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Difference Between Senior Citizen and Family Health Insurance Plans

Team AckoJan 17, 2024

As a single health insurance plan can cover multiple family members, it can get confusing whether to buy a Senior Citizen plan or include the elderly in the Family-floater policy. The confusion can lead you to buy insufficient coverage and increase your out-of-pocket expenses in case of medical issues. This article will help you understand the difference between Senior Citizen and Family health plans. This will help you to figure out the type of plan suitable for your senior citizen parents.

Contents

What is the difference between Senior Citizens and Family Health Insurance?
- Benefits of buying a Senior citizen and a Family-floater health plan health insurance plan
Inclusions of Senior Citizen vs Family Health Plans
Exclusions of Senior Citizen vs Family Health Plans
What is the claim settlement process for Senior Citizens and Family Health Insurance?
Takeaway
Frequently asked questions

What are Senior Citizen and Family-floater plans?

Senior Citizen and Family-floater plans are types of health insurance policies that offer specific insurance coverage to the insured members. People above the age of 60 years are eligible to get insured under a Senior Citizen plan. The premium and sum insured are both on the higher side due to a high chance of medical issues and claims in elderly people.

You can insure immediate family members under the Family health insurance plan with health insurance. This plan insures your parents, children, spouse, or in some cases, even your parents-in-law.

What is the difference between Senior Citizens and Family Health Insurance?

The requirements of the elderly are different from younger family members when it comes to health insurance. Let’s understand the difference between Senior Citizens vs Family Health Insurance with the help of the following table.

Parameters	Senior Citizens Health Insurance	Family Health Insurance
Coverage	Provides health coverage to senior citizens i.e., people aged 60 years and above.	Covers family members including children, spouse, and parents (or parents-in-law) under health insurance
Entry age	People below the age of 60 years cannot be a part of this plan.	People of all ages can be a part of a Family-floater plan (dependent children are covered up to the age of 25 years, depending on the policy).
Eligibility	Eligibility criteria depend upon the insurance company. However, the person must be a senior citizen aged 60 years or above and must furnish basic documentation like KYC, address proof, etc.	Any person who wishes to cover the unforeseen medical expenses can avail family health insurance policy for himself and his family. Most companies provide an entry age of 18 years for the primary insured. For dependents, age criteria vary as per the terms of the policy.
Tax benefits	Under section 80D of the Income Tax Act, 1961, a deduction of up to Rs. 50,000 paid as a premium can be availed (these figures are subject to change).	Under section 80D of the Income Tax Act, 1961, a deduction of Rs. 25,000 for the premium paid to cover self, spouse, and dependent children and a deduction of Rs. 50,000 for senior citizen parents can be availed by the policyholder (these figures are subject to change).

Benefits of buying a Senior citizen and a Family-floater health plan health insurance plan

Here is a list of benefits of buying a Senior citizen and a Family-floater health plan health insurance plan over the family health policy.

Senior citizen plan	Family-floater health plan
Option of lifetime renewability for senior citizens health policy (as per terms).	The entry age is as less as 91 days, i.e. coverage for a newborn baby.
The waiting period for senior citizen health insurance is less as compared to the family-floater policies.	Lower co-payment condition as compared to Senior citizen insurance.
Regular preventive health checkups for early detection of any disease.	Peace of mind, especially when you comprehensively cover medical risks.
Easy access to daycare treatments and checkups.	The sum insured is shared on a floater basis that allows each family member (including senior citizens) to get full access to it.

Inclusions of Senior Citizen vs Family Health Plans

Inclusions are coverages of a health plan.

Senior citizen plan

Family-floater health plan

Hospitalisation expenses including room rent, operation theatre rent, doctor’s visit, nursing charges, etc, ICU charges, Pre and post hospitalisation expenses as per the terms of the policy, Ambulance charges for transportation of the patient, Preventive health checkups to detect early signs of any disease, Fees for the second opinion taken from another doctor, Domiciliary cover for treatments done at home., Daycare treatment for cases that do not require hospitalisation for more than 24 hours, Other coverage depending upon the terms and conditions of the policy.

Room rent charges, nursing charges, operation theatre charges, doctor’s visits, ICU charges, AYUSH treatment includes Ayurveda, Yoga, Unani, Siddha, and Homeopathy, Daycare treatment for cases not requiring hospitalisation exceeding 24 hours, Ambulance Charges for transportation of the patients as per the terms of the policy, Daily hospitalisation cash benefit

Note that coverages may vary as per the terms of the policy.

Exclusions of Senior Citizen vs Family Health Plans

Exclusions are conditions that are not covered under a health insurance plan.

Senior citizen plan

Family-floater health plan

Injuries due to human warfare, Cosmetic surgeries (unless medically required), Medical treatment is required due to any adventurous sport, Gender transformation, Dental treatment (unless required as a result of an accident), Unproven treatments or experimental therapies, Intentional injuries (like self-harm or suicide attempt), Sexually Transmitted Diseases or Venereal Diseases, Other exclusions as per the terms of the policy

Claims were raised during the waiting period, especially for pre-existing diseases, Injuries caused due to any adventurous sport, Dental treatment (unless specifically included due to any reason), Intentional injuries, Cosmetic surgeries, Unproven treatments, Injuries due to human warfare, Other exclusions as per the terms of the policy

Read through the insurance policy or contact your insurance company to know more information about the exclusions of your policy.

What is the claim settlement process for Senior Citizens and Family Health Insurance?

The claim settlement process is similar for both types of health insurance plans. Claim settlement type depends upon when or who pays for the incurred expenses during treatment. Claim settlement can be done in either of the two ways.

Reimbursement claim: Firstly, you will have to pay the entire expenses and then can claim reimbursement from the insurance company as per the policy terms.
Cashless claim: For treatments taken from the network hospitals of the insurance company, the insured person only has to pay the deductible amount, and the remaining portion of the claim amount will directly be taken care of by the insurance company.

Takeaway

Senior citizens and Family Health plans both provide good health insurance coverage. However, if you are looking to insure senior citizens under health insurance then consider buying a separate policy i.e. a Senior Citizen plan as they are more prone to specific old age diseases that may not be covered under a Family Health plan.

Age criteria for family health insurance may pose another hurdle for senior citizen coverage. Therefore, it is necessary to provide adequate cover to senior citizens for their policy requirements through a Senior Citizen health insurance plan.

Frequently asked questions

Here is a list of common questions related to Senior Citizen and Family-floater health insurance plans. You can write to us at [email protected] in case of more queries.

Are there any restrictions regarding diseases for senior citizens in health insurance?

Diseases restricted for senior citizens health insurance depend upon the terms of the insurance company.

Why do senior citizens require health insurance coverage?

Senior citizens are more prone to health-related issues like heart ailments, cancer, and chronic diseases like diabetes. Also, old age invites several diseases. Therefore, it becomes of utmost importance to have insurance coverage for senior citizens.

Which are the primary things to check while buying senior citizen health insurance?

Primary things to check include -

Maximum entry age
Various benefits that are provided, including the waiting period
Co-payment clause
Premium charged and diseases covered
Renewal options, whether lifetime or till a specific age

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.