Senior Citizen Health Insurance

No Waiting Period (under ACKO Platinum Plans): Under the ACKO Platinum Health Plans, you are free to claim from the first date of your health insurance plan. Different types of waiting periods like initial, pre-existing diseases, specific illness, etc. do not apply if you disclose all your medical history upfront.

100% Claim amount: Usually, there are multiple types of deductions in the claim amount and often the policyholder needs to pay out of pocket. However, under ACKO Standard and Platinum Health Plans you get the full claim amount with absolutely no deductions.

Multiple built-in Add-ons: We have added multiple useful add-ons like Doctor On-call, Room Rent Waiver, and Waiver of Non-medical Expenses to ACKO Health Plans. You don’t have to go through the hassle of adding them separately while buying the plan.

Secure Customer Data: Your personal and medical information is safe with us. At ACKO, we use advanced security protocols and encrypted systems to ensure that your data stays protected. Whether you're buying a policy or filing a claim, you can trust us to keep your details private and secure at every step.

Easy Claim Process on the ACKO App: Raising a claim against your health insurance plan from the ACKO app is quick and simple. You can initiate and also track your claim directly from the app, no paperwork or lengthy procedures required. Simply upload the relevant documents, and we will take care of the rest. It’s a completely digital, hassle-free process designed to save you time and effort during stressful situations.

Helps with instant treatment: You don't have to wait for the treatment to begin. You can even opt for cashless hospitalisation of your are running low on funds.

Can cover Critical Illnesses: Some health plans offer coverage for listed Critical Illnesses. Just ensure that you have this coverage while buying the plan.

Free health check-up: You can get access to free health check-ups every year under a health plan.

Peace of Mind for the Family: Senior Citizen Health Insurance removes the financial worry so seniors can focus on getting better.

Hospitalisation Costs: It helps pay for expenses like room rent, doctor's fees, and medicines during hospital stays.
Pre and Post Hospitalisation: It covers medical expenses a little before and after hospitalisation, like tests or follow-up treatments.

Day Care Procedures: Some plans cover treatments that don't require overnight hospitalisation.

Ambulance Charges: It pays for ambulance services during emergencies.

Domiciliary Care: If a senior citizen can't go to the hospital, it covers treatment at home.

Pre-Existing Conditions: After a waiting period, it may cover existing health issues.

Critical Illness: Some plans cover specific severe illnesses when you buy the critical illness add-on.

Cashless Hospitalisation: You don't have to pay upfront; the insurance company settles the bill directly with the hospital.

Waiting Period: There might be a waiting period before certain conditions are covered.

Specific Treatment Limits: Some plans may have limits on particular treatments or room rents.

Alternative Therapies: Some alternative or experimental treatments may not be covered.

Dental and Vision: Many plans exclude dental and vision care unless required as a result of an accident.

Routine Check-ups: Regular check-ups or preventive care might not be covered.

Certain Medications: Expensive or non-generic medicines may not be fully covered.

Non-Medical Expenses: Costs like transportation or non-medical amenities may not be covered.

Day Care Treatments: Many modern treatments like dialysis, chemotherapy, and radiotherapy can be done without 24-hour hospitalisation. Choose a senior citizen health plan that covers such day care procedures for faster claims and better benefits.

Coverage Amount: Look for a plan that offers enough coverage for medical expenses, like hospitalisation and treatments.

Pre-existing Conditions: Check if the plan covers pre-existing health conditions, as many seniors may have them.

Network Hospitals: Ensure the insurance company has tie-ups with good hospitals in your area for cashless treatments.

Copay and Deductibles: Understand co-payments (your share of expenses) and deductibles (initial costs you pay) and choose what fits your budget.

Room Rent Limit: Look for policies with a higher or no cap on room rent to avoid out-of-pocket expenses during hospital stays.

Renewal Age: Opt for a plan with a high renewal age, so you're covered for a longer time.

Premiums: Compare premiums from different insurers to find an affordable one

Waiting Periods: Be aware of waiting periods for pre-existing illnesses and try to choose plans with shorter waiting periods.

Additional Benefits: Look for plans that offer benefits like ambulance cover, domiciliary treatment, and critical illness coverage.

Notification of Claim: The process begins with the insured or their family notifying the insurance company about the hospitalisation or medical treatment. This notification should be made as soon as possible to avoid any delays in claim processing.

Approval or Rejection: Based on the verification, the insurance company either approves or rejects the claim. If approved, the insurance company will settle the hospital bill directly with them. You may just have to bear nominal charges.

Notification of Claim: The process starts with the insured or their family informing the insurance company about hospitalisation or medical treatment. This notification should be made as early as possible to avoid any claim processing delays.

Document Submission: Upon notification, the insurance company will provide a list of documents required for claim processing. These typically include:

Approval or Rejection: Based on the verification, the insurance company either approves or rejects the claim. If approved, the insured or their family will receive the claim amount as per the policy's coverage.

Settlement Timeframe: The Insurance Regulatory and Development Authority of India (IRDAI) mandates that insurance companies settle health insurance claims within 30 days of receiving all necessary documents. In case of delays, the insurer is liable to pay interest on the claim amount.

For parents below 60 years of age: Up to ₹25,000 per year.

For parents aged 60 and above (senior citizens): Up to ₹50,000 per year.

