is the insurer's purpose-built health insurance for senior citizens aged 60–80. Two plans — Plan A (essentials) and Plan B (Plan A plus hospital cash, doctor home visit, funeral expenses, RTA reinstatement, and Plan B's unique 6-month health check-up cycle). Pre-existing diseases covered after just 24 months — the best PED wait for any the insurer senior product. HIV treatment and four categories of mental illness covered from day one of activation.
the insurer Health· Fetched
"Senior Citizen Mediclaim Policy is an indemnity health insurance policy for the aged having higher Sum Insured up to 10 Lakhs. The Policy covers expenses in respect of inpatient treatment (allopathy, ayurveda and homeopathy), domiciliary hospitalization, reasonably and customarily incurred for treatment of a disease or an injury contracted/sustained during the policy period." Available in two plans — Plan A (core coverage) and Plan B (Plan A plus premium senior-specific benefits including hospital cash, doctor home visit, funeral expenses, and RTA reinstatement).
"All pre-existing diseases included after first twenty four months (24) of Policy." At 24 months, has the shortest PED wait in the insurer's portfolio for senior-focused products. ASP: 48M. NPMPP: 36M.: 24M. For a 68-year-old with hypertension, diabetes, and arthritis: all covered after 2 years vs 3–4 years elsewhere.
24 Months — Best in the insurer for Seniors"HIV treatment & Mental illness hospitalization covered." covers 4 specific mental illness categories for hospitalisation: Major Depressive Disorder (aggressive/violent), Acute psychotic conditions, Schizophrenia (psychotic episodes), Bipolar disorder (manic phase). Strict criteria — must exhibit 2+ behavioural traits + psychiatrist referral. Counselling/OPD psychotherapy excluded.
4 Conditions· Strict Criteria"Doctor's home visit, nursing care by qualified nurse, aya, attendant charges during post hospitalisation." Plan B uniquely covers home care during post-hospitalisation when physical mobility is severely restricted — critical for elderly recovering from surgery, strokes, or fractures.
Plan B Only· Post-Discharge"In the event of death of the insured person during hospitalisation, the Company shall pay funeral expenses subject to limit as mentioned in Table of Benefit." Plan B is the only the insurer health product with a funeral expenses benefit — acknowledging the realistic health risk profile of the 60–80 age group with sensitivity.
Plan B Only· Unique in the insurer"Reinstatement of SI for road traffic accidents." Plan B: If RTA exhausts the SI, the balance SI is reinstated once for subsequent hospitalisations. Detailed illustrations in the prospectus for Case I and Case II scenarios. Road accidents are a significant risk for elderly pedestrians/vehicle passengers.
Plan B· RTA Only· Once/Year"Every 6 claim free months, Regular medical consultation and prescribed diagnostics tests up to INR 1,000 per insured person." Plan B's 6-monthly check-up cycle is unique in the insurer's portfolio — no other product offers health check-up this frequently. Ideal for senior citizens who need regular monitoring.
6 Months· ₹1,000/Person· UniqueProspectus Sections 1.2 + 1.3· What Plan B Adds to Plan A
comes in two plans. Plan A covers the core health benefits. Plan B includes everything in Plan A plus five additional senior-specific benefits that are uniquely appropriate for the 60–80 age group: hospital cash, home care, funeral expenses, RTA reinstatement, and 6-monthly health check-ups. Both plans offer ₹1L to ₹10L SI.
Prospectus Sections 2.2–2.3· Who Can Propose· Who Can Be Insured
"Policy can be proposed by: (i) Any Senior Citizen (i.e., aged between 60 to 80 years). (ii) Son or Daughter for parents, where at least one parent is Senior Citizen (i.e., aged between 60 to 80 years). No one else can be Proposer for this Policy." The maximum entry age of 80 years at inception applies to all insured persons.
If the senior citizen proposes for themselves only: aged 60–80 at inception. Individual basis. Sum insured ₹1L–10L. Zone-based premium. Pre-policy check-up mandatory.
60–80· IndividualSenior citizen proposer for self (60–80) and spouse (60–80 at inception) on individual basis — each with own SI. Both undergo pre-policy check-up. Each has own sum insured.
Both 60–80· Individual Each"Policy on Floater Basis can be availed for Self and Spouse together, where self is aged between 60 to 80 years and spouse is aged between 50 to 80 years at inception." Spouse can be as young as 50 for the floater option.
