HOPE, or Health of Privileged Elders, is a particular type of Senior Citizen health insurance that was created specifically for senior citizens. It is a wise investment. The HOPE policy is a great option for seniors who want coverage for particular diseases because it is comprehensive and reasonably priced. The HOPE policy by Oriental Insurance covers Ayurvedic, Unani, and homeopathic treatment in government hospitals and colleges and provides coverage for hospital admissions lasting longer than 24 hours, room rent, and ICU, among other things. The policy’s best feature is its reimbursement of hospital and/or home care costs incurred by the insured person due to certain diseases or injuries.
Coverage Aspects of Senior Citizen Health insurance
- Chronic Renal Failure, Cancer, Stroke, Cardiovascular Diseases, Chronic Obstructive Lung Diseases, and five additional injuries/illnesses are included.
- coverage for lodging, food, and medical costs
- Insurance coverage for ambulance fees and ICU unit costs
- Fees for the surgeon, anesthetist, and other medical professionals in addition to the price of anesthesia, blood, oxygen, operating room fees, surgical instruments, etc.
- Hospitalization for at least 24 hours
- 30 days’ worth of pre-hospitalization costs
- Expenses for 60 days following hospitalization
- Domiciliary hospitalization expenses are covered up to Rs. 20,000. Up to 20,000 rupees in domiciliary hospitalization costs are covered.
Important Advantages of Oriental Health Insurance for Seniors Citizens
The Oriental Insurance HOPE – Health of Privileged Elders program is intended for seniors over 60. The policy includes specific diseases in its extensive list of covered conditions.
The policy offers additional benefits along with health insurance. The policy’s distinguishing characteristic is that it pays for medical expenses that are ordinarily not covered, like ambulance fees, prescription drug costs, and prosthetic device costs.
Age-related illnesses are common, but they can be expensive and challenging to treat because of the age factor. Senior citizens can choose from specialized health insurance plans according to individual needs and requirements. Seniors who purchase Oriental Health Insurance receive the following main advantages:
- Options for different insurance sums ranging from Rs. 1 lakh to Rs. 5 lakh
- Individual coverage is offered
- If you choose to pay voluntarily, you will receive a discount of up to 50%.
- Offering a 5% No Claim Bonus for each year without a claim, up to 20%
- After four years of being claim-free, there is a free health checkup facility.
- According to Section 80D of the Income Tax Act, premiums can be paid with tax savings.
The following are some of this plan’s features and advantages:
Listed below are the features and benefits of this plan
Entry age | any person 60 years old or older |
Basis | personal policy |
Periodic police | The policy’s minimum and maximum term is one year. |
Renewability | After a year, the insurance contract may be renewed if necessary. |
Medicals | Not necessary |
Sum Insured | between Rs. 1,00,000 and Rs. 5,00,000 |
Discount | Depending on the chosen co-pay, the policy offers a discount on the premium. For a 10% co-payment: 10% off the premium 20% off the premium is given for a 20% co-payment. 30% off the premium is given for a co-payment of that amount. 40% off the premium is given for a co-payment of that amount. 50% off the cost of the premium is given for co-payments of 50% or more. |
Co-payments | The plan requires a mandatory 20% co-payment. |
Coverage offered on the policy | There is a maximum liability with respect to each disease, and the policy only covers the listed diseases, illnesses, and injuries.incidental harmreplaced kneeCancerStrokevascular conditionsOrthopaedic conditionsharmless prostatediseases of the eyes, oropharynxlung disease with chronic obstructionailments of the liver and bilelong-term renal failureICU fees, hospital room, board, and nursing costsA medical emergency ambulance feeFees for specialists or consultants as well as for physicians and surgeonsAnesthesia, blood, oxygen, operating room fees, and surgical equipment costsCost of prescription drugs, consumer goods, and other itemsThe price of prosthetics like pacemakers and artificial limbsX-ray and other diagnostic test costs |
Benefits and the political system | gives the advantage of home hospitalizationreduces the premium for voluntarily making a co-paymentUp to Rs. 1 lakh, cashless service through TPAafter four years of continuous claim-free time, offers benefit on the cost of a health check-up.provides tax advantages on the premium under Income Tax Act section 80D. |
Exclusivity and the policing | Any illness, condition, or ailment, or any condition resulting from one, other than those listed in the policy as coveredAge-related osteoporosis and osteoarthritis, cataract surgery, benign prostatic hypertrophy, calculus disease, etc. are all excluded from treatment for two years.a history of illnesses and any accompanying conditions for the first two yearsAny illness that the insured person contracts within the first 30 days of the policy start date that is covered by the policy, including treatment for accidental injuries.any illness or injury brought on by a conflict, an external enemy, or nuclear materialsvaccinating, immunizing, and shavingCorrectional eye surgery, the cost of eyeglasses, contact lenses, hearing aids, crutches, braces, and walkers, among other expensesany illnesses brought on by abusing drugs, alcohol, or intoxicantsGeneral weakness or rest cureSuicide and self-inflicted injuriesPsychosomatic and psychiatric conditionsAIDS, HIV, and STDsUnless they are part of treatment, the cost of vitamins, tonics, etc.Ayurvedic treatments include massages, steam baths, shirodhara, and similar procedures.hospitalization period attendant and nursing fees, as well as doctor’s home visits fees.Acupuncture, accupressure, and naturopathy |
Oriental Senior Citizens Health Insurance Plans
The senior Oriental Health Insurance plan is shown in the following table:
HOPE (Oriental Health Of Privileged Elders) Plan
The Oriental Insurance Company created this policy specifically to meet the needs of senior citizens and their healthcare. It is a complete health program that provides a variety of benefits, including hospitalization and home health care.
