A family health insurance covers an individual alongwith his/her family under the same policy the policyholder has taken.

Whereas, a senior citizen health insurance plan is only for the people who are aged above 60 years. 

The requirements of elderly people are very different from the requirements of young members of the family and hence, knowing and taking health insurances for people of both the age groups are extremely important. Nowadays, families take their parents health insurance for security and protection. Elderly people are more prone to illnesses and hence in this article, we will be explaining to you about the significance of having these insurances. 

Major differences between the two insurances

The table below differentiates between the two policies on different parameters.

ParametersSenior Citizens Health InsuranceFamily Health Insurance
CoverageThis particular insurance provides health coverage to the people who are above the age of 60. This insurance covers the family members including spouse, children and parents (or parents-in-law) under health insurance
Entry agePeople only the age of 60 and above can be a part of this plan. All ages are accepted in this insurance policy. The dependent children are covered upto the age of 25. Also, it depends on the terms and conditions of the particular policy.
EligibilityEligibility criteria totally depends upon the company. However, the person must be a senior citizen aged 60 years or above and must provide and have basic documents like KYC, address proof, etc.Anybody who wants to cover the medical expenses of an unforeseen event can be a part of this. Most companies provide an entry age of 18 years. For the dependents, age criteria does vary as per the terms of the policy.
Tax benefitsUnder the section 80D of the Income Tax Act, year 1961, a deduction of up to Rs. 50,000 paid as a premium can be availed.A deduction of Rs. 25,000 for the premium paid to cover self, dependent children and spouse and a deduction of Rs. 50,000 for senior citizen parents can be availed by the policyholder (the figures are subject to change).

What all are included in the Senior Citizen Health Insurance plan?

The following things are included in this plan:

  • Room rent of the hospital
  • Hospital expenses
  • Doctor’s visit
  • Rent for operation theatre
  • ICU charges
  • Nursing charges
  • Ambulance charges
  • Pre and post hospitalisation charges (as per the T & C)
  • Health check-ups for prevention of diseases
  • Fees for the second doctor
  • Daycare treatments
  • Domiciliary treatments-at home
  • Other coverage on the basis of terms of the insurance plan

What all are included in the Family Health Insurance plan?

The followings are included in this plan:

  • Nursing charges
  • Rent for the room
  • Doctor’s visits
  • ICU charges
  • Operation theatre charges
  • AYUSH treatments- Ayurveda, Yoga, Unani, Siddha and Homoeopathy
  • Ambulance charges
  • Daycare treatments
  • Daily hospitalisation cash benefit

What all is not included in the Senior Citizen Health Insurance plan?

  • Cosmetic surgeries unless if it is medically essential
  • Injuries due to human wars
  • Dental treatment- unless it is a result of an accident
  • Injuries caused because of performing in some adventurous sport
  • STDs or Venereal diseases
  • Self harm or any intentional injuries
  • Other exclusions mentioned in the policy

What all is not included in the Family Health Insurance Plan?

  • Pre-existing diseases- claims raised in the waiting period
  • Injuries caused to any adventurous sport
  • Cosmetic surgeries
  • Dental treatment 
  • Self harm or intentional injuries
  • Injuries caused due to participation in human warfare
  • Unproven treatments
  • Other exclusions mentioned in the policy

 

Senior Citizens Health Insurance Policy and Family Health Insurance- Claim Settlement Process

The claim settlement process is the same for both the health insurances. Claim settlement type depends upon when or who pays for the incurred expenses during treatment.  

The claim settlement can be done in either of the two ways.

  1. Reimbursement Claim: Firstly, the person has to pay the entire expenses himself and then he can claim reimbursement from the insurance company as per the terms of the policy.
  2. Cashless Claim: For the treatments taken from the network hospitals of the insurance company, the person who is insured can only have to pay the deductible amount. The remaining part of the claim amount will itself be taken care of by the insurance company of the policyholder. 

Summing Up

This article must have helped you to know about both the types of health insurance policies- Senior Citizen and Family. The major difference between the two is the age part. Other than that, there are minimal differences. But, knowing them before going for these policies are extremely beneficial for you and your family members. After all, it is the question of the lives of your family members.