Self 60–80· Spouse 50–80"Son or Daughter for parents, where at least one parent is Senior Citizen (i.e., aged between 60 to 80 years)." Son/daughter (any age) can propose for either parent individually, both parents on individual basis, or both parents on floater (at least one 60–80; other 50–80).
Son/Daughter Proposes"No one else can be Proposer for this Policy." Siblings, grandchildren, nieces/nephews, or any other relation cannot propose for elderly parents even if within the 60–80 age band. Only the senior citizen themselves, or their direct son/daughter.
Only SC or Son/Daughter"The Policy can be issued for a period of one (01) year." No 2-year or 3-year long-term policy option. must be renewed annually. Lifelong renewal available for insured persons.
Annual Only· Lifelong RenewalProspectus Section 2.10· 8 Mandatory Tests· 50% Reimbursed
"Pre Policy Check Up: For Whom – For all individuals irrespective of age, for fresh proposal.50% of the expenses incurred for pre policy check-up shall be reimbursed, if the proposal is accepted. Terms and conditions apply." Unlike younger-buyer policies, requires pre-medical for ALL fresh proposals — every new buyer regardless of age within 60–80.
Full physical by a doctor with minimum MD (Medicine) qualification. Report signed by the examining doctor. Assesses general health, vitals, cardiovascular status.
3-month average blood sugar level. Screens for diabetes and pre-diabetes. Critical for the 60–80 cohort where T2D prevalence is highest in India.
Total cholesterol, LDL, HDL, triglycerides. Screens for cardiovascular risk — a leading health concern for the 60–80 age group.
Kidney function test. Elevated creatinine indicates chronic kidney disease — common in senior citizens. Needed to assess renal risk at underwriting.
Urinalysis for glucose, protein, cells, casts. Screens for kidney disease, urinary tract infections, and systemic conditions. Standard senior health panel.
Cardiac rhythm assessment. Screens for arrhythmias, prior MI evidence, conduction blocks. Standard for all senior citizen health insurance underwriting.
"Eye check-up (including retinoscopy)." —. Vision assessment and retina examination. Screens for glaucoma, diabetic retinopathy, macular degeneration. Unique to vs other the insurer health products.
"Any other investigation required by the Company." —. the insurer reserves the right to request additional diagnostic tests based on medical history, disclosed conditions, or initial test findings.
Prospectus Sections 1.2.1–1.2.13· All Benefits Available in Both Plan A and Plan B
All benefits below are available in BOTH Plan A and Plan B — the foundational coverage scope confirmed from the prospectus. Plan B adds 5 more benefits on top of these (covered in the next section).
Room charges, ICU, nursing, RMO, surgeon/consultant/anaesthetist, anaesthesia, blood/oxygen/OT, medicines, diagnostics, prosthetics, dental (injury), plastic surgery (illness/injury), HRT (if medically necessary), vitamins/tonics (treatment). Plan A: room rent sub-limit per ToB + cataract + BPH sub-limits. Plan B: no sub-limits for room/cataract/BPH.
Plan A: Sub-Limits· Plan B: No Limits"The Company shall indemnify the medical expenses incurred 30 (thirty) days immediately before the insured person is hospitalised." Shorter than NNPMP's 45 days — confirm this for specifically. Same condition required. Part of hospitalisation claim.
30 Days"The Company shall indemnify the medical expenses incurred 60 (sixty) days immediately after the insured person is discharged from hospital." Standard 60-day post-hosp window. Same condition required. Plus Plan B's doctor home visit benefit during this 60-day period.
60 Days"The Company shall indemnify the medical expenses incurred under domiciliary hospitalisation.up to the limit as shown in the Table of Benefits.": up to 20% of SI. Two triggers: patient cannot be moved; no hospital room available. Min 3 days required. Domiciliary beyond 7 days treated as post-hospitalisation. 11 excluded diseases (10 standard + HIV/AIDS uniquely excluded).
Up to 20% of SI· 11 ExclusionsMedical expenses (including pre and post-hospitalisation) for Day Care Treatments requiring less than 24 hours hospitalisation. Not OPD department. All standard day care procedures covered. Prior TPA approval required for non-listed procedures.
All Day Care· Up to SI"The Company shall indemnify the Medical Expenses for In-patient Care, Pre-Hospitalisation expenses and Post-Hospitalisation expenses, incurred for AYUSH treatment, provided the treatment is undergone in an AYUSH Hospital."
