Individual Health Insurance Plans
In the last few years, people have realised the importance of having health insurance and are keeping themselves financially secure. If you are a young, independent person, an Individual health insurance policy is helpful to cover all healthcare-related costs. Such policies are designed to help meet the medical expenses related to hospitalization, diagnostics, treatments against Critical Illnesses, and several other conditions or unexpected emergencies.
What is an Individual Health Insurance Policy?
Individual Health Insurance is a type of health insurance policy wherein one can avail of medical coverage on an individual sum insured basis. Individual Health Insurance plans offer scope for customizations, which allows you to include family members/dependents under separate covers. With these plans, come several benefits such as offering wider coverage including in-patient hospitalization, pre and post-hospitalization expenses, daycare procedures, ambulance charges, etc.
Eligibility Conditions
- Any adult above the age of 18 years is eligible to invest in an Individual Health Insurance policy
- Further, there is generally a waiting period of 2-4 years in case the policyholder suffers from a pre-existing medical condition.
- Individuals in the age bracket of 45-65 years and above may need to undergo pre-medical screening prior to policy issuance.
Why do I need Individual Health Insurance?
Protection against lifestyle diseases and Mental Health issues: Lifestyle conditions such as PCOS, diabetes, obesity, coupled to mental stress and anxiety are likely to increase your expenses significantly. An Individual Health Insurance policy that offers psychiatric benefits in addition to covering the cost of health check-ups can help you deal better under such circumstances. However, the coverage of Mental Illnesses varies from Insurer to Insurer, therefore, it is advised to always read the policy brochure in detail.
Quality treatment against Critical Illnesses: Critical or Terminal Illnesses such as cancer are associated with huge costs. Treatment, diagnosis, surgeries etc. require an individual to spend a large portion of their capital. However, a Health Insurance Cover at this stage can ensure quality care without the financial burden, given that these plans offer a percentage of the Sum Insured towards such expenses.
Security over healthcare inflation: Healthcare inflation rose from 3.8% in December 2019 to 7.7% in June 2021*. If you are the sole earning member in your family, investing in an Individual Health Insurance plan should be one of your key priorities. It is important to remember here that prices are only going to increase with time which makes Health Insurance a crucial investment.
Opportunities to maximise Savings: When you are covered under a Health Insurance policy, the Insurance Provider is liable to pay the expenses associated with your medical conditions. This allows you to save on unexpected healthcare expenditures and, in turn, protect/grow your existing capital reserves.
Individual Coverage amount for each member: Sum Insured with an Individual Health Insurance plan is separate for each member covered under the policy. Therefore, claims raised are independently addressed, eliminating the need to wait for the Life Insured’s claim to be settled.
* Source - The Hindu
Features & Benefits of Individual Health Insurance
Lifelong Renewability
An Individual Health Policy can be renewed for life without any kind of restrictions.
Tax Benefits
Under section 80D of the Income Tax Law, policyholders can avail of Tax Deductions subject to a limit of Rs. 25,000 to Rs. 50,000.
Wider Coverage
On receiving treatment at a Network Hospital, the Health Insurer covers your hospital bills, eliminating the need to pay out of pocket.
Cashless Hospitalization
On receiving treatment at a Network Hospital, the Health Insurer covers your hospital bills, eliminating the need to pay out of pocket.
Coverage against Pre-Existing illnesses
You can avail cover for treatment expenses related to Pre-Existing medical conditions, subject to the waiting period.
Pre- and Post Hospitalization costs
An Individual Health Policy covers up to 60 days of Pre-Hospitalization charges and up to 90 days of Post-Discharge charges.
Ambulance / Day Care charges
Certain Health Policies cover the expenses incurred as a result of Day Care procedures and road ambulance costs.
Cumulative Bonus
With each claim free year, the Insurer increases the Sum Insured by a certain amount.
Individual Sum Insured
Sum Insured is specific to every member covered under the policy.
