New Health Insurance Rules For Senior Citizens

What are the New Senior Citizen Rules in Health Insurance?

In January 2025, IRDAI came up with a new circular that states some new senior citizen rules in health insurance. IRDAI (Insurance Regulatory and Development Authority of India) has made many changes recently to help health insurance policyholders. These changes aim to make health insurance more helpful and easier for everyone.

1. Free Health Insurance Under AB-PMJAY

On September 12, 2024, the Union Cabinet made a major decision to support the health and well-being of India’s elderly population. The government announced that all senior citizens aged 70 years and above will now be covered under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) completely free of cost. The financial help up to 5 Lakh is given per family by the government.

2. Better Coverage for Senior Citizens

IRDAI has set a fixed time limit for approving cashless claims. Health insurance companies must now offer more plan options, add-ons, and riders that suit people of all age groups.

Senior citizen plans will also cover all kinds of health problems, long-term diseases, different types of treatments, and all kinds of hospitals and doctors. Also, it covers AYUSH treatments without any sub-limits on the claiming amount.

3. Decline in Waiting Periods

The waiting time for pre-existing diseases has been reduced from 4 years to 3 years in the new guidelines. This step by the IRDAI has given assurance of financial support to the senior citizens in case of any medical problem.

Also, the limit of the moratorium period has been declined from 8 years to 5 years for the insured person.

Note: The Moratorium period in health insurance is a fixed time which ensures that after completion of the moratorium period insurance companies cannot reject any claim related to pre-existing diseases.

4. Special Customer Support Service

To help senior citizens, IRDAI has asked all insurance companies to create a special support system just for them. This will help in solving their health insurance problems and claims faster. Insurance companies should also share the details of this support system on their official websites.

5. Extension of Entry Age

As per the circular of IRDAI, the entry age of a senior citizen has been increased to 65 years. So that many people can get financial benefits in their older age. Also, any of the severe medical-related issues, such as cancer, heart disease, and AIDS can not be rejected by the insurance company.

6. Restriction on Premium Hike

To protect senior citizens from rising health insurance costs, the Insurance Regulatory and Development Authority of India (IRDAI) has introduced a new rule. According to this rule, insurance companies are not allowed to increase the premium (cost of the policy) for senior citizens by more than 10% in a year.

This step was taken because many people were struggling to afford their health insurance due to sudden and high premium hikes.

7. Approval Needed for Major Premium Hikes or Plan Withdrawal

If a senior citizens’ health insurance company wants to increase the premium by more than 10%, it must first get permission from IRDAI. The same rule applies if the company wants to stop offering a health insurance plan for senior citizens. It helps protect older policyholders and keeps their health coverage more stable and reliable.

8. Transparency of Rules and Rights

Insurance companies are required to share all the steps they are taking to support senior citizens, including these new rules and benefits. This helps senior citizens understand their rights, available services, and any changes in their health insurance plans. It also ensures transparency and builds trust between the insurer and the policyholder.

9. Standardizing Hospital Costs

Senior Citizens' Health Insurance companies are encouraged to work together to create a common list of hospitals that are part of their network. They should also try to fix standard treatment costs, similar to how it is done in the PMJAY (Pradhan Mantri Jan Arogya Yojana) scheme.

This can help reduce high hospital charges and make health insurance more affordable, especially for senior citizens.

Why Were Senior Citizens' Health Insurance Rules Introduced?

Rules relating to Health Insurance for Senior Citizens were introduced to make the buying experience easy and hassle-free for people above 60. Here are some reasons why IRDAI came up with the idea of a new set of rules:

1. High Premium Hikes

While keeping an eye on health insurance plans, it was noticed that some insurance companies have increased the premium (cost of the policy) for senior citizens who are 60 years or older.

2. Increasing Cost of Health Insurance

The cost of a health insurance plan (called the premium) mainly depends on how much the insurance company pays for claims and other costs like marketing and servicing. The claim amount usually depends on how much hospitals charge for treatments and surgeries.

3. No Fixed Hospital Rates in Private Health Insurance Plans

In government health schemes like PMJAY, hospital charges are fixed and the same across many hospitals. But in regular health insurance, there is no such fixed pricing. Because of this, hospital costs are higher, which increases the amount insurance companies have to pay. This leads to higher premiums for customers.

4. Limited Income of Senior Citizens

Senior citizens are the most affected by this because they usually have limited income. When premiums go up a lot, it becomes difficult for them to afford health insurance. IRDAI is aware of this issue and has taken steps to protect senior citizens.

Conclusion

The new health insurance rules are a positive step for senior citizens. They offer better coverage, fewer restrictions, and more support for medical needs. These changes make health insurance more friendly and useful for older people. If you or your loved ones are senior citizens, it is a good time to review your health plan and make sure it matches the new rules. Good health and peace of mind should always come first.

If you want to buy Health Insurance for Senior Citizens and are facing some issues while purchasing, feel free to contact our customer care executive.