Coverage Of Senior Citizen Health Insurance Plan Scheme And Exclusions Of Claim

Coverage Of Senior Citizen Health Insurance Plan Scheme And Exclusions Of Claim


Senior Citizen Health Insurance Plan (SCHIP) is a specialised coverage policy designed to cater to the healthcare needs of senior citizens. As individuals age, their healthcare requirements may additionally boom, and that they turn out to be extra at risk of various health situations and illnesses. SCHIPs intention to provide financial safety and get admission to to high-quality clinical take care of elderly people.


Coverage Offered by SCHIPS:

Hospitalization Expenses:

The SCHIPS plan covers hospitalization charges incurred with the aid of senior citizens, which include room costs, ICU expenses, nursing expenses, and medical doctor’s prices. The plan also covers the cost of drugs and medical substances used at some stage in hospitalization, as well as diagnostic exams and laboratory prices.

Pre-Existing Diseases:

Pre-present sicknesses are illnesses that a senior citizen has before buying the medical insurance policy. SCHIPS covers pre-current diseases after a ready length of 1-four years, depending at the coverage company. The ready duration may also vary depending at the form of disorder and the coverage’s phrases and conditions.

Daycare Procedures:

SCHIPS covers daycare methods such as cataract surgery, dialysis, chemotherapy, and radiotherapy, amongst others. Daycare methods are scientific treatments that require much less than 24 hours of hospitalization.

Ambulance Charges:

The plan covers the prices incurred for transportation of the senior citizen by means of ambulance from the sanatorium to the residence or from one health center to another health center. The ambulance expenses are covered up to a positive limit, which varies depending at the coverage issuer and the coverage’s terms and conditions.

Domiciliary Hospitalization:

The plan presents insurance for scientific remedy acquired via the senior citizen at domestic for a period exceeding three days. Domiciliary hospitalization is blanketed up to a positive limit, which varies depending at the insurance provider and the policy’s phrases and situations.

Alternative Treatments:

SCHIPS also covers opportunity treatments along with Ayurveda, Homeopathy, and Unani, amongst others, situation to positive phrases and conditions. The plan covers alternative remedies up to a positive restrict, which varies relying on the insurance issuer and the policy’s terms and situations.

Exclusions of Claim under SCHIPS:


Pre-Existing Diseases:

While SCHIPS covers pre-present diseases, there’s a ready period of 1-4 years, depending at the coverage provider. During this waiting period, the plan will not cowl any medical costs associated with the pre-existing sickness.

Cosmetic Treatments:

The plan does no longer cover beauty remedies or surgical procedures, including liposuction, hair transplant, and others. Cosmetic treatments are not considered crucial clinical treatments and are consequently no longer blanketed underneath SCHIPS.

Non-Allopathic Treatments:

While alternative remedies together with Ayurveda, Homeopathy, and Unani are blanketed, different non-allopathic treatments along with acupuncture, acupressure, and naturopathy are not covered. Non-allopathic remedies aren’t identified as critical medical treatments and are therefore not included underneath SCHIPS.

Hospitalization within 30 days:

The plan does not cover hospitalization costs incurred inside the first 30 days of purchasing the coverage, besides in cases of injuries. This ready length is designed to prevent human beings from shopping the policy most effective after they require medical remedy.

Treatment Abroad:

SCHIPS does not cowl medical treatment acquired with the aid of the senior citizen outside India, except in specific cases which include an emergency.

Certain Illnesses and Procedures:

The plan won’t cowl sure ailments and clinical procedures, along with HIV/AIDS, infertility remedies, and beauty surgical procedures. It is essential to test the policy’s terms and situations to recognize what clinical treatments are included.

Experimental and Unproven Treatments:

SCHIPS does now not cowl experimental and unproven remedies, which are not diagnosed as standard clinical treatments. Experimental and unproven remedies may also consist of stem cell remedy, gene remedy, and others.

Non-Medical Expenses:

The plan does now not cowl non-scientific costs, which includes food, toiletries, and other private expenses incurred all through hospitalization.

War and Terrorism:

The plan does now not cover scientific costs incurred because of warfare, terrorism, or any act of violence.

Intentional Self-Harm:

The plan does no longer cover scientific prices incurred because of intentional self-harm or attempted suicide


Coverage Of Senior Citizen Health Insurance Plan Scheme And Exclusions Of Claim


Coverage Of Senior Citizen Health Insurance Plan Scheme And Exclusions Of Claim


When choosing a SCHIPS coverage, it is essential to recollect the subsequent elements:


Check the coverage’s coverage to ensure that it meets your medical wishes. Look for policies that provide complete coverage, along with hospitalization expenses, pre-current illnesses, daycare methods, and ambulance expenses.


Compare premiums from exceptional coverage carriers to find a coverage that offers the excellent cost for money. Keep in mind that higher charges may also offer better insurance or decrease deductibles.

Waiting Period:

Check the coverage’s waiting period for pre-current sicknesses to make sure that it aligns together with your medical needs. Consider policies with shorter waiting intervals when you have a pre-present situation that requires instant clinical interest.

Network Hospitals:

Check the insurance company’s network of hospitals to make certain that there are hospitals to your region that take delivery of the policy. Having get admission to to a network of hospitals can make it less complicated to receive medical treatment while not having to pay out-of-pocket charges.

Coverage Of Senior Citizen Health Insurance Plan Scheme And Exclusions Of Claim


Documents required for the claim process

Senior residents’ fitness plans have a fantastically simple claims system. The coverage corporation have to be notified if there is a clinical emergency or a planned hospital stay. Here are a few documents that should be furnished to insurance agencies to manner a well timed declare. Different businesses may have specific requirements.

Completed and signed declare form

Card for coverage health

Receipts and medical bills

Prescriptions and exact scientific reviews

Reports of diagnostic exams

Time is taken to settle Claims

For a timely agreement of a declare, it’s miles critical to follow the right manner and publish all required documents. The IRDA states that a senior citizen’s medical health insurance plan must be accepted within 30 days of the date they’re submitted. If there’s a similarly research, it can take in to 45 days.


The Senior Citizen Health Insurance Plan Scheme is an extremely good manner for senior citizens to shield themselves from the excessive costs of healthcare. The plan offers coverage for various medical charges, which includes hospitalization charges, pre-present sicknesses, daycare procedures, ambulance costs, domiciliary hospitalization, and alternative remedies.

When choosing a SCHIPS coverage, it is crucial to recollect factors together with insurance, charges, waiting duration, community hospitals, and exclusions. By cautiously thinking about these factors, senior citizens can choose a policy that gives the high-quality fee for money and meets their specific medical desires.

Coverage Of Senior Citizen Health Insurance Plan Scheme And Exclusions Of Claim


Q1. Is the senior citizen coverage plan transferable?

Yes, the coverage policy comes with the portability choice. This lets in you to change your coverage organization or coverage. You have to inform the corporation of your purpose to alternate the coverage or insurance enterprise earlier than the renewal date.

Q2. Is it vital to have a scientific examination before shopping a plan of health insurance?

Before buying a plan for medical health insurance, all people over forty five ought to have a medical exam.

Q3. Who will pay for the clinical exam earlier than shopping a medical health insurance coverage?

The coverage organisation normally has a check lab that may perform the examination. The coverage enterprise covers the fee of the exam.

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