AYUSH benefits
Individual Health Plans also cover Ayurveda, Yoga, Unani, Siddha, Homeopathy based treatments.
Eligibility Conditions
- Any adult above the age of 18 years is eligible to invest in an Individual Health Insurance policy.
- Further, there is generally a waiting period of 2-4 years in case the policyholder suffers from a pre-existing medical condition.
- Individuals in the age bracket of 45-65 years and above may need to undergo pre-medical screening prior to policy issuance.
Cost of Individual Health Insurance
The premiums charged for an Individual Health Insurance policy depends on the policyholder’s Age, Annual Income, Pre-Existing medical conditions, Location, Family Members and Sum Insured, among others. It is important that you consider these aspects and decide on a budget that ensures comprehensive coverage.
Usually, the more benefits you wish to cover under your Health Plan, the more will be the premium that you have to pay.
Age and income directly affect the premium amount. Higher the age and annual income of an individual, higher is the premium payable.
The cost of healthcare is likely to be more expensive in metropolitan areas. Therefore, for individuals living in metros, a high cover is required, which effectively means that you’ve to pay higher premiums.
Those who are at high risk in terms of their health, should opt for an Individual Health Insurance plan. This ensures that they don’t have to share the collective Sum Insured, unlike plans on a Floater basis.
Opting for a multi-year Health Insurance Policy makes you eligible for discounted premiums.
Adding a member to the policy increases the premium payable against it.
For in-depth insights into how premium amounts vary, visit ‘Health Insurance Price Index’.
Claim Settlement for Individual Health Insurance
The Health Insurance provider, upon validating the legitimacy of your condition, moves to settle the claims raised. The amount paid is subject to the Sum Insured by the policyholder. For your information, Claim Settlement is done either through Cashless Hospitalization or Reimbursements.
Cashless Claims
If the policyholder chooses to get treated in a Network Hospital, they can avail Cashless Hospitalization. This means that the Insurance Provider directly settles the bills with the hospital, eliminating the need for the policyholder to pay out of pocket.
Claim Intimation
Fill up the requisites at the hospital and notify your Health Insurer.
Claim Approval
Following review, the Insurer updates you about the status of your claim.
Claim Settlement
On approval, the Insurer settles your claim directly with the hospital.
Reimbursement Claims
If you choose to get treated in a hospital other than the ones in the Insurer’s network i.e. a Non- Network Hospital, you will need to pay the bills yourself and then later claim Reimbursement for the same.
Claim Registration
After hospitalization, send bills, invoices, etc. to your Insurer.
Claim Verification
The Insurer verifies the invoices and treatment related documents.
Claim Settlement
Once approved, the Health Insurer transfers the claim amount to your account.
Tax Savings with Individual Health Insurance Plans
Under the current Tax laws in India, there are certain Tax Benefits that you can avail of on purchasing an Individual Health Insurance Policy. These are:
Tax Benefits on Single Premium Payment: As per prevailing Income Tax Laws in the country, Tax deductions (up to Rs. 25,000 or Rs. 50,000) can be availed under Section 80D for lump sum premium paid towards a multi-year plan.
Tax Deductions for Senior Citizen Health Policies:Tax Deduction up to Rs. 50,000 can be claimed by policyholders for the premiums paid towards a Health Insurance policy bought for their parents. The Tax Deduction limit can range up to Rs. 1 Lakh for expenses incurred as a result of pre-specified illnesses.
Tax Savings on Preventive Health Check-Ups: Costs incurred due to Preventive Health Check-Ups are eligible for Tax Benefits, to the limit of Rs. 5,000. Further, charges related to OPD consultations and Diagnostic Tests are also associated with tax exemption benefits.
Key Pointers to Note before Buying
In order to choose the best Individual Health Insurance policy for yourself, it is important that you scout through the available options carefully. There are certain pointers that you should take a note of prior to making a purchase. These are:
-
Scope of Health Insurance coverage
If you suffer from an illness, you should estimate the costs that you might incur as a result of it. You must consider Diagnosis and Consultation fees, potential need for future Hospitalization, Cost of Medical Procedures related to your condition, etc. This will help you decide the extent of coverage that you need and further shortlist Health Insurance providers offering these benefits.
