Page 161 - IC38 GENERAL INSURANCE

E. Senior citizen policy

These plans are designed to offer cover to elderly people who often were
denied coverage after certain age (e.g. people over 60 years of age). The
structure of the coverage and exclusions are much like a hospitalization policy.
Special attention is paid to diseases of the elderly in setting coverage and
waiting period. Entry age is mostly after 60 years and renewable lifelong. Sum
insured range from Rs. 50,000 to Rs. 5,00,000. There is variation of waiting
period applicable to certain ailments. Example: Cataract may have 1 year
waiting for one insurer and 2 year waiting period for some other insurer.
Also certain ailments may not have waiting period for a particular insurer where
as another may have. Example: Sinusitis does not fall in waiting period clause of
some insurers but few others include it in their waiting period clause.
Pre-existing disease has either a waiting period or capping in some policies. Pre-
post hospital expenses are either paid as a percentage of hospital claims or a
sub limit whichever is higher. In some policies they follow the typical indemnity
plans such as expenses falling within specified period of 30/60 days or 60/90
days.
IRDAI has mandated special provisions for insured persons who are Senior
Citizens:

1. The premium charged for health insurance products offered to senior
citizens shall be fair, justified, transparent and duly disclosed upfront.

2. The insured shall be informed in writing of any underwriting loading
charged over and above the premium and the specific consent of the
policyholder for such loadings shall be obtained before issuance of a
policy.

3. All health insurers and TPAs shall establish a separate channel to address
the health insurance related claims and grievances of senior citizens.

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