Government Senior Citizen Health Insurance Schemes

Government Health Insurance for Senior Citizens

India’s soaring medical inflation can pose a financial threat to senior citizens. Due to an increase in overall prices, access to quality medical care might be limited. To bridge this gap, the Government of India has introduced several medical insurance schemes that provide affordable and comprehensive coverage to older people. These schemes reduce out-of-pocket expenses and ensure necessary medical treatments for senior citizens without financial strain. Let us explore the various government health insurance schemes for senior citizens in India.

Key Facts

As per IRDAI guidelines, an individual must be 65 years or older to avail of a senior citizen government scheme. Additionally, insurers must offer clear reasons for any senior citizen application denial, with rejections limited to only fraudulent cases.

List of Government Health Insurance Schemes for Senior Citizens

Let us take a look at some government health policies for senior citizens.

1. Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

   Launched in the year 2017 to fulfill the goal of 'Insurance for everyone by 2047', it is a flagship scheme by the Government of India. In a significant development, the Union Cabinet announced health coverage of up to INR 5 Lakhs to all senior citizens above 70 years under PMJAY, regardless of their income.

   Features

   • Sum insured of up to INR 5 Lakh per family.
   • Socio-economic background is not a criterion.
   • Covers senior citizens with private health insurance policies or the Employees’ State Insurance Scheme.

2. Central Government Health Scheme (CGHS)

   A government health scheme designed to offer healthcare services to central government employees and their dependent family members. The scheme also covers pensioners along with their family members post-retirement.

   Features

   • Treatments are available at all CGHS-empaneled hospitals and medical centers.
   • OPD consultations are covered under the CGHS scheme.
   • Diagnostic tests are provided free of charge to people covered under the CGHS scheme.

3. Employees’ State Insurance Scheme (ESIS)

   The scheme was launched in the year 1952. It is designed to provide health insurance and social security benefits to employees in the organized sector. It is a mandatory insurance scheme for establishments like factories and businesses with at least 10 employees, and in certain states, it extends to shops, transportation services, restaurants, and newspapers employing 20 or more individuals.

   Features

   • Dependents will receive benefits in case of an employee’s death or injury at the workplace.
   • Maternity benefit is offered under the Employee State Insurance Scheme.
   • All medical emergency expenses are taken care of by the Employee State Insurance Scheme for the workers.

4. National Varishtha Mediclaim Policy

   This is a dedicated health insurance scheme for senior citizens between 60 to 80 years of age. The tenure of the policy is 1 year, but it can be renewed until the individual is 90 years, ensuring long-term healthcare accessibility.

   Features

   • Offers sum insured of INR 1 Lakh and INR 2 Lakhs, as per the financial capacity of the individual.
   • Includes domiciliary coverage.
   • Covers ambulance charges up to INR 1,000 per illness.

Benefits of Government Health Insurance for Senior Citizens

Let us take a look at some of the benefits included with government senior citizen health schemes:

• Cashless hospitalization facilities are available for senior citizens, giving them access to efficient medical care.
• It offers peace of mind to you and your family members as medical expenses increase with growing age.
• Pre and post-hospitalization expenses are covered under most government health schemes.
• Government health insurance schemes for senior citizens offer features like OPD care, diagnostics, and more.
• Regardless of income bracket, government schemes such as AB-PMJAY will cover senior citizens across the country.
• Tackle rising medical inflation with the government’s senior citizen health schemes.

Government Senior Citizen Health Schemes vs. Private Senior Citizen Health Schemes

Let us look at some basic differences that set government health insurance schemes apart.

Government Senior Citizen Health Schemes: A Necessity?

Health schemes designed by the Indian government for senior citizens are a boon to many. However, you must be aware of the coverage limitations attached to them. Most government health schemes for senior citizens have a sum insured of not more than INR 10 Lakhs, which might not be enough to cover the rising medical care costs. However, for families with a lower income capacity, government health schemes are the best option to fight medical bills. Flagship government schemes like AB-PMJAY play a major role in making insurance accessible to all.

While government health plans are affordable, general senior citizen health plans have a higher premium attached to them. For more insights on government health schemes, stay connected with our insurance experts.

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