How Zone based health insurance works in Senior Citizen Health Insurance

How Zone based health insurance works in Senior Citizen Health Insurance

You must have experienced times when your relatives came to your city from ancestral homes to avail themselves of better treatments and amenities at your city hospital. This is mainly because even in this century, modern therapies, better hospitals, and expert doctors are not available in tier 2 and 3 cities of this country. Hence, in addition to age and history of your medical condition, the area of your residence also plays a critical part in determining your premium amount of health insurance. 

The significant differences in medical infrastructures in a metro and a non-metro city are solely responsible for health insurers' introduction of zone based health insurance. 

Zone-based Insurance Plans for Senior Citizens

Care Classic, with a maximum entry age of 65, is the most comprehensive Zone based health insurance for the elderly and young families in various cities of India.

This further reduces the regular medical costs, and the older generation is protected even if they live away from their immediate families who reside in metro cities. 

The premium is based on your current place of residence : 

  • Zone 1 includes Mumbai MMR, Thane, and Delhi NCR (with areas like Faridabad, Gurgaon, Ghaziabad, and Noida), Ahmedabad, Baroda, and Surat.
  • Zone 2 includes Bangalore, Pune, Nasik, and the rest of Gujarat.
  • Zone 3 includes the rest of India.

Although it is a Zone based insurance plan, it is an exhaustive plan covering in-patient and daycare hospitalisation, a no claim bonus of 150% of the sum insured, unlimited automatic SI recharge, and even new age benefits like e-consultations, discounts on medicines, and lab tests. Hence, if a senior citizen aged below 65 years resides in Zone 2 or Zone 3 cities, he can enjoy all benefits with a lower premium.

Those over 65 need not worry. Care Health has created another exclusive plan for seniors in India called Care for Senior Citizens. The zoning is somewhat similar, except for Zone 1, which has a much larger reach than sub-zone 1A, including Telangana. The best part is that there is no co-payment clause for treatment in a higher and lower zone.  

Hence, zone-based insurance for seniors need not be as restrictive as the area's medical services; instead, it can be beneficial in giving the elderly access to better treatment at lower cost. 

What is the Impact of Zone-based Health Insurance on Senior Citizens?

Being in a comfort zone is human nature, which is the key to these zone-based policies.

1. Premium Burden Reduced: The premium burden is substantially reduced, although the features of the policy remain the same. In the case of some insurers, a co-payment clause might be included. However, Care for  Senior Citizens is such a plan that the co-payment clause is waived, but the benefits remain the same. You do not need to bear any out-of-pocket expense even if you get the treatment done in a higher zone. So, to optimise the usefulness of zone-based insurance plans, you need to keep in mind three essential points : 

  • The city of your residence
  • The city from where you pay the premiums 
  • The city of hospitalisation or medical care services 

2. Access to Advanced Medical Care: The best part of any zone-based insurance plan is the access to advanced medical treatment. Zone 2 and 3 cities may not have hospitals with technologically advanced surgeries or tests. This opens the door to all and sundry to avail themselves of the benefits of medical advancement without the headache of expenses. You can afford to check your options and go for the treatment best suited to your budget without delay. The network of hospitals works as a boon to many seniors living in Tier II or III cities who need to be made aware of the up-to-date facilities available in Tier I cities. 

3. Freedom to Choose Place of Treatment: It's nothing new to see your grandmother or an elderly in your family being adamant about staying in their ancestral home irrespective of their medical condition. These zone-based health insurance plans for seniors have OPD care benefits, which cover doctor consultation, diagnostics and pharmacy bills when you are not around to take care of them daily. They are happy they can stay at their place, and you are relieved their health will be under check. All within the reduced premium you pay based on the zone. 

4. Cashless Benefits Across the Country: How easy and convenient that sounds. With cashless benefits across network hospitals all over India, convenience is in everyone’s hands. The Care for Senior Citizen Plan even covers Air ambulance services in case of emergency and if the doctor prescribes a condition to be critical. 

5. Benefits of Zone-based Policies For Seniors: For the elders, it is all about getting affordable coverage that will make them feel financially independent, not push them out of their own homes, and get them the best medical care even after hospitalisation.

6. Affordable Premiums: One of the significant benefits of a zone-based policy is that the cost of insurance is almost 20% lower depending on your city of residence. If one resides in Zone 3, he might pay a premium approximately 10% lower than in Zone 2.  Similarly, if he is in Zone 2, he will pay 10% less than the person in Zone 1. Since inflation and expenses are always on the rise, and sources of income for seniors are stagnant and restricted, this feature tends to lure a more geriatric population under the health insurance umbrella. 

7. High Sum Insured: The sum insured remains high irrespective of the city of your residence. Hence, you need not forgo coverage due to the low premium amount. This is significant in the case of seniors as they are more susceptible to long-term and complicated diseases that may be a fallout of pre-existing illnesses. 

8. Access to Countrywide Medical Services: In zone-based health insurance, lowering premiums does not mean restricted access to network hospitals or diagnostic centres. The Care for Senior Citizen policy even has no co-payment clause when availing treatments in a higher or lower zone. This is a huge financial relief for any senior who is undergoing any treatment that requires new-age technology, which is available only in some metros.


City-based pricing of health insurance introduces fairness in premium charging, as you can pay as per the cost of medical services available in your city, subject to some restrictions as per the insurance provider. It opens up the door for seniors living in tier 2 and 3 cities to go for advanced treatment in tier 1 cities on an as-needed basis without having to pay extra premiums. Some insurers charge a 10 or 20 % co-payment, but Care for Senior Citizen, a comprehensive Zone-based insurance for seniors, has no co-payment clause for treatment access to higher or lower zones. However, if the residence changes to a higher zone, the insurer must be informed to work out the zone-based premium amount. 

>> Also Read: Benefits of Zone-Based Health Insurance

Disclaimers: The above information is for reference purposes only. Kindly consult your general physician for verified medical advice. The health insurance benefits are subject to policy terms and conditions. Refer to your policy documents for more information.

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