Individual Health Insurance Plans

Understand the features and benefits of individual health insurance. Check plans and coverage details.
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3 mins
10-May-2023

Individual health insurance offers coverage tailored to an individual sum insured basis. Given the vast healthcare challenges in India, staying financially prepared for emergencies is crucial. This type of insurance safeguards against unforeseen medical expenses, ensuring financial protection during unexpected health crises.

What is