AYUSH Hospital· Pre+PostHospitalisation of organ donor for harvesting: covered provided organ donation conforms to the Transplantation of Human Organs Act 1994. Donor's pre/post excluded. Organ acquisition cost excluded. Any complication post-harvesting excluded. Experimental transplants excluded.
Harvesting Hosp. Only"Ambulance charges will be subject to maximum INR 2,500 for Any One Illness for each insured person." Road ambulance for emergency transport to hospital, inter-hospital transfer, hospital to diagnostic centre and return during hospitalisation. Inpatient claim must be admitted.
₹2,500 Max/Illness12 modern treatments at 25% of SI per treatment per policy period: Robotic Surgery, HIFU, Balloon Sinuplasty, Deep Brain Stimulation, Oral Chemotherapy, Immunotherapy (Monoclonal Antibody), Intravitreal Injections, Stereotactic Radio Surgery, Bronchial Thermoplasty, Prostate Laser, IONM, Stem Cell Therapy. All confirmed in Prospectus Section 1.2.11.
25% SI Each· 12 TreatmentsBariatric surgery: BMI ≥40 or BMI ≥35 with severe co-morbidities (cardiomyopathy, CHD, severe sleep apnea, T2D). "Subject to Waiting Period of three (03) years." Insured must be 18+. Clinical protocol support required.
3-Year Wait· BMI ≥40Correction of refractive error ≥7.5 dioptres. "Subject to Waiting Period of two (02) years." Inpatient + pre and post-hospitalisation expenses covered.
≥7.5D· 2-Year Wait"Expenses related to treatment necessitated due to participation as a non-professional in hazardous or adventure sports, subject to Maximum amount admissible for Any One Illness shall be lower of 25% of Sum Insured." Senior citizens participating in adventure activities: covered up to 25% of SI per illness.
25% SI MaxProspectus Sections 1.3.1–1.3.4· 5 Additional Benefits Exclusive to Plan B
Five additional benefits are exclusively available in Plan B — all from the prospectus (Sections 1.3.1–1.3.4 and 1.4.2.2). These are designed specifically for the unique health risk profile and care needs of the 60–80 age group.
"The Company shall pay the insured a daily hospital cash allowance up to the limit as shown in the Table of Benefits for a maximum of five (05) days, provided the hospitalisation exceeds three (03) days. Hospital Cash shall be payable for each day from the 4th day of Hospitalisation up to the 8th day of Hospitalisation only." Day care (<24 hours): no hospital cash.
Days 4–8· Max 5 Days· Plan B"The Company shall reimburse the insured, for medically necessary expenses incurred for doctor's home visit, nursing care by qualified nurse, aya, attendant charges during post hospitalisation up to the limit as shown in the Table of Benefits, provided.the physical mobility of the insured person outside residence is severely restricted as advised in the discharge summary."
Mobility Restricted· Discharge Summary Req."In the event of death of the insured person during hospitalisation, the Company shall pay funeral expenses subject to limit as mentioned in Table of Benefit provided hospitalisation claim is admitted as per Section In-patient Treatment." Death must occur during active hospitalisation with an admitted claim. Limit as per Table of Benefits — confirm amount with Probitas at 022 4302 0000.
During Hosp. Only· Plan B Only"In the event of available sum insured.being exhausted anytime during the policy period on account of hospitalisation/domiciliary hospitalisation claims arising out of any injury due to a road traffic accident (RTA), the Company shall reinstate the sum insured (excluding Cumulative Bonus) to the extent as available prior to such RTA hospitalization." Once per policy period. Not for CI exclusion list. Reinstated SI not carried forward.
RTA Trigger· Once/Year· Plan BProspectus Sections 1.2.7 + 1.2.8· Strict Criteria· Also
"HIV treatment & Mental illness hospitalization covered." 's mental illness coverage is more precisely defined than any other the insurer health product — with specific qualifying conditions and behavioural criteria that reflect the kinds of psychiatric emergencies most relevant to the 60–80 age group.
"Acute HIV infection – acute flu-like symptoms. Clinical latency – usually asymptomatic or mild symptoms. AIDS – full-blown disease; CD4 < 200." All three stages covered for inpatient + pre/post-hospitalisation. Exclusions: OPD HIV treatment excluded; domiciliary HIV treatment excluded (both explicitly stated in prospectus).
