Individual Health Insurance

What is Individual Health Insurance? 

An Individual Health Insurance is an insurance plan that covers the medical expenses for various healthcare problems on an individual basis, according to the amount insured and premium paid. Health Insurance has become a necessity ever since the Covid-19 pandemic has become a part of our lives. This insurance policy is different for every individual and hence must be taken for every member of a family. It is customizable based on every individual’s needs. You can avail of tax benefits under section 80D or this insurance policy.  

You can renew this policy for a lifetime. Individual Health Insurance can also be bought if an individual has company-sponsored health insurance. Since company-sponsored health insurance policies do not cover all medical expenses can be extended coverage. This insurance policy acts as a savior for all emergency medical services such as ambulance, hospitalization, surgical expenses, organ donation, daycare products, etc. Since the policy is created on an individual basis, one can not share its benefits with the other members of their family.  

Features of Individual Health Insurance 

Following are the features of Individual Health Insurance:  

  • Individual Coverage: Individual Health Insurance can be purchased on an individual basis. Hence, the benefits of the covers can only be utilized by the individual and not by anyone else in their family.

  • Necessary Insurance for Elderly People: Elderly people are prone to health issues. With old age, they are always at a greater risk of having a medical emergency as compared to the younger generations. Individual Health Insurance is one of the necessary insurance policies for senior citizens to cover their medical expenses.  

  • Insurance Amount: The insured sum differs as per the different plans. The maximum amount insured under Individual Health Insurance is Rs 1 Crore.  

  • Coverage: Individual Health Insurance covers a wide variety of medical expenses for an individual. Some of the expenses covered under this insurance policy includes hospitalization charges, ambulance costs, surgical expenses, pre and post-admission costs, daycare products, etc. 

  • Multiple Claims in a Given Period: Individual Health Insurance is usually renewed for a period of 365 days. You can claim multiple medical expenses during this time without worrying about the insured amount being exhausted.  

  • Discounts and Offers: There are scopes of availing various offers on Individual Health Insurance. If two or more family members purchase the insurance policy on an individual basis, they can get certain family discounts on the overall policy.  

  • Bonus on Premiums: Individual Health Insurance also has a cumulative bonus feature. The feature allows you to get a bonus on the premium amount in a case where you did not file the claim in the previous year.  

  • Lifetime Renewability: There is no barrier on how many times you can renew Individual Health Insurance. You can renew the policy for a lifetime if you want to.  

  • Tax benefits under Section 80D: An individual can claim tax benefits on this insurance policy under section 80D.  

Benefits of Buying Individual Health Insurance 

Individual Health Insurance comes bearing multiple benefits for you and your family. Some of the benefits of having Individual Health Insurance are:  

  • Works as a Cushion for Emergency: Individual Health Insurance is claimed whenever you face a medical emergency. They are cost-effective as they cover your medical expenses without hammering your personal savings. This comes as a cushion for you to fall back on in times of emergency.  

  • Paying for Hospital Expenses without Cash: Individual Health Insurance comes with a cashless card. This card serves the purpose of cash payments during your hospital visits. If you have a hospitalization expense to cater to, you do not need to arrange cash when you have the cashless card. The cashless cad helps you pay your hospital bills without cash.  

  • Gives you peace of mind: Having Individual Health Insurance assures you that you will not be burdened financially in times of a health crisis. Medical emergencies can occur anytime. Individual Health Insurance covers your medical expenses and you do not have to worry about arranging finances on an urgent basis.  

  • Expense coverage: Individual Health Insurance covers your pre-post-hospitalization expenses at ease. You can cover your pre-hospitalization expenses up to 60 days and post-hospitalization expenses up to 90 days with the insurance policy. 

  • Renewable for a lifetime: You never have to worry about your medical expenses as Individual Health Insurance covers your health charges till your living and breathing days.  

  • Savings in Tax: The insured party received a tax benefit under section 80D by purchasing Individual Health Insurance.  

What is covered under Individual Health Insurance? 

