Varistha Mediclaim Policy: Comprehensive Coverage for Senior Citizens

Discover the extensive coverage and benefits provided by the Varistha Mediclaim Policy for senior citizens.
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3 min
08-July-2024

As people age, their healthcare needs typically increase, making health insurance a crucial aspect of managing their well-being. For senior citizens in India, finding a health insurance policy that caters specifically to their needs can be challenging. The National Insurance Company Limited has addressed this challenge with the Varistha Mediclaim policy, designed exclusively for senior citizens. This article provides an in-depth look at Varistha Mediclaim, exploring its features, benefits, and how it caters to the unique healthcare requirements of the elderly.

What is Varistha Mediclaim?

Varistha Mediclaim is a health insurance policy offered by the National Insurance Company Limited, tailored specifically for senior citizens aged 60 to 80 years. The policy can be renewed up to the age of 90, ensuring long-term health coverage. It is designed to provide financial protection against medical expenses, including hospitalisation, domiciliary hospitalisation, and critical illness treatment, which are particularly relevant for the elderly.

Explore: Government health insurance schemes for senior citizens

Key features of Varistha Mediclaim

Varistha Mediclaim stands out due to its comprehensive coverage and benefits tailored for senior citizens. Here are the key features of the policy:

Eligibility and renewal:

The policy is available for individuals aged 60 to 80 years at the time of entry and can be renewed up to the age of 90.

Sum insured:

The policy offers two options for the sum insured – Rs. 1 lakh and Rs. 2 lakh, providing flexibility based on the policyholder's needs and financial capabilities.

Hospitalisation coverage:

It covers expenses for hospitalisation, including room charges, nursing, surgeon’s fees, and diagnostic tests.

Pre- and post-hospitalisation:

Expenses incurred 30 days before and 60 days after hospitalisation are covered under this policy.

Domiciliary hospitalisation:

It includes coverage for treatment at home if hospitalisation is not possible due to the patient's condition or non-availability of hospital beds.

Critical illness coverage:

An additional benefit of Rs. 2 lakh is provided for critical illnesses such as cancer, kidney failure, stroke, and major organ transplants.

Pre-existing diseases:

Pre-existing diseases are covered after a waiting period of one year for continuous coverage under this policy.

Ambulance charges:

It covers ambulance charges up to Rs. 1,000 per illness, ensuring that emergency transportation costs are manageable.

Daily cash allowance:

The policy offers a daily cash allowance for accompanying an insured person during hospitalisation, up to Rs. 500 per day.

Premium discounts:

Discounts are available on insurance premium for policyholders who opt for a higher sum insured or include family members under the same policy.

Benefits of Varistha Mediclaim for Senior Citizens

Varistha Mediclaim provides numerous benefits that address the specific needs of senior citizens, making it a preferred choice for elderly health insurance

  • Comprehensive coverage: The policy covers a wide range of medical expenses, ensuring that seniors have access to necessary treatments without financial stress.
  • Critical illness protection: With an additional sum insured specifically for critical illnesses, seniors can receive adequate treatment for life-threatening conditions without exhausting their primary sum insured.
  • Ease of renewal: The policy’s renewability up to the age of 90 provides long-term security, a crucial factor for senior citizens who may struggle to find new coverage at an advanced age.
  • Financial relief for families: By covering major medical expenses, Varistha Mediclaim helps reduce the financial burden on the policyholder's family, allowing them to focus on care rather than costs.
  • Domiciliary care: Coverage for home treatment is especially beneficial for seniors who may prefer or require treatment in the comfort of their homes.
  • Pre-existing disease coverage: After a short waiting period, pre-existing conditions are covered, which is significant for seniors who are more likely to have ongoing health issues.
  • Ambulance and daily cash allowance: Additional benefits like ambulance charges and daily cash allowance for attendants provide further financial support during medical emergencies.

Also, read: Benefits of health insurance

Claims process under Varistha Mediclaim

The claims process for Varistha Mediclaim is designed to be user-friendly and efficient, ensuring that policyholders receive timely reimbursement for their medical expenses. Here are the steps involved:

  • Notify the insurer: Inform the insurance company or their third-party administrator (TPA) about the hospitalisation or treatment as soon as possible.
  • Submit claim form: Fill out and submit the claim form along with necessary documents, including medical reports, bills, and discharge summary.
  • Pre-authorisation for cashless treatment: For cashless hospitalisation at network hospitals, obtain pre-authorisation from the insurer. This facilitates direct billing between the hospital and the insurance company.
  • Reimbursement claims: If treated at a non-network hospital, submit all relevant documents and bills to the insurer for reimbursement of expenses.
  • Claim settlement: The insurer will review the claim and process the payment based on the policy terms and coverage limits.

Read more: How to claim health insurance?

Pro Tip

Avail hospitalisation and treatment benefits with health insurance plans starting at just Rs. 15*/day.

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The premium for Varistha Mediclaim depends on various factors, including the sum insured, age of the insured, and health status. Here’s how it is calculated and how discounts can be availed:

  • Age and sum insured: Premiums increase with age and the sum insured selected. Higher sums insured attract higher premiums but offer more extensive coverage.
  • Medical history: Health conditions and medical history can influence the premium amount. Applicants with pre-existing conditions might have higher premiums or need to undergo more thorough medical examinations.
  • Policy tenure and renewal: Longer policy tenure and continuous renewal without breaks can sometimes attract loyalty discounts or bonuses.
  • Discounts: Discounts are available for policyholders who choose higher sums insured or include multiple family members in the policy.

Key exclusions and limitations

While Varistha Mediclaim offers extensive coverage, there are certain exclusions and limitations that policyholders should be aware of:

  • Initial waiting period: Claims for any illness occurring within the first 30 days of the policy start date are not covered, except for accidental injuries.
  • Pre-existing diseases: Coverage for pre-existing diseases begins after a waiting period of one year from the policy inception.
  • Specific ailments: Certain ailments have specific waiting periods before coverage starts, typically two years. These may include cataract surgery, joint replacement, and hernia.
  • Cosmetic treatments: Cosmetic or aesthetic treatments, including plastic surgery, are not covered unless required due to an accident or illness.
  • ·Self-inflicted injuries: Injuries or illnesses resulting from self-inflicted harm or substance abuse are excluded.
  • Non-prescription treatments: Expenses for treatments not prescribed by a registered medical practitioner or for over-the-counter medications are not covered.
  • Other exclusions: Treatment for conditions such as HIV/AIDS, war-related injuries, or participation in hazardous activities are generally excluded.

Read more: Exclusions under health insurance

VARISTHA Mediclaim for Senior Citizens by the National Insurance Company Limited offers a comprehensive and tailored solution for the healthcare needs of the elderly. With its extensive coverage, critical illness benefits, and financial support for hospitalization and domiciliary care, it provides a valuable safety net for senior citizens. By understanding the policy’s features, benefits, and the application process, seniors and their families can make informed decisions to secure their health and financial well-being in their golden years.

Frequently asked questions

What is covered under the Varistha Mediclaim Policy?
VARISTHA Mediclaim covers hospitalisation, pre- and post-hospitalisation, domiciliary care, critical illnesses, ambulance charges, and offers daily cash allowance for attendants, ensuring comprehensive protection for senior citizens.
What are the eligibility criteria for senior citizens to avail the Varistha Mediclaim Policy?
Senior citizens aged 60 to 80 years are eligible for Varistha Mediclaim, which can be renewed up to the age of 90, offering tailored health coverage for elderly individuals.
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