VARISHTHA Mediclaim for Senior Citizens by National Insurance Company
Medical insurance (an improbability after 60years) and rising healthcare costs put seniors in a spot. Government has finally taken note and introduced a special health insurance scheme for senior citizens. For this purpose Varishtha Mediclaim has been launched by National Insurance Company earlier this year. Government has directed all other public-sector insurance companies, such as New India Assurance, Oriental Insurance Company and General Insurance Company, to come up with similar versions.
Major points for Varishtha Mediclaim Policy-
• Under this scheme, fresh health insurance policies may be issued to people up to 80 years of age, the policy is renewable up to 90 years of age.
• The policy has two sections, Section I covers Hospitalization & Domiciliary Hospitalization Expenses and Section II covers expenses for treatment of critical illnesses. Critical illness cover is optional.
• Sum Insured (S.I.) is fixed under section I is Rs. 1, 00,000 and under section II is 2, 00,000.
• Pre-existence diseases except malignant diseases will be covered – under section I after one claim free year.
• Pre-existing Diabetes & Hypertension (excluding any ailment already manifested due to Diabetes & Hypertension) can be covered from the inception of the policy on payment of additional premium.
• Cumulative Bonus @ 5% of S.I. for each claim free year up to a maximum of 50% of S.I. or 5% discount in renewal premium will be allowed in respect of each claim free year.
• Under section I, Ambulance Charges up to a maximum of Rs.1000 in a policy year will be reimbursed.
• Cost of Health check up @2% of average S.I. at the end of the block of 3 underwriting years.
• Under Section I, Hospitalization expenses of person donating an organ during the course of organ transplantation will also be payable.
• Cashless Access service available through TPA ( Third Party Administration )
Critical Illnesses are as under:
• Coronary Artery Surgery
• Cancer
• Renal Failure i.e. Failure for both kidneys
• Stroke
• Multiple Sclerosis
• Major Organ Transplants like kidney, Lung, Pancreas or Bone marrow
• Paralysis and blindness at extra premium
Domiciliary Hospitalization benefit means medical treatment for a period exceeding three days for such illness/disease/ injury which in the normal course would require care and treatment at a Hospital / Nursing Home but actually taken whilst confined at home in India under any of the following circumstances, namely:
• The condition of the patient is such that he /she cannot be removed to the Hospital / Nursing Home or
ii) The patient cannot be removed to Hospital / Nursing Home for lack of accommodation therein
Premium for different age group
Premium on VARISTHA Mediclaim for Senior Citizens by National Insurance Company
Age Group |
Premium on sum insured |
Mediclaim (1,00,000) |
Critical Illness (2,00,000) |
Total |
60-65 years |
4180 |
2007 |
6187 |
66-70 years |
5196 |
2130 |
7326 |
71-75 years |
5568 |
2200 |
7768 |
76-80 years |
6890 |
2288 |
9278 |
Pre-existing diseases of Hypertension and /or Diabetes from the inception of the policy he / she has to pay additional premium @ 10% for either hypertension or diabetes & 20% for hypertension & diabetes for first year of the policy.
Paralysis and Blindness may be covered under Critical illness by loading the Critical illness premium by 15% in each case or 25% in case of both covers together.
From the above discussion we see that the upper limit on amount insured is Rs.100,000 (Rs.200,000, if you opt for ‘critical illness' option ), which seems quite inadequate considering today's healthcare costs. The premium (inclusive of critical illness cover) ranges from Rs 6,187 per year for the age group 60-65 to Rs 9,178 for those in the age group of 76-80. Nearly 76%, Indians live without an insurance cover. (News published in 7 July 2007, The Statesman, Col – 1, Page 8). Nearly 30% of the elderly people are below poverty line. According to survey report conducted by teachers, non-teaching staff and students from Netaji Nagar Day College and Computer Centre under the leadership of Dr. Dilip Kumar Chakraborty in 2003-2004 in the urban areas in West Bengal 51% had yearly household income below 30,000. In such a situation large section of the senior citizens is deprives of getting such benefits. The government should consider the matter for increasing premium for upper age group so that at least the problem of non-availability of cover will be resolved at a reasonable cost.
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