Individual Health Insurance – A Quick Guide

What is Individual Health Insurance?

Individual health insurance is an insurance plan that offers medical coverage to a person on an individual sum insured basis. It refers to the type of health insurance plan that needs to be purchased separately for each family member. It allows you to customize the coverage as per your own health needs and not of the entire family.

Most individual health insurance plans provide comprehensive coverage to an individual for emergency medical expenses resulting from hospitalization costs, day care procedures, road ambulance services, alternative treatment, organ donor expenses, etc. However, the premium and coverage of an individual health policy cannot be shared amongst your family members.

Features and Benefits of Individual Health Insurance

An individual health insurance policy comes with the following features and benefits:

• Solo Coverage - It ensures that the sum insured can be utilized only by you.
• Suitable for Older People- It is more suitable for elderly people with greater health risks.
• Sum Insured – It comes with a maximum sum insured of Rs 1 crore depending on the plan.
• Wider Coverage- Individual health insurance policies offer a wider coverage including in-patient hospitalization, pre and post-hospitalization expenses, daycare procedures, ambulance charges, etc.
• Add-on Covers- It provides you with the option of buying add-on covers, such as critical illness cover, outpatient treatment benefit, restoration benefit, maternity benefit, etc.
• Multiple Claims- You can make multiple claims in a year as long as the sum insured is not exhausted.
• Family Discount- Most individual health plans offer a family discount if more than two family members are covered on an individual basis.
• Cumulative Bonus – It provides a discount on premium if you do not file a claim in the previous policy year.
• Renewal for Life- The plan comes with lifetime renewability.
• Tax Benefits– It offers tax savings on the paid premium under Section 80D of the Income Tax Act

What is Covered under Individual Health Insurance Plans?

An individual health insurance policy provides coverage for the following:

• In-patient Hospitalization Expenses– It covers the medical expenses incurred due to getting admitted to a hospital for more than 24 hours. It includes room rent, medicine cost, ICU charges, etc.
• COVID-19 Treatment– It provides coverage for the expenses incurred on the treatment of COVID-19.
• Day Care Procedures– It covers the cost of availing day care procedures that requires less than 24 hours of hospitalization.
• Pre and Post-hospitalization Expenses– It covers the medical expenses incurred before getting admitted to the hospital and after getting discharged.
• Domiciliary Hospitalization– It pays for the cost of availing medical treatment at home on the recommendation of a doctor.
• Emergency Road Ambulance– It covers the charges for availing road ambulances services in case of a medical emergency.
• Alternative Treatment– It provides coverage for the treatment taken through the alternative schools of medicine, including Ayurveda, Unani, Siddha, Yoga and Homeopathy.
• Organ Donor Expenses– It pays for the expenses incurred on harvesting a major organ from a donor if you need an organ transplant.
• Preventive Health Check-up– It covers the cost of availing preventive health check-up facility.

What is Not Covered under Individual Health Insurance Plans?

Individual health insurance plans do not provide coverage for the following:

• Dental treatment
• Self-inflicted injuries
• Abuse of alcohol or drugs
• Obesity treatment
• Infertility treatment
• Cosmetic treatment
• Injures due to participation in dangerous sports
• Congenital external anomalies
• HIV AIDS
• Injuries or illness due to war or nuclear perils

Is Cashless Treatment Available under Individual Health Insurance Policy?

Yes. A cashless treatment facility is available under the individual health insurance policy. Under this facility, your insurance provider pays your hospitalization bill amount directly to the network hospital where you were undergoing treatment. It does not require you to pay the medical expenses out of your own pocket. You can avail cashless hospitalization facility at any of the network hospitals of your insurance company.

Are There Any Waiting Periods under Individual Health Insurance Plans?

Yes. All individual health insurance plans come with certain waiting periods. Firstly, you cannot raise a non-accidental claim during the first 30 days of the policy commencement. Specific diseases and surgical procedures like arthritis, cataract, joint replacement surgery, bariatric surgery, etc. are covered after a waiting period of 1 to 3 years depending on the plan. Similarly, you can raise a claim for pre-existing diseases after a waiting period of 2 to 4 years as per the policy terms.

In case you have opted for a critical illness add-on cover, you will be able to raise a claim after 90 days of the policy commencement date. Moreover, the claim will be approved subject to a survival period of 30 days.

How to Buy an Individual Health Insurance Policy Online?

You can easily buy an individual health insurance policy online at the website of Policybazaar Insurance Broker Private Limited. Follow the steps given below to purchase individual health insurance online:

• Visit the website of Policybazaar.com
• Click on the icon of ‘Health Insurance’
• Enter your name, gender, mobile number and age
• Choose the city in which you live
• Provide details of any existing diseases or previous surgeries
• Individual health insurance plans from multiple insurers will be shown
• Select the most suitable plan and pay its premium online
• Your policy will be issued in less than 2 minutes.

To make a better decision, make sure to compare individual health insurance plans offered by various insurers and choose the plan that best covers your health requirements.

How Much Individual Health Insurance Coverage Should You Have?

As per insurance experts, the coverage under your health insurance policy should be at least 50% of your yearly income. A minimum of Rs 10 lakh of medical insurance cover is required to meet expensive treatments like bypass surgery, COVID-19 treatment and related complications, etc. The coverage can go as high as Rs 1 crore depending on the plan.

Things to Keep in Mind While Buying an Individual Health Insurance Policy

While buying an individual health insurance policy, you must keep the following things in mind:

• Analyze Your Health Requirements– Before you begin the process of buying an individual health policy, you should analyse your health requirements. Make a list of coverage and service benefits that you want under your policy. Also, estimate the ideal coverage amount to help you choose the right sum insured.
• Check the List of Network Hospitals– At the time of selecting the policy, remember to check the list of network hospitals of the insurance company. Find out if you have any network hospitals near your home and office. If not, then go for a policy by another insurance company.
• Affordability of the Plan– You should buy an individual health insurance policy with affordable premiums. Do not opt for an expensive policy to get higher coverage as it may create an unnecessary financial burden. Instead, choose a policy that best fulfills your coverage expectations without overshooting your budget.
• Check for Any Sub-Limits– Most health plans may come with a sub-limit for certain covers. You must check the applicable sub-limits under various covers before choosing a policy. This would ensure that you get sufficient coverage under different covers as per your expectations and are not in for a surprise during claims.  
• Go Through the Claim Process– Before selecting a health insurance plan, you must go through the claim of the insurance company. Check if the claim procedure is easy or cumbersome. Also, find out the number of days that the insurance company takes to settle the claim. Do not opt for a plan with a lengthy and complicated claim process.
• Check the Claim Settlement Ratio– While buying an individual health insurance policy, you must check the claim settlement ratio of the insurance providers. A company with a high claim settlement ratio is more likely to approve your claim than a company with a lower ratio.

Bottom Line

Individual health insurance plans are a must for people who have their own health issues. It offers your sum insured amount exclusively for you and you do not have to share it with your family members on a floater basis. So go ahead and buy an individual health insurance policy for yourself from Policybazaar.com after an in-depth comparison.