Individual Health Insurance covers a wide range of medical expenses for an individual. Some of the items covered under Individual Health Insurance are:  

  • Hospitalization charges: If an individual is hospitalized for more than 24 hours, the insurance policy covers the hospitalization expenses for that individual. These expenses include the room rent, ICU charges, surgical charges, medical expenses, etc.  

  • Treatment of Covid-19: Individual Health Insurance has become the need of the hour with the inception of the Covid-19 pandemic. It covers the expenses incurred while undergoing the treatment for Covid-19. 

  • Charges for Day Care Procedures: Not all hospitalization cases require the patient to be admitted for more than 24 hours. When an individual avails of hospitalization services that last less than 24 hours, it is known as a daycare procedure. Individual Health Insurance covers the expenses of such daycare procedures as well.  

  • Pre and Post Hospitalization Costs: There are several costs associated with the pre and post-admission of an individual to a hospital. Individual Health Insurance covers these said expenses.  

  • Domiciliary Treatment: There are cases when an individual can not be hospitalized and the doctors recommend medical treatments at home. Senior citizens or extreme illness can be some examples where a domiciliary hospitalization is required. Individual Health Insurance covers the costs of availing of medical treatments at home in such cases.  

  • Road Ambulance Services: If an individual requires an ambulance in a medical emergency, the policy covers the ambulance charges. 

  • Alternative Treatment Forms: If you avail of treatments from alternative medical schools, such as Yoga, Homeopathy, Ayurveda, Siddha, etc, the insurance policy covers the charges of such alternative medical treatments.  

  • Organ Donation: For individuals who require an organ transplant, Individual Health Insurance covers the expenses associated with harvesting an organ from an organ donor.  

  • Preventive Medical Check-up: The insurance policy covers the charges associated with preventive medical checkups.  

What is not covered under Individual Health Insurance? 

Although Individual Health Insurance covers various medical expenses, there are some exclusions from this policy. The following medical scenarios are not covered under the insurance policy:  

  • Injuries that are self-inflicted 
  • Dental problems and treatments 
  • Medical conditions due to overuse of alcohol or drugs 
  • Injuries of medical issues due to participation in dangerous sports or activities 
  • Obesity 
  • Cosmetic issues and treatments 
  • Treatment of HIV AIDS 
  • Treatment of STDs 
  • Medical illness due to exposure to war or nuclear perils 
  • Treatment of infertility 
  • Mental well being or treatment 
  • Any injury or illness due to involvement in criminal activity or a breach of law 
  • Any injuries due to military operations 

Is cashless covered in an Individual Health Insurance plan? 

Cashless treatment is one of the major benefits and features of Individual Health Insurance. Under this feature, you do not have to pay for your medical treatments in cash. All hospitalization expenses and medical treatments that you undergo will be taken care of by your insurance provider. You can avail of this benefit at any of the network hospitals according to your insurance company. If you are hospitalized at a network hospital, your insurance provider will pay for all your covered expenses directly to the hospital and you would not have to shell out a penny from your pocket.  

Is there any waiting period in the Individual Health Insurance plan? 

Yes. There are certain criteria that an individual must meet in order to claim insurance under Individual Health Insurance. The waiting period for the policy can be summarised as follows:  

  • During the first 30 days after the commencement of the policy, no accidental claims can be raised by an individual.  

  • The waiting period varies as per the plan bought by the individual. If you want to raise a claim for any specific disease or any surgical procedure such as cataract, joint replacement surgery, arthritis, bariatric surgery, etc., there is a waiting period of 1 to 3 years as per your insurance policy.  

  • Claims can be raised for pre-existing diseases as well. The waiting period varies from 2 to 4 tears as per the terms and conditions of your insurance policy.  

  • For raising an add-on claim for a critical illness, you have to wait for 90 days since your policy has commenced.  

The claims raised are approved subject to the 30 days of survival. If an individual manages to survive the first 30 days from the commencement of their policy, their claims will be approved as per the terms and conditions of the insurance policy.  

Things to consider before buying an Individual Health Insurance plan? 