The premium must be paid using a mode other than cash to claim the deduction. The deduction is available only for premiums paid for health insurance policies and not for life insurance policies.

The total deduction limit for senior citizens' health insurance is inclusive of the premiums paid for both individual and family health insurance policies.

To avail of these tax benefits, senior citizens need to maintain proper records of premium payments and provide relevant documents when filing their income tax returns.

Sum Insured: The sum insured is the highest amount that an insurance company will pay for claims during the policy period. If your medical expenses are more than this amount, you will have to pay for the extra charges yourself. Common sum insured options are Rs. 5 lakh, Rs. 10 Lakh, Rs. 25 lakh, etc.

Inclusions: Inclusions refer to the set of medical services, treatments, and conditions that are included in a health insurance policy. Common inclusions include:

• Hospitalisation expenses

• Daycare treatments

• Pre and post-hospitalization bills

• Ambulance costs

Exclusions: Exclusions are the specific conditions or treatments which are not covered by the health insurance policy. Common exclusions include:

• Pre-existing diseases (usually for 2-3 years)

• Cosmetic surgeries and Dental treatments (unless due to accidental injury)

• Self-inflicted injuries

• Substance abuse-related treatments

• Experimental treatments

Critical Illness Coverage: The critical illness coverage is a supplement to the health insurance policy which can be added as an extra benefit or rider. It is a one-time cash payment given to the recipient if he/she is diagnosed with a specified serious illness, for instance, cancer, heart attack, stroke, or kidney failure. This coverage is for the treatment of critical illnesses and thus, it helps in the management of the high costs that are related to the treatment. Also, it provides financial support during the recovery period.

Pre-Existing Diseases: The pre-existing diseases are the medical conditions or illnesses that the policyholder had before buying the health insurance policy. Insurers usually have a waiting period during which they do not cover the treatments of these conditions. The waiting period can be from 2 to 3 years, after which the conditions may be covered depending on the policy terms.

Cashless Health Insurance policy for senior citizens: Cashless mediclaim policy for senior citizens enables them to get the treatment at network hospitals without having to pay the money upfront. The insurance company directly pays the bill to the hospital. This reduces the pressure of having to arrange money in case of medical emergencies. To use the cashless services, the insured has to be admitted to one of the insurer's network hospitals and follow the claim process specified by the insurer.

Has a strong network of hospitals: Choose an insurance company that has a high number of network hospitals. These help you to get cashless treatment in case of an emergency.

Has a high claim settlement ratio: An insurance company with a high claim settlement ratio is deemed more likely to settle your claim instead of rejecting it.

Has an active customer support: The insurance company must provide instant assistance so that you can get your queries answered faster in case you are in an emergency situation.

Offers additional benefits: Choose an insurance company that offers additional benefits like full claim amount, less waiting, no capping on room rents, etc.

Research and Compare Policies: Before making any decisions, it's essential to research and compare different insurance policies available for senior citizens. Look for policies that offer comprehensive coverage, including hospitalisation, pre-existing conditions, and critical illness coverage. Take into consideration factors like premium costs and coverage limits.

Assess Your Health Needs: Evaluate your health needs and those of your spouse if applicable. Consider any pre-existing medical conditions, as these can significantly impact your choice of policy. Some policies offer coverage for pre-existing conditions after a waiting period, so be sure to check the terms and conditions.

Calculate Premiums: Based on your age, medical history, and coverage requirements, calculate the premiums for the shortlisted policies. Keep in mind that premiums tend to increase with age, so choose a policy that is sustainable in the long run.

Check Network Hospitals: Ensure that the insurance policy you select has tie-ups with hospitals and healthcare providers in your vicinity. This will ensure easy cashless hospitalisation and a hassle-free claims process.

Understand the Waiting Period: Most senior citizen health insurance policies have a waiting period for specific illnesses. Make sure you understand these waiting periods and choose a policy that aligns with your medical needs.

Fill Out the Application Form: Once you've selected a policy, fill out the application form accurately and honestly. Any discrepancies in the information provided can lead to claim rejections in the future.

Medical Check-up: Depending on your age and the policy, you may be required to undergo a medical check-up. This helps the insurance company assess your health status and determine the premium.

Review the Policy Document: Carefully read and review the policy document, paying special attention to the terms and conditions, coverage limits, and exclusions. Seek clarification from the insurance company if you have any doubts.

Make the Payment: After reviewing and accepting the policy terms, make the premium payment. Ensure that you pay your premiums on time to keep the policy active.

Receive Policy Documents: Once the payment is processed, you will receive the policy documents. Store them in a safe place and make digital copies for easy access.

Renew Your Policy: Senior citizen health insurance policies need regular renewal. Make sure to renew your policy before it expires to maintain continuous coverage.

File Claims Promptly: In case of a medical emergency, notify the insurance company and file a claim promptly. Follow the claim process as per the guidelines mentioned in the policy document.

Keep Records: Maintain detailed records of all medical expenses, hospitalisation, and communication with the insurance company. This will be invaluable during the claims process.

Visit your State Government's Social Welfare Department website

Look for the section on Senior Citizen ID Cards, Elderly Welfare, or Old Age Benefits

Register/login with your basic details

Fill out the online application form

Upload scanned documents (age proof, address proof, photo)

Submit and note your application reference number