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Individual Health Insurance

Health insurance is a contract between an insurer and an individual, where the former guarantees to deal with specific medical expenses of the insurance holder depending upon the investment being made. Health insurance providers in India offer health insurance plans for individuals, as well as for the family. 

The individual health insurance plans cover just a single individual, the policyholder, who receives the advantages of health insurance in times of need. 

What is Individual Health Insurance? 

Individual health insurance plans are designed to cover the policyholder against different diseases with the help of cashless hospitalization and various other add-ons, depending upon the plans chosen. Under this policy, the whole sum insured is offered to one individual only. 

Some of the features of individual mediclaim policies include- cashless hospitalisation benefit, 100% sum insured restoration, free health checkups (subject to terms and conditions), daycare treatment, Domiciliary expense cover etc. Pre and post-hospitalization expense cover along with robust financial advice and claim assistance is another attraction of these plans. Some health insurers even cover pre-existing diseases as well. The potential policyholder can get insured from the safety of his/her home, as the process of application and verification are conducted online. 

In order to settle down with the best option available, one should compare health insurance plans. There are various insurance aggregator websites, which help the potential policyholders to compare the individual health insurance plans online and shop for maximum benefits. Online insurance comes with certain benefits such as discount on policies, multiple policy options to choose from, best quote suggestions based on the requirement, saving on time and money and more. 

Why Should You Choose Individual Health Insurance? 

The reasons for buying individual health insurance are: 

  • This kind of health insurance plan is most appropriate for individuals who have higher health issues
  • Individuals may extend the benefits of their plans to their family members who will also be protected
  • An individual shall get the advantage of the assured sum as opposed to floating sum
  • Individuals can renew the policy without having to stress over any age limitation
  • An individual who needs insurance benefits than what is offered under a family floater plan
  • Cashless hospitalization benefits without formalities of immediate payment in case of life-threatening emergencies 

Features and Benefits of Individual Health Insurance 

The key features of individual health insurance plans are: 

  • Health insurance for individuals offers the coverage for insured only
  • The insurance provider will provide coverage for certain medical costs incurred by the policyholder, depending on the plan chosen
  • Some policies come with lifetime renewal benefit
  • This policy also offers tax deductions under the section 80D of the Income Tax Act 1961 upon the premium paid
  • Under in-patient coverage, this policy compensates the insured for room rent, physician’s fee, surgery costs, the costs for laboratory tests and more during a hospitalisation
  • Some policies come with co-payment option where a portion of the claim is shared by the insured.
  • Pre- and post-hospitalization expenses will also be covered under this plan
  • This plan can be clubbed with other add-on covers such as critical illnesses 

Benefits of Individual Health Insurance Plan 

Some of the unique benefits of this policy are mentioned below: 

  • This plan is suited for people with high health risks
  • The sum insured amount can be availed as an individual basis, where the policy benefits are paid to the insured only
  • Immediate family members including parents may also be added to this plan
  • There will be no restrictions on the maximum age for extant policyholders who wish for the renewal of their policy (If the insurer provides lifetime renewability option)

Best Individual Health Insurance Plans in India 

There are many insurance providers offering individual health insurance policies with vivid features. However, to help you with making an informed choice, we’ve compiled a list of top health insurance policies to choose from. Although, a thorough comparison is still recommended. 

Bajaj Allianz Health Insurance - Individual Health Guard 

Individual health insurance from Bajaj Allianz helps the insured to mitigate those unplanned expenses arising out of a medical emergency. The insurer ensures cashless hospitalisation facilities at 6500+ network hospitals across the country. 

The main attributes of the Bajaj Allianz Individual Health Guard are as follows: 

  • This individual health insurance policy allows the policyholder to receive a waiver on hospitalization charges.
  • This policy allows the policyholder to receive a 10% discount for his/her family members.
  • This policy allows the policyholder to receive cashless hospitalization benefits in the insurer's partner hospitals in more than 6500 hospitals across the whole country.
  • This policy will cover relevant pre- and post-hospitalization expenses, within a timeframe of 60 days before the hospitalization or 90 days after the hospitalization has taken place.
  • In case of any emergency, this policy also covers the costs of the ambulance to and from the medical facility up to Rs 1000.
  • The sum assured provided by this policy will be in the range of Rs 1.5 - Rs 10 lakhs for any individual who is aged anywhere between 3 months to 55 years. For any individual who is aged anywhere between 56 years to 65 years, the sum assured provided by the policy will be somewhere between Rs 1.5 to Rs 5 lakhs.
  • There are 130 different daycare procedures which are covered under the Bajaj Allianz Individual Health Guard policy.
  • For the Bajaj Allianz Individual Health Guard policy, any individual who is aged between 18 to 65 years, will eligible for an individual health insurance policy.
  • This policy may also be extended to the parents as well as spouse.
  • The policyholder may also take this policy up for his/her children. They need to be aged between 3 months to 25 years for the policy to be extended to them. 

