Individual Health Insurance vs Group Health Insurance

Buying health insurance has become one of our top priorities today. But when it comes to buying it, most people overlook buying an individual health plan if they already have group health insurance. While both these types of plans may offer similar coverage, they are not the same. Know the differences between group health insurance and individual health insurance in this article.

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      What is Individual Health Insurance?

      An individual health insurance policy covers the medical expenses of an individual only. This type of policy is purchased by individuals and families. The policy is issued to the person buying the policy, who becomes the policyholder.

      What is Group Health Insurance?

      A group health insurance policy covers the medical expenses incurred by a group of people. This type of health insurance policy is usually purchased by employers, cooperative societies or groups for its employees or members. While the policy is issued to the employer or the group secretary, the coverage is offered to all its members.

      Individual Health Insurance vs Group Health Insurance

      Check out the following table to know the difference between individual health insurance and group health insurance plans:

      Categories Individual Health Insurance Group Health Insurance
      Meaning Offers coverage to an individual Offers coverage to a group of people
      Who Can Buy? One individual Employers, groups, cooperative societies
      Who is Insured? Policyholder Group members and their family members
      Eligibility Criteria Must be 18 years and above (Children can be covered if the parent(s) is covered with the same insurer) Must be a permanent employee of the company or permanent member of the group
      Pre-policy Medical Check-up May be required (especially in the case of senior citizens) Not required
      Sum Insured High sum insured options available Low sum insured options available
      Pre-existing Diseases Covered after a waiting period of 2 to 4 years Covered from day 1
      Maternity Benefit May or may not be available Available
      Critical Illness Cover Available if opted by the policyholder Not available
      No Claim Bonus Available Not available
      Tax Benefit Available Not available
      Extent of control Full control by the policyholder to increase/decrease coverage Limited control is available with the insured as the coverage is decided by the employer
      Customizations Can be customized to suit the policyholder’s medical needs Not possible
      Flexibility to Compare Full flexibility to compare different insurers and choose a plan of choice No freedom to choose the insurer as it is chosen by the employer
      Premium Payment Paid by the policyholder Paid by the employer
      Claims Claims can be raised directly with the insurer Claims may have to be raised with a TPA
      Exit Criteria Most plans come with lifetime renewability Policy ceases to exist when the employee leaves the company

      In a Nutshell

      Individual health insurance and group health insurance have more differences than similarities. While one is designed to cater to the individual health needs of a person, the other one is designed to meet the medical needs of an entire group. Now that you clearly know the differences between these two types of health plans, you can sensibly decide if you need to buy an individual health plan in spite of being covered under a group health policy.

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      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

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      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

      *The scope of coverage may vary from plan to plan.

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