Health insurance plans play a chief role in safeguarding the senior citizens’ health, providing them with assistance during emergencies. The essence of health insurance is that it provides the elderly with the best quality medical assistance without draining their hard-earned savings.
To make health insurance more inclusive and accessible for seniors, the IRDAI regularly releases new guidelines. Some of the latest and most important rules are listed below.
New Health Insurance Rules for Senior Citizens
IRDAI New Rules 2025:
As per the latest guidelines provided by the IRDAI, insurance companies cannot hike the premium for senior citizen health coverage beyond 10%. Besides, all insurers are required to adhere to the following:
- They must seek IRDAI approval if the proposed premium hike is more than 10%.
- Prior permission should be obtained from IRDAI if they propose to withdraw any individual health plans offered to senior citizens.
- All insurers must take the necessary steps to negotiate the package rates of hospitals according to the PMJAY scheme and strive for the common empanelment of hospitals.
IRDAI Rules 2024:
The IRDAI also released some guidelines in 2024 for senior citizen health plans, which are crucial to understand.
- Ayushman Bharat Free Health Coverage
Under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojna, senior citizens above 70 years are eligible for free medical coverage. This benefit is available to all senior citizens across the country, irrespective of their financial status and background.
- No Upper Age Limit
As per the new rules, the IRDAI has scrapped the upper age limit of 65 years for buying health plans for senior citizens. Thus, now elderly individuals above 65 years of age will have more health insurance options to choose from.
- AYUSH Treatment Without Sub-Limit
Under the new rules, one can avail of Ayurvedic, Yoga, Unani, Siddha and Homeopathy treatments without the application of any sub-limits. This guideline is specifically beneficial to senior citizens who prefer AYUSH treatments. Earlier, they could claim up to the maximum limit mentioned, but now the claim can be made up to the sum insured.
- Reduced Waiting Periods for Specific Diseases
There has also been a reduction in the waiting period to 36 months (3 years) for diseases and procedures. So, aged individuals who require specific treatments or procedures now have to wait for a shorter period before they can get the treatment.
- PED Waiting Period Reduced to 3 Years
The IRDAI has reduced the waiting period for pre-existing diseases to 3 years. Since senior citizens and elderly individuals are more likely to contract age-related diseases, this rule benefits them by allowing them to get health coverage sooner.
- Customised Senior Citizen Health Products
IRDAI has also encouraged insurers to curate more customised plans for senior citizens, so they can pick the best plan as per their health needs and budget.
- Claims from Multiple Insurers
All policyholders, including senior citizens with benefit-based policies, can file a claim with multiple insurers. This rule enables senior citizens to claim from multiple insurers, especially in the case of a major disease.
- Moratorium Period Reduced
The moratorium period has also been reduced from 8 to 5 years. Thus, senior citizens who have been renewing their insurance plans for 5 continuous years cannot be refused a claim from the insurance company, except if there is fraud.
- Senior Citizen Helplines
The new IRDAI rules also require insurers across the country to set up dedicated help channels for senior citizens. The insurance providers are required to inform the senior customers clearly about these helplines through the websites and other mediums.
- Non-Rejection of Severe Health Conditions
Under the new rules, insurance companies cannot refuse claims for severe diseases, such as heart disease, renal failure, cancer, etc. This rule enables senior citizens with such conditions to buy insurance without a claim rejection fear.
Stay Healthy and Happy with TATA AIG Health Insurance
The IRDAI guidelines have paved the way for efficient, flexible and affordable insurance plans for senior citizens in the country. All elderly people with a health insurance plan can now get some added benefits out of their health insurance plans.
As for those elderly who are looking for senior citizen health insurance, TATA AIG has got them covered. Their plans have some excellent features, such as post-operative care, wellness service, home care treatment, and so on. Their plans cover elderly individuals starting 61 years with no upper age limit, accommodating the elderly of all ages.
Besides, senior individuals can also get coverage for hospitalisation charges, preventive check-ups, expenses related to medical tests, pre- and post-hospitalisation charges, etc.
