Senior Citizen Health Insurance Policy

Who can take the Policy?
The Policy can be taken by a Senior Citizen who is above 60 years of age for covering himself/ herself and his/her spouse.

Eligibility
The following conditions shall apply for seeking coverage under the Policy

You must be above 60 years of age on last birthday for taking a policy.
Must be a permanent resident of India
Maximum entry age under the Policy for you and your spouse is restricted to 70 years. The renewals under the Policy shall, however, be provided for lifetime.

Medical Examination
We may ask You or Your spouse (if proposed for insurance under the Policy) to undergo below mentioned medical tests for purpose of consideration of Your proposal


It is agreed and understood that details in the table above, including the list of medical tests is indicative and we reserve the right to add, to modify or amend these details.

If your proposal is accepted by us, then 50% of the costs incurred in conducting the above mentioned medical tests shall be reimbursed by Us.

We may waive Medical Examination for You or Your spouse under the Policy

If You or Your spouse have been continuously covered under a health insurance policy from Us or any other insurers for a period of three years and have had no claims under the policy

You shall immediately notify us in writing of any material change in the risk and cause at your own expense .If there is change in the your health status known to you, you shall intimate about the same to us

What is covered under the Policy?
The Policy comprises of below two sections

Section A- Hospitalization
This Section is mandatory to be taken under the Policy.
The following benefits shall become payable under this section. The cover shall be available to both the Insured and his/ her spouse if covered under the Policy.

Benefits under Section A
Inpatient Treatment:- The Policy shall cover you for expenses incurred subject to limits as per below for each and every day of hospitalization under the policy.


Day Care Procedures/ Surgeries:- Specified Procedures / Surgeries requiring less than 24 hours of hospitalization would be covered under the Policy.

Pre- Hospitalization:- Relevant medical expenses incurred 30 days prior to your being hospitalized shall be covered under the Policy.

Post-Hospitalization:- Relevant medical expenses incurred 60 days after your being discharged from hospital shall be covered under the Policy.

Domiciliary Hospitalization:- expenses incurred on availing medical treatment at home which otherwise would have required hospitalization .The Sum Insured under this benefit shall be limited to 50% of SI or the actual amount incurred whichever is less under the Policy.

Cost of Health Check-up:- the charges incurred for medical check-up once in a block of every 3 claims free years up to 1.25% of the average Sum Insured or the actual amount incurred whichever is less. In case of floater policies, the limit of 1.25% shall be for the two family members covered under the Policy.

Daily Allowance:- 0.1% of Sum Insured or Rs 250 whichever is less, as a Daily Allowance, for each continuous and completed period of 24 hours of Hospitalization subject to a maximum of Rs 2500 shall be covered under the Policy.

Ambulance Charges:- Ambulance charges incurred for engaging an ambulance for transferring yourself to a hospital to the extent of 1% of SI or Rs. 1500 or the actual amount incurred in such transportation shall be payable under the Policy.

Expenses of accompanying person:- Expenses incurred up to 1% of Sum Insured or the actual amount incurred whichever is less for the person accompanying you shall be payable under the policy.



For the purpose of applicability of the said sub-limits, multiple Hospitalizations pertaining to the same Illness or medical procedure surgery occurring within a period of 45 days from the date of discharge of the first Hospitalization shall be considered as one Hospitalization.

No other sublimit for any major surgery or procedure other than the ones mentioned above shall be applicable under the policy.

Section B- Critical Illness (Optional)
You also have the option of covering listed Critical Illnesses and/ or Surgical Procedures under the Policy.

On diagnosis or undergoing of below mentioned Critical Illness or Surgical Procedure, the Sum Insured opted under this section shall become payable under the Policy. The Sum Insured under this section shall be in addition to hospitalization sum insured.

Cancer of specified severity
Open Chest CABG
Kidney Failure requiring regular dialysis
Stroke resulting in permanent symptoms
Major Organ /Bone Marrow Transplant
Multiple Sclerosis with persisting symptoms
Provided that, we will not cover

1. Any Illness, sickness or disease , other than the above specified Critical Illness.

Any Critical Illness of which, the signs or symptoms first occurred prior to or within Ninety (90) days following the Policy Issue Date unless due credit for such time bound exclusion has been accrued in previous similar health insurance policy from us or any of Indian insurers.

Any Critical Illness based on a diagnosis made by you or your immediate family member or anyone who is living in the same household as you or by a herbalists, acupuncturist or other non-traditional health care provider.