Oriental Health Insurance - Individual Mediclaim: 

This policy from Oriental Insurance is available for individual between the age 18 to 65 years.

The main features of this Oriental Health Insurance - Individual Mediclaim are: 

  • This policy offers cashless hospitalization and reimbursement upon hospitalization to the policyholder if he or she has been admitted to any of the partner hospitals across the country.
  • This policy covers relevant pre - and post-hospitalization expenses, within a timeframe of 60 days before hospitalization has taken place or 90 days after the hospitalization has taken place.
  • Under this policy, the hospital charges will be waived, whether it is for nursing expenses or room/boarding, up to either an amount of Rs 5000/- or 1% of the sum assured, whichever is less of these two.
  • As for the family members who are covered under the same policy, they will receive a discount of up to 10% on medical expenses
  • Any special fees, whether it is for an ambulance, surgeons, medical consultation, etc. will be covered under this policy
  • Option of voluntary co-payment of 10% and 20% leading to corresponding discount on premium up to 20%.
  • The sum insured will range between Rs 1 lakh to Rs 10 lakh 

Star Health Insurance - Medi Classic Insurance

The main features of the Medi Classic Insurance offered by Star Health Insurance are: 

  • The individual who is insured will receive insurance protection including in-patient hospitalization expenses
  • Fees of medical practitioners, such as Surgeons, Specialists, Anesthetists, Consultants, etc. will be covered
  • In case of any emergencies, the charges for the covered patient's transportation to any partner hospital via an ambulance will be covered up to Rs 750 per hospitalization, and a maximum of up to Rs 1500 per policy period
  • The charges of Anesthesia, Blood, Oxygen, charges for the Operation theatre, Pacemaker costs, etc. will also be covered under this policy
  • Under this policy, nursing expenses, room charges, and boarding facilities as provided by the Hospital or Nursing Home will also be covered at the rate of 2% of the total Sum Insured, up to a maximum of Rs 5,000 per day
  • Non-Allopathic treatments will also be covered by this policy, till a sum of up to 25% of the total sum insured, till a maximum of Rs 25,000 per policy period
  • The policy term is generally one-year long. However, a special discount of 5% is provided when the total premium is paid for two years in advance. 

Eligibility Criteria for Individual Health Insurance 

While the eligibility criteria for individual health insurance plans may differ from one insurer to another, it generally follows the below-specified criterion 

  • As per product specifications of most of the individual health insurance plans, the minimum entry age for an individual can be 18 years (depending upon plans), while the maximum age can be up to 65 years. 
  • Some policy come with lifetime renewability, where there is no maximum entry age required. 
  • The policy term also varies from plan to plan. The policy term can be renewed every year for the entire lifetime of the policyholder. 
  • As for the Premium Paying Term (PPT), for the regular payment plans, it is equal to the policy term. For the limited pay or single pay plans, it may be similar to the policy term or five years. The premium paying frequency can be annual, half-yearly, quarterly, or monthly. 

Inclusions of Individual Health Insurance 

The basic policy coverage include the following – 

In-patient Hospitalisation 

In hospitalization cases, the expenses incurred by 24 hours or more are covered. The inclusions are the following: 

  • The room rent of the hospital is covered.
  • ICU room rent is also covered
  • OT charges in case of surgeries are covered
  • Fees incurred on the services by Nurse, Doctor, Surgeon, Anesthetist are covered.
  • The cost of medicine, blood, oxygen, is also included. 

Pre and Post-hospitalization 

Pre hospitalization medical costs (before being hospitalised) incurred and post-hospitalization medical costs (after being discharged from the hospital) are covered for a specified time frame. 

Ambulance Costs

Costs incurred to take the insured to the hospital and also cost for treatment (if any) in an ambulance are covered up to a limit. 

Daycare Treatments

 The expense for daycare treatments, i.e., treatments which do not require hospitalization for 24 hours, are covered. 