Which Characteristics Stand Out?
- Designed specifically for citizens 60 years of age and older.
- Available in various Sum Assured options
- Only addresses specific diseases
- For choosing voluntary co-payment, the premium is reduced.
- The premium has no claim discount.
- Rapid claim resolution procedure
How Do the Plan Benefits Work?
Policy Advantages
- For stays of more than 24 hours, in-patient hospitalization costs such as lodging, nursing, and board are covered.
- Subject to sublimity, the policy covers specific diseases, illnesses, and injuries.
- Costs associated with pre- and post-hospitalization are covered for a period of 30 days before admission and a period of 60 days following discharge.
- Surgeon, anesthetist, doctor, consultant, and specialist fees, among others, are covered.
- Covers specified illnesses like Knee Replacement, such as knee replacement, cardiovascular and vascular disease, chronic renal failure, Cancer, stroke, etc. including coverage for certain diseases, such as knee replacement, cardiovascular and vascular disease, chronic renal failure, cancer, and stroke.
- For the listed diseases or illnesses, domiciliary hospitalization costs are covered.
- The following expenses are covered, subject to the policy limits: anesthesia, blood, oxygen, operating room fees, surgical appliances, medicines & drugs, dialysis, chemotherapy, radiotherapy, artificial limbs, cost of prosthetic devices implanted during surgery, such as pacemakers, relevant laboratory / diagnostic tests, X-ray, etc.
- includes Ayurvedic, Unani, and homeopathic care provided in government hospitals.
- Subject to sublimity, the policy covers specific diseases, illnesses, and injuries.
Value Added Advantages
- After each claim-free policy year, a No Claim Discount of 5% (five percent) of the renewal premium is due, up to a maximum of 20% (twenty percent).
- Benefit from taxation under Section 80 D of the Income Tax Act of 1961.
- Available TPA services include a Rs. 1 lakh cashless service cap and are only available through TPA.
- This plan provides reimbursement for ambulance service costs.
- The choice of voluntary copayment and the ability to receive a discount on the premium up to a maximum of 50%
- For every block of four claim-free years, a free health checkup is provided.
- Benefit from taxation under Section 80 D of the Income Tax Act of 1961.
Lower Limits
- Not more than 1% of the sum insured is spent each day on the room, board, and nursing costs that are provided by the hospital or nursing home.
- Home health care costs were covered up to 20% of the basic amount insured.
- ICU costs are limited to 2% of the insured amount per day.
- 20% of each valid claim will be co-paid under this plan.
- Free health examinations for insured individuals are limited to a maximum of 1% of the average amount insured.
- The cost of a knee replacement is limited to 70% of the insured amount.
- Treatment costs for cancer, hepato-biliary disorders, chronic renal failure, cardiovascular diseases, and others are capped at 50% of the insured amount.
- Treatment costs for COPD and stroke are restricted to 20% of the insured amount.
- Costs for orthopedic and benign prostatic diseases are limited to 15% of the insured amount.
- The maximum amount that can be spent on eye diseases is 10% of the insured amount.
- Home health care costs were covered up to 20% of the basic amount insured.
Waiting Period Provision
- 30 days is the initial waiting period for all illnesses (but not for renewals or accidents).
- 24 months for certain diseases. Specific waiting periods.
- Pre-existing conditions: covered after a continuous 12-month period of coverage.
- 24 months for certain diseases. Specific waiting periods.
Oriental Insurance’s HOPE Plan for Senior Citizens offers additional benefits.