Extensions/ Endorsement under the Policy

Floater Benefit: With this extension, the Sum Insured under the mandatory section A- Hospitalization shall be available on floater basis.

Additional Benefits under the Policy

1. Cumulative Bonus
Subject to no claims and continuous renewal of the Policy with us, the Sum Insured under the Policy under Section A Hospitalization shall be increased by 5% subject to maximum of 10 such non claim years.

In case of claim under this section, the increased percentage will be reduced by 5% of sum insured at the next renewal. However, basic sum insured will be maintained and will not be reduced. Cumulative Bonus incurred in previous health insurance policies held by you with us or any of the Indian Insurers shall be allowed to be carried forward to this Policy.

2. Long Term Policy: Policy terms 1 year to 3 years are available under the policy. The following discounts will be offered if the Policy is taken by paying the appropriate premium for 2 years/ 3 years at once. No installment facility is available for payment of premium under the Policy.
Duration of policy - Premium to be charged
2 years - 2 year premium in advance less 10% discount
3 years - 3 year premium in advance less 15% discount

3. Family discount: A family discount of 10% shall be applicable on hospitalization premium when you opt for covering your spouse under the policy on individual Sum Insured basis. This discount shall not be applicable when your Spouse is covered under the Policy on Floater Sum Insured basis.

4. Sum Insureds Options: The Policy provides Sum Insured starting from 1 Lakh to 5 Lakhs Rupees for each section Hospitalization and Critical Illness.

5. Portability
1. If You were insured continuously and without a break under another Indian retail health insurance policy with Us or any other Indian General Insurance company, it is understood and agreed that:

If You wish to exercise the Portability Benefit, We should have received Your application with complete documentation at least 45 days before the expiry of Your present period of insurance;

This benefit is available only at the time of renewal of the existing health insurance policy.

The Portability Benefit shall be applied subject to the following:

Your proposal shall be subject to Our medical underwriting

We reserve the right to modify or amend the terms and the applicability of the Portability Benefit in accordance with the provisions of the regulations and guidance issued by the Insurance Regulatory and Development Authority as amended from time to time

6. Free Look up Period:
1. We shall provide you a free look period under the policy. The free look period shall be applicable at the inception of the policy and:

You will be allowed a period of at least 15 days from the date of receipt of the Policy to review the terms and conditions of the Policy and to return the same if not acceptable

2. If You have not made any claim during the free look period, You shall be entitled to
A refund of the premium paid less any expenses incurred by Us on Your medical examination and the stamp duty charges or;

where the risk has already commenced and the option of return of the policy is exercised by You, a deduction towards the proportionate risk premium for period on cover or;

Where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such period

7. Conditions under the Policy

1. You can opt for any Sum Insured under both the sections of the Policy, in other words, the Sum Insured under both the sections need not be identical.

2. You may choose to cover your spouse under individual Sum Insured basis or on floater basis. When you choose to cover your spouse under the Policy on individual SI under the Policy, we shall provide you a discount of 10% on your total hospitalization premium.

2. Co-pay

Co-Payment means a cost-sharing requirement applicable under this Policy in which you shall bear the percentage of the admissible claim amount which is specified in the table below. A Co-Payment does not reduce or otherwise affect the Sum Insured. This is applicable for all roll-over cases (cases of portability) as well.



This policy shall ordinarily be renewable for lifetime except on grounds of fraud, moral hazard or misrepresentation or non-cooperation by you

Renewal of the policy sought by you shall not be denied arbitrarily. If denied, we shall provide you with cogent reasons for such denial of renewal.

We also agree that We shall not deny the renewal of the policy on the ground that you made a claim or claims in the previous or earlier years except for Section B- Critical Illness where the cover under the section, if available, shall terminate for the Insured Person on whose behalf We have admitted and paid claim under the Section. The Policy for hospitalization for you and your spouse, if covered, shall however continue to exist.

We shall provide for a mechanism to condone a delay in renewal up to 30 days from the due date of renewal without deeming such condonation as a break in policy. However coverage shall not be available for such period.

Premium of the Policy may be revised subject to approval from IRDA. We also agree that no loading on premium shall be applicable on your individual claims experience basis.

What is not covered under the Policy?
Investigation & Evaluation
Rest Cure, Rehabilitation and Respite Care
Obesity/ Weight Control
Change-of-Gender Treatments
Cosmetic or plastic Surgery
Hazardous or Adventure sports
Breach of law
Excluded Providers
Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.
Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.
Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure
Refractive Error
Unproven Treatments
Sterility and Infertility
Maternity Expenses