Organ Donor Expenses

The health plan covers the cost of harvesting the organ from the donor and the cost for the transplant surgery. 

AYUSH Treatment

Ayurveda, Unani, Siddha, and Homeopathy, and other alternative non-allopathic therapies are covered under many health plans. 

Domiciliary Treatment Cover

The expense for Domiciliary treatment, where non-availability of hospital beds or critical condition of the insured leads to treatment taken at home, are covered. 

Free Health Check-ups

Free preventive health check-ups are allowed once in 1-4 claim-free policy years by almost all health insurance policies. 

Restore Benefit

A prevalent benefit that is available in many health insurance plans today is to Restore advantage. When the policy gets partially or wholly exhausted due to claims, you are allowed to reinstate the entire sum insured in the policy year by Restoration benefit. However, the benefit cannot be taken the same illness of the same person or for more than once in a year. 

Additional Coverage: 

The above are the standard features found in most health plans, however, the popular plans include some of the below-mentioned features as well–

  • The cost of childbirth in case of maternity coverage
  • Maternity cover bundled with Newborn baby coverage
  • Coverage of medical costs incurred on an outpatient basis, i.e., OPD coverage
  • Personal accident cover either as in-built or add-on cover 

Exclusions of Individual Health Insurance 

Although individual health insurance plans cover most of the general medical expenses, there are still some exceptions, which are listed below: 

  • Individual health insurance plans may cover the policyholder's pre-existing diseases, which is subject to a waiting period of 2-4 years which may prove to be a disadvantage to some potential policyholders.
  • Costs of prescription glasses, visual-aids such as lenses as well as hearing aids are not covered by this plan.
  • Dental treatment is not covered by this plan.
  • Naturopathy treatment is not covered by this plan.
  • Specific ailments such as hernia, cataract, sinusitis, etc. will not be covered under the first year of the policy. 

*Kindly refer to the policy document for the complete list of exclusions 

Claim Process of Individual Health Insurance 

Before you choose the right individual health insurance plan, it is essential to know the process of claim settlement, as it differs from insurer to insurer. Also, any eventuality is generally unplanned, so secure processing of the claim becomes a necessity. 

  • Reimbursement Claim: Reimbursement claim facility is to be taken in case of healthcare services availed from a non-network hospital. Once the insured or beneficiary of the policy submits the claim form along with important documents; the insurance company verifies the claim form. After verifying the form thoroughly, the insurance company processes the claim and transfers the sum assured to the beneficiary's account. In case of reimbursement claim, the hospital bills are paid by the insured on his/her own initially and register a claim later. 
  • Cashless Claim: Cashless Claims are generally settled directly by the insurer, where the insured has to request for seeking cashless services through a pre-authorisation letter. Also, some individual health insurance plans offer hassle-free as well as customer-friendly direct claim settlement without the intervention of TPA, which makes the process faster as well as seamless. 

Documents that ought to be kept handy while filing for the claim are: 

  • Original Policy Document
  • Claim Form (All relevant fields must be thoroughly filled)
  • Original/Attested Death Certificate by a relevant Government officer, which must state the exact cause of death
  • Address Proof
  • Photo identity
  • Bank Pass Book or Cancelled Cheque or Bank Statement 

Apart from submitting the documents mentioned above, the beneficiary needs to provide a written mandate for the insurance provider to be allowed to transfer the amount claimed to the nominee’s bank account through NEFT. 

Renewal Process of Individual Health Insurance 

The renewal process of individual health insurance plans can be done over a lifetime, by any of the following modes, which are: 

  • Online through the insurer’s website
  • Through sending toll-free SMS with specific codes
  • Through an agent or broker
  • Payment may be made online, through debit/credit card, net banking or by cash through the intermediaries 

The Home Page will have an option called 'Renewal Premium Payment.' One should click on that, then submit the specific Policy Number, registered Email ID, and Date of Birth. After successful renewal, he/she would get the digital payment acknowledgment slip in their registered Email ID. 

If the policyholder chooses to opt for the case of Advance Premium Payment, the renewal receipt will become generated only after allocation/adjustment upon the due date of premium. 

Alternatively, the policyholders can choose to renew the policy processing by using the kiosks (in case the policy providers are banks) and selecting the specific option for renewal processing. 

Individual Health Insurance FAQs 

Written By: Paisawiki - Updated: 22 February 2021
Disclaimer: Paisawiki does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.