- Health examination fee following a block of four years with no claims
- Available premium discount for voluntarily contributing
Exclusions
- Any illness, disorder, or ailment, or any condition resulting from one, other than those covered by the policy.
- Injury or illness caused directly or indirectly by, or attributable to, war, invasion, an act committed by an enemy foreign or domestic, warlike operations (regardless of whether war is declared or not), or nuclear weapons or materials.
- Procedures to correct vision problems, the price of eyeglasses, contact lenses, and hearing aids, etc.
- Rehabilitation benefits, etc.
Oriental Health Insurance for Senior Citizens Eligibility Requirements
Review the following eligibility requirements before purchasing an Oriental Health Insurance plan for senior citizens:
Minimum Age to Enter – 60 years
Maximum Age to Enter – No age limit
Renewability – lifetime
Oriental Insurance’s HOPE Policy for Senior Citizens: Eligibility and Restrictions
Minimum | Maximum | |
Amount of Coverage (in Rs.) | 1,00,000 | 5,00,000 |
Term of the Policy (in Years) | 1 | 1 |
Age at Entry (in years) | 60 | – |
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Oriental Health Insurance for Senior Citizens- Inclusions
The following benefits are included in Oriental Health Insurance for seniors:
- The cost of hospitalization
- Domestic Hospitalization Costs
- Charges for ambulance services
- The Daycare Process
- Costs of pre-hospitalization
- Hospital Readmission Expenses
- The AYUSH Approach
- There is a maximum liability with respect to each disease, and the policy only covers the listed diseases, illnesses, and injuries.
- Incidental harm
- Replaced knee
- Cancer
- Stroke
- Cardiovascular conditions
- Orthopaedic conditions
- Unharmful prostrate
- Optical (eye) disorders
- Long-term obstructive pulmonary disease
- Disorders of the liver and bile
- long-term renal failure
- Incidental harm
- ICU fees, hospital room, board, and nursing costs
- Cost of an emergency ambulance
- Fees for specialists or consultants as well as for physicians and surgeons
- Anesthesia, blood, oxygen, operating room fees, and surgical equipment costs
- Cost of prescription drugs, consumer goods, and other items
- The price of prosthetics like pacemakers and artificial limbs
- Price of diagnostic procedures like X-rays
Tax advantages for Senior citizens’ HOPE Policy
Under Section 80D of the Income Tax Act, this plan provides tax benefits for the premiums as a deduction from the taxable income.
Oriental Health Insurance Exclusions for Seniors
- Other than those listed in the policy as covered, any disease, health condition, illness, or ailment, as well as any condition resulting from it
- Age-related osteoporosis, cataract surgery, osteoarthritis, calculus disease, and arthritis are all excluded from treatment for two years.
- disease and conditions that have existed for the first two years and are related
- Except for treatment for accidental injuries, any illness covered by the policy that the insured person develops within the first 30 days of the policy’s start date
- Any harm or ailment brought on by a foreign enemy, a war, or nuclear materials
- Vaccination, inoculation, and circumcision
- Expenses associated with hearing aids, crutches, braces, and walkers, as well as surgery to correct vision problems,
- any illnesses brought on by abusing alcohol, drugs, or other sedatives
- Weakened state or rest cure
- Suicidal thoughts and self-inflicted wounds
- Disorders of the mind and body
- AIDS, HIV, and STDs
- Unless they are part of treatment, the cost of vitamins, tonics, etc.
- Such treatments include naturopathy, acupuncture, and acupressure.
- Ayurvedic treatments include massages, steam baths, Shirodhara, and similar procedures.
- Fees for medical home visits, as well as pre-and post-hospitalization fees for attendants and nurses.
The following are the exclusions for senior citizens’ Oriental Health Insurance:
- Corrective eye surgery
- The cost of organ donors
- Convalescence
- Self-harm with intent
- HIV AIDS
- Addiction to drugs or alcohol
- Plastic surgery, cosmetic surgery
- Outside of India’s borders, treatment
FAQs
Q1. What waiting periods are there for senior citizens who purchase Oriental Health Insurance?
Ans: The following waiting periods apply to the Oriental Health of Privileged Elders plan:
Existing Conditions waiting time of two years
a. 30 days is the initial waiting period.
b. Listed illnesses have a waiting time of two years
Q2: Do I need to get a pre-acceptance physical before purchasing Oriental Health Insurance for Seniors?
Ans: In order to purchase the Oriental Health of Privileged Elders plan, senior citizens must go through a pre-acceptance health examination.
Ans: By visiting the insurance company’s official website, you can view the premium schedule for the Oriental Health of Privileged Elders plan. As an alternative, you can use the health insurance premium calculator to check the premium for your HOPE policy.