All 3 Stages· No OPD/Domiciliary"Major Depressive Disorder - when the patient is aggressive or violent." Not all depression: only when the patient exhibits aggressive or violent behaviour requiring hospitalisation. Two or more qualifying traits must be present simultaneously. Treatment at a Hospital categorised as Mental Health Establishment, under a Mental Health Professional.
Aggressive/Violent· 2+ Traits"Acute psychotic conditions - aggressive/violent behaviour or hallucinations, incoherent talking or agitation." Includes first psychotic episodes, drug-induced psychosis with the behavioural criteria, and other acute psychotic presentations requiring inpatient psychiatric care.
Psychosis· Behavioural Criteria"Schizophrenia - esp. Psychotic episodes." Schizophrenic psychotic episodes requiring inpatient care under a psychiatrist at a designated mental health establishment. Remission maintenance: not covered (outpatient maintenance). Acute decompensation: covered.
Psychotic Episodes· Inpatient"Bipolar disorder - manic phase." Bipolar manic phase (not depressive phase unless meeting MDD aggressive criteria). Manic episodes with 2+ qualifying traits (suicidality, aggression, violent behaviour, or failure to respond to OPD treatment) requiring inpatient admission.
Manic Phase Only· 2+ Traits"The above covers are subject to the patient simultaneously exhibiting two or more of the following traits and requiring hospitalisation as per the treating psychiatrist's advice: Suicidality· Aggression· Violent behaviour which are harmful to the patient and people around him· Patients not responding to OPD drugs/treatments/therapy." Treatment: Mental Health Establishment + Mental Health Professional.
2+ Traits Must Be Present4 Optional Covers· Including PA with PPD Table
"Optional covers like OPD, Critical illness, Personal accident & coverage of pre-existing Diabetes and Hypertension." offers 4 optional covers on additional premium. The Personal Accident add-on is uniquely available as optional in (unlike NYIMP where it's built in to the base policy) — appropriate for the senior cohort where PA is an add-on choice rather than a standard feature.
Optional 1
DM / HTN Day 1Optional 2
OPD TreatmentOptional 3
Critical IllnessOptional 4
Personal AccidentProspectus Section 4· 24-Month PED — Best for Seniors in the insurer
Prospectus Section 2.7· 10% Direct/Online Only
"For Policy bought by walk in customer (where no intermediary is involved) - Discount of 10% shall be allowed on the final payable premium for new and subsequent renewals. Above discount is not applicable to the premium for Optional Covers." Tax benefit under Section 80D is a standard entitlement, not a discount.
"Walk-in customer (where no intermediary is involved)." 10% off base premium for new policies AND subsequent renewals bought directly. Not applicable to OPD, CI, PA, DM/HTN optional cover premiums.
5% of SI per claim-free year, max 50% of SI. "Annual Increase in SI by 5% for each claim free year up to maximum 50% of SI opted." Reduces 5% on claim year. Basic SI never reduced.
"50% of the expenses incurred for pre policy check-up shall be reimbursed, if the proposal is accepted." — + Prospectus 2.10.ii confirmed. Not a premium discount but a meaningful cost offset for the mandatory pre-acceptance check-up panel.
"Tax Rebate under Section 80D of Income Tax Act 1961 for premium paid." premium for senior citizens: ₹50,000 annual deduction available (proposer is senior citizen) under Section 80D. Both base + optional cover premiums qualify.
+ Prospectus· Standard + -Specific
"Only claims arising out of accidents are payable for the first 30 days of Inception of the Policy." Accident claims from Day 1. All illness claims: excluded in first 30 days. Continuous renewals: not applicable.
Pre-existing diseases excluded for 24 months. Exception: DM/HTN covered from Day 1 with optional add-on (with co-pay). All PEDs must be disclosed at proposal. Non-disclosure risks claim rejection and policy voiding.
Standard 10 (Asthma, Bronchitis, Chronic nephritis, Diarrhoea/Gastroenteritis, Epilepsy, Influenza/Cold, All mental illnesses, Pyrexia of unknown origin <10 days, Tonsillitis/URTI, Arthritis/Gout/Rheumatism) PLUS HIV/AIDS (11th) — also excluded from domiciliary. Unique to.
Mental illness without 2+ qualifying traits (suicidality, aggression, violent behaviour, OPD non-response): excluded. Psychotherapy, counselling, OPD treatment for mental illness: excluded. Domiciliary mental illness: excluded.