-
Sum Insured adequacy
With healthcare inflation on the rise, your Sum Insured should be sufficient to cover expensive treatment costs. The amount should reflect both current and future medical needs. Ideally, experts recommend a range of Rs. 7 Lakhs to Rs. 10 Lakhs for an Individual Cover.
-
Pre-Existing Illnesses and Waiting Period
Pre-Existing medical conditions such as diabetes, thyroid, cardiac and renal conditions are associated with a Waiting Period. The benefits under your Health Insurance policy start only after this period has lapsed. Different Insurance providers have set different waiting periods against these ailments.
-
Premiums and Co-payment
You must ensure that the premium charged is worth the coverage offered by the plan.
Alternatively, if you wish to lower your premium against the plan chosen, look for options to share the medical charges with the Health Insurer.
While Co-payment does not affect the Sum Insured, it can reduce the burden of high premiums to a certain extent.
You need to check with your Insurance Provider to confirm if the plan comes with the Co-payment clause.
-
Limits to room rent
Room Rent sublimit is an important factor to consider when buying an Insurance policy. The clause basically caps the maximum amount that can be availed for the hospital room against the total Sum Insured. Typically, you should look for plans with minimal or no sub-limits in order to avoid paying out of pocket.
-
Network Hospitals and Cashless Claim Settlement
Network hospitals in your vicinity can guarantee Cashless Hospitalization, subject to the Sum Insured. Check for the list of hospitals networked with an Insurance Provider to come to a decision.
-
List of Inclusions and Exclusions
It is always advisable to check the benefits offered and Exclusions which your Individual Health Insurance plan does not cover. The following list mentions certain inclusions and exclusions applicable under a standard Individual Health Insurance cover.
| Inclusions | Exclusions |
| Pre- and post hospitalization | Cosmetic/ plastic surgeries |
| In-patient hospitalization | Cost of Ambulance |
| Day care treatments | Injuries while being engaged in war, unlawful activities, adventurous sports, etc. |
| Health check-ups | Sexually transmitted diseases |
| Domiciliary hospitalization | Sex-changing surgeries |
| AYUSH Benefits | |
Does Individual Health Insurance have any Waiting Periods?
Yes, all Individual Health Insurance Plans come with a waiting period. To begin with, you cannot file a non-accidental claim within the first 30 days of your policy's inception. Arthritis, cataracts, joint replacement surgery, bariatric surgery, and other ailments and surgical treatments are covered after a 1 to 3-year waiting time, depending on the plan. Similarly, you can file a claim for pre-existing conditions after a 2- to the 4-year waiting period, depending on the policy terms.
If you have added critical illness coverage to your personal health insurance, you will be eligible to file a claim 90 days after the policy starts. Furthermore, the claim will be authorized after a 30-day surviving period.
Comparison between Individual Health Insurance and Family Floater
The following table highlights distinguishing features of an Individual Health Insurance Plan and a Family Floater plan.
| Family Floater Health Plan | Individual Health Plan |
| Sum Insured |
| A Family Floater plan is a comprehensive Health Cover for the entire family, wherein the Sum Insured is shared among every member. | On the contrary, the Sum Insured under an Individual Health plan is specific to the individual who bought it. |
| Claims |
| When a claim is made by a member covered under a Family Floater plan, the total Sum Insured for the entire family reduces by the amount that has been claimed. | In case of an Individual plan, a claim raised by another member of the family does not affect the cover amount of the remaining members. |
| Premium Payable |
| The premium payable against the Health Plan is calculated (among other factors) based on the age of the oldest member covered under the policy. | Under an individual policy, the age of the insured person who bought the policy determines the premium. |
| Premium vs. Coverage |
| While the premiums are lower under a Family Floater policy, the coverage offered by an Individual Health Insurance policy is more extensive. |
