golden years. Check out the new health insurance rules for senior citizens below:

1. Upper Age Limit Reference for Buying Health Insurance Removed

   The IRDAI has removed the maximum entry age reference of 65 years across health insurance policies. This step especially benefits senior citizens over the age of 65 years, who so far had limited options to buy medical insurance. With the new guidelines in place, senior citizens can buy mediclaim insurance at any age.

2. Free Health Coverage Under Ayushman Bharat for Seniors Aged 70+

   Senior citizens above 70 years can now avail free health insurance coverage under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), regardless of their financial background. This expansion, effective from September 11, 2024, benefits approximately 6 crore elderly people by providing free health insurance coverage of ₹5 lakh per family per year for surgeries and complex procedures.

3. No Rejection for Severe Medical Conditions

   In a ground-breaking move by IRDAI, health insurance companies are now prohibited from rejecting mediclaim policy applications from people with severe medical conditions, including renal failure, cancer, heart disease, and AIDS. This allows senior citizens with such pre-existing conditions to buy medical insurance without the fear of denial.

4. Pre-existing Diseases (PED) Waiting Period Cut to 3 Years

   The maximum waiting period for covering pre-existing diseases has now been reduced from 4 years to 3 years. This move largely benefits senior citizens as they are more prone to age-related health conditions like degenerative joint diseases, liver or kidney issues, diabetes, hypertension, etc. With the new rules, elderly people no longer have to wait for 4 years and can claim their PED expenses after 3 years of buying the policy.

5. Dedicated Support Channels for Senior Citizens

   To make health insurance claims more streamlined for senior citizens and resolve their grievances on time, IRDAI has directed insurance companies to create dedicated support channels for senior citizens. This would include a special helpline number or customer service teams that specifically cater to the health needs of elderly customers. In fact, insurance companies need to clearly inform their customers about these support channels on their official website if they are not already in place.

6. Tailored Insurance Products for Senior Citizens

   The insurance regulator has encouraged health insurance providers to design customised products specifically for senior citizens. This allows senior citizens to have ample insurance options and pick the one that meets the unique health needs of their golden years.

7. Shorter Waiting Period for Specific Diseases/Procedures

   According to IRDAI, the waiting period for specific diseases/procedures, such as knee replacement surgery, varicose veins, etc., has been shortened from 4 years to 3 years. This reduced waiting period is highly beneficial for senior citizens who may need to undergo such treatments and procedures, as they can now claim these medical expenses after 3 years of buying the policy.

8. Sub-Limits on AYUSH Treatments Removed

   AYUSH treatments, i.e. Ayurveda, Yoga, Naturopathy, Siddha, Unani, and Homeopathy, are now covered under health insurance policies without any sub-limits. This is especially beneficial for senior citizens who prefer alternative treatments but had a limit to the maximum amount they could claim. With the new IRDAI rules, senior citizens can now claim AYUSH treatment costs up to the sum insured limit.

9. Moratorium Period Drops to 5 Years

   The IRDAI has shortened the moratorium period from 8 years to 5 years. With this rule, senior citizens cannot be denied any claim covered by their policy after 5 continuous renewals, except in cases of fraud. This change makes health insurance more reliable for long-term policyholders.

10. Multiple Insurer Claims

    The new IRDAI rules allow policyholders, including senior citizens, with benefit-based policies to file multiple health insurance claims across insurers. This move offers better flexibility to senior citizens as they can raise more than one claim when dealing with a major illness.

Wrapping It Up

The new senior citizen health insurance guidelines of 2024 mark a significant step toward making healthcare more inclusive for senior citizens in India. By removing age limits, reducing waiting periods, and providing specialised support, the IRDAI make it easier for elderly people to secure the coverage they need without the hurdles that previously existed. In short, the new health insurance rules enable senior citizens to buy what they want, when they want and claim what they need.