"Dental treatment (unless arising out of accident and requiring hospitalization." Routine dental: excluded. Accident-caused dental requiring hospitalisation: covered. OPD dental: covered only with OPD add-on.
"Non Prescription Drug, Home visit charges." Doctor home visit charges are excluded under the BASE. They are ONLY covered under Plan B's specific home care benefit (Section 1.3.2) — and only when discharge summary confirms severely restricted mobility.
Medical treatment received outside India: excluded. covers only in-India hospitalisation. Air ambulance is not a benefit — ambulance is capped at ₹2,500 for road transport within India.
"Change-of-Gender Treatments, Cosmetic or Plastic Surgery.Vitamins, Tonics Drug/alcohol abuse, Self-Inflicted Injury." Standard universal health insurance exclusions apply.
Cashless + Reimbursement· TPA or Direct· 72-Hour Intimation
can be serviced by TPA (cashless + reimbursement) or directly by Company (reimbursement only). "Cashless facility is available, if opted for TPA service, subject to prior approval by the TPA." For elderly who prefer cashless: choose TPA service at policy purchase. For reimbursement-only: Company direct service is cheaper (TPA charges waived).
"The proposer has the option of claims being serviced by TPA (in which case both Cashless Facility and Reimbursement Facility will be available) or the Company (in which case Cashless Facility shall not be available)." If the senior citizen wants cashless hospitalisation: TPA service must be opted at policy purchase. Cannot switch mid-term. Direct Company service: lower premium (no TPA charges) but no cashless.
"For planned hospitalisation, intimation is to be sent to the TPA/Company in advance (72 hours prior).In case of an emergency hospitalisation, intimation is to be sent to the TPA/Company within 24 hours of admission." Cashless: at network hospitals only. Check network hospital list via TPA or. Hospital insurance desk submits pre-authorisation request to TPA.
"Before leaving the hospital, Discharge Summary, investigation report and other relevant documents (Claim form – Part A& Part B) may be obtained from the hospital authorities." Critical for elderly patients: family member should manage document collection at discharge. Required: completed claim form, photo ID, prescriptions, all original bills with itemised break-up, payment receipts, discharge summary, investigation reports, surgical/OT notes.
"All documents in original are to be submitted within 15 days to TPA, after completion of Post Hospitalisation treatment." Two deadlines: 1) Main claim documents: 15 days from discharge. 2) Post-hospitalisation expenses: 15 days from end of 60-day post-hosp period. Separate claim for Plan B's doctor home visit/nurse/aya charges during post-hosp.
Hospital Cash (Days 4–8): "For Cashless Claims, Hospital Cash shall be paid along with Post Hospitalisation Claim/separate benefit." Doctor Home Visit/Nurse/Aya: submit discharge summary (confirming mobility restriction) + home care receipts within 15 days. Funeral Expenses: hospitalisation claim must be admitted + death certificate + claim form submitted to TPA/Company.
For Road Traffic Accident reinstatement: standard hospitalisation claim documents PLUS police investigation report confirming the road traffic accident (FIR/MLC). Submit proof that the RTA is the event that exhausted the SI. Once confirmed: the insurer reinstates the balance SI for subsequent claims in the same policy year. Reinstatement is automatic after confirmation — no separate application needed.
Senior Citizen Mediclaim Policy — Frequently Asked Questions
Get Your the insurer Senior Citizen Mediclaim Policy Quote
Tell us about the senior citizen(s) to be covered — age, plan preference, and DM/HTN status. Our specialist will provide the exact premium (Plan A and B), advise on DM/HTN and other optional cover pricing, and help coordinate the pre-policy check-up.
By submitting you agree to our Privacy Policy and Terms & Conditions. Senior Citizen Mediclaim Policy· the insurer· IRDAI Entry age: 60–80 years. SI: ₹1L–10L. Plan A: core benefits. Plan B: + hospital cash, home care, funeral, RTA reinstatement, 6-monthly health check-up. PED: 24 months. Mandatory pre-policy check-up for all fresh proposals (8 tests, 50% reimbursed). DM/HTN add-on: 10%/10%/25% co-pay for 36 months then removed. 4 optional covers. CB: 5%/year max 50%. Health check-up: Plan A every 2 years; Plan B every 6 months. RTA reinstatement: Plan B only, RTA trigger, once per year. All terms per prospectus. Probitas Insurance Brokers Pvt. Ltd.· IRDAI Lic. No. 528.