Buying an insurance policy requires detailed thinking and consideration of factors. Before you buy Individual Health Insurance, the following are a few things you must consider:  

  • Analyze your requirements and determine the sum insured: You must analyze your requirements and movies for buying Individual Health Insurance. You can make a list of all services and medical expenses you want to be covered under the policy. This will help you determine the plan you want to choose and the amount of sum you want to insure. You must make sure that the sum insured is sufficient for our requirements. This will prevent you from paying from your savings when there is a medical emergency.  

  • Network Hospitals and their accessibility: One of the terms of Individual Health Insurance is that you can claim coverage only when you undergo treatment in one of the network hospitals listed in the insurance policy. You must check the list of these network hospitals and analyze their accessibility. If they are not situated in close proximity to your home or work, you must consider another insurance company to buy the policy.  

  • Affordable plans that cover your expenses: It is seen that people aim for plans with high premium amounts in order to claim high coverage. While the coverage amount can be high, such plans can also create a huge financial burden. You must choose a plan as per your medical requirements and financial feasibility. Find a plan that takes care of your expenses and is also affordable to you.  

  • Check for hidden terms and sub-limits: Reading through the terms and conditions of your insurance policy is important to prevent any last-minute hassle. There are various conditions and sub-limits associated with certain coverages. You must know about all these limits and choose your plans accordingly. This will ensure that the policy covers your expenses and you are not caught by surprise during a crisis.  

  • Ease of claim settlement: The procedures for raising and settling claims varies as per the insurance companies. You must go through the claim process carefully before signing an insurance policy. It is suggested that you choose a policy that has an easy procedure and the one that settles claims within a reasonable time.  

  • Ratio of claim settlement: It is crucial to know about a company’s claim settlement ratio before you buy the insurance policy. Not every company settles every claim raised for all individuals. A company with a high claim settlement ratio is expected to settle your claims better as compared to a company that has a low settlement ratio.  

  • Inclusions and Exclusions of the policy: The inclusions and exclusions can differ as per the plan you choose. You must understand the items that are covered in the plan you want to buy. This will help you in forecasting your financial needs better in case you encounter medical situations that are not covered in the policy.  

  • Time of Renewability: Not every insurance policy has lifetime renewability. You must decide the time of renewability before choosing a plan. It is advisable that you choose an insurance policy with a lifetime renewability.  

  • Additional Benefits in the policy: Alongside the items covered in the policy, many insurance companies offer additional benefits such as organ donation expenses, daily hospital claims, etc. You must check these benefits and choose a plan accordingly that provides you with the benefits you require.  

FAQ of Parents Health Insurance Plans 

1.What is Individual Health Insurance and how does it work? 

An Individual Health Insurance is an insurance policy that takes care of all medical expenses on an individual basis. The policy is claimed on an individual basis. Hence one cannot share the benefits of their policy with their family, friends, or any other individual.  
You can purchase Individual Health Insurance by contacting your nearest insurance company and providing the necessary documents required. These documents include your identity proof, address proof, proof of income, passport-size photographs, and any medical reports required by the company. Once your policy is commenced and you have survived the 30 days of survival, you can raise claims as per the items covered and the insurance company will take care of your medical expenses

2.When should I buy an Individual Health Insurance plan? 

There is no set timeline for someone to buy Individual Health Insurance. It is advisable that you get insurance as soon as possible. For individuals who are already insured under the company-sponsored insurance policy, buying Individual Health Insurance can act as extended coverage as company-sponsored policies do not cover all expenses.  

3.What is covered under Individual Health Insurance? 

Individual Health Insurance covers a huge range of medical and hospitalization expenses including emergency road ambulance charges, hospitalization expenses, medicine costs, surgeries, pre-existing diseases, daycare facilities, domiciliary treatment, organ donation charges, and treatment of Covid-19.

4.What is the waiting period for Individual Health Insurance? 

Individual Health Insurance comes with an initial waiting period of 30 days since the policy is commenced. Once the waiting period is over, the waiting period ranges from 1 to 3 years according to the terms of your policy. To raise a claim for specific diseases, an individual has to wait for 2 to 4 years.

5.What are the eligibility criteria for Individual Health Insurance? 

An individual must be above 18 years and below 60 years of age to get an insurance policy in general cases. However, the plan varies for families, senior citizens, and according to the insurance companies and hence the eligibility can differ as well.