Individual Health Insurance Plans in India

What is Individual Health Insurance?

As the name suggests, this policy covers the medical expenses of only an individual, i.e., of one person only. This means purchasing an individual health policy will cover only you for medical bills and treatments. Your family cannot use this policy for their medical situations or emergencies. Similarly, if you purchase this insurance, say for your spouse, only they can utilize it for their healthcare, you cannot use it for your medical expenses. This is the key difference between an individual health insurance policy and a family floater plan.

Since it covers only one person, it offers more diverse coverage than a family floater plan and may have a higher premium. It usually includes coverage for hospitalisation, day-care treatments, surgeries, organ donor expenses, modern treatments, critical illnesses, etc. The premium amount for individual health insurance depends on various factors, such as your age, medical history, gender, coverage, and so on.

Want to know more about health insurance? Read our guide on what is health insurance and its different types.

Features of Individual Health Insurance

Some of the key benefits of an individual health insurance plan are as follows:

• Comprehensive Coverage: The main feature of the individual health insurance plan is that it provides you with better coverage than a family floater plan, where the benefits are shared among the covered family members. You can customise this plan based on your individual needs, thus including more relevant services.
• Cashless Facility: With individual health insurance, you can get your covered treatments without worrying about upfront payments. It means that in case of hospitalisation or surgery, medical expenses covered under your medical policy are paid by the insurance company to the hospital, allowing you to focus more on your health rather than financial obligations.
• Sum Insured: While the sum insured varies per various factors and a wide range of options are offered by the insurance plans, the maximum sum insured amount can be as high as INR 1 crore.
• Tax Benefits: A health policy allows you to avail yourself of tax savings on the premium amount you pay under Section 80D of the Income Tax, 1961.
• Complimentary Health Check-ups: Most individual health policies in India offer annual preventive health check-ups. This lets you know your health conditions and address any issues before they intensify. The frequency of the health check-up may be once or twice a year, depending on the insurance provider you choose.
• Can be Clubbed with Government Schemes: You can combine a private individual health policy with the various government health insurance schemes like Ayushman Bharat Yojana - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) for better coverage and benefits.

What is Covered under Individual Health Insurance Plans?

It is to be noted that not all medical bills and treatments are covered under a health policy. The inclusions vary across different health insurance providers. However, most individual health insurance plans in India cover the following:

• In-patient hospitalisation
• Pre and post-hospitalisation
• Day-care treatments
• Out-patient care (OPD) consultations
• Home healthcare
• ICU charges
• COVID-19 treatment
• Modern day treatment
• Personal accident
• Organ transplant
• AYUSH treatment*

*Note: According to an IRDAI mandate, all health insurance providers are now required to add options for AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy) treatments. Some insurance companies offer this as an in-built option in the health policy, while others provide it as an add-on.

What is Not Covered under Individual Health Insurance Plans?

The exclusions (benefits not covered by your insurance plan) vary from one insurance provider to another. Hence, you should check the exclusion for your preferred policies before choosing.

Most individual health insurance plans do not cover the following:

• Cosmetic Surgery Costs
• Dental Treatment (Some insurance plans may cover it partially)
• Adventure Sport Injuries
• Self-inflicted injuries or suicide
• Any injury caused due to a breach of law
• War-inflicted injuries
• Treatment for Alcoholism & Drug Abuse
• Congenital external anomalies
• HIV AIDS

What is the Optimum Coverage for Individual Health Insurance?

Usually, the health cover should be around at least half of your annual salary. However, considering the constantly rising medical care costs in India, this amount may not be sufficient to support the modern day medical expenses. Hence, it is recommended to purchase an individual healthcare policy of around INR 5 to 10 lakh.

How to Buy Individual Health Insurance Online?

Purchasing individual health insurance online is a straightforward process. You also get the opportunity to review and compare various policies together, thus understanding what premium amount you will have to pay and what coverage & benefits you will get in each of them. It is quicker than the traditional method as it involves minimal or no paperwork and no human interference. You can complete the process yourself, making it a convenient option.

Let us briefly look at how you can buy an individual health insurance online with Policybazaar:

• Visit the official website Policybazaar.com.
• Click on the 'Health Insurance' icon.
• Select 'self' or the family member you want to insure, and click Continue.
• Enter your age, location, name, and mobile number.
• Provide details of any existing diseases or previous surgeries.
• You will be shown a list of multiple insurers offering individual health plans.
• Thoroughly read and compare the terms and conditions of the plans that appeal to you.
• Choose the plan most suited to your health requirements and pay its premium online.
• You will receive a copy of your policy in the mail in less than 2 minutes.

Individual Health Insurance Claim Process

You can make a claim with individual health insurance in two ways: cashless claim and reimbursement.

1. Cashless Claim:

   With a cashless claim, you do not have to make upfront payments and can directly go for your medical treatment. The medical bills are cleared directly by the insurance company.

   To raise a cashless claim, follow the below steps:

   • You must submit the duly filled claim form at the time of hospitalisation. This form can be taken from the hospital or directly downloaded from the insurance provider's website.
   • The claim form and your medical reports are then sent to the insurance company for review.
   • Once the insurer approves the claim, your medical bills are paid directly to the hospital, subject to the terms and conditions of your health plan.

2. Reimbursement Claim:

   This form of claim is mostly used at non-network hospitals. Here, you have to pay the medical bills first, and then the insurance company reimburses it to you, subject to the terms and conditions of your individual health policy.

   • Submit the duly filled claim form along with your reports and medical bills to the insurance company.
   • Once they review and approve the claim, you will receive the eligible reimbursed amount for your medical expenses.

   It is to be noted that with the new government initiative 'Cashless everywhere,' you can avail a cashless treatment at a hospital of your choice, even if it is not in the insurance company's network.

Things to Keep in Mind Before Buying Individual Health Insurance

Before you purchase an individual health policy, it is important to critically analyse and determine your health needs so that your chosen plan meets your expectations. Below are some important things to remember before making an informed decision.

• Thoroughly check the exclusions which are not included in your health policy. Ensure that the individual health insurance plan you choose is tailored to your health needs and covers all or most medical aids you may require.
• Pay special attention to the waiting period as you can claim for certain specific treatments and pre-existing diseases only after this duration.
• Greater the amount of sum insured, greater would be the scope of coverage, and greater may be the premium amount.
• Remember to check the sub-limits under various covers and the co-payment options so that you have sufficient coverage per your expectations.

If you want more tips on how to choose the right health policy, read our article where we have covered 10 tips to choose an ideal health insurance plan.

Conclusion

Individual health insurance plans are meant exclusively for the policyholder. The sum insured cannot be shared with the family members. Hence, it is a suitable option for people who prefer wider coverage and want to address their own health issues. Remember to read all the terms and conditions of the plans thoroughly before selecting the one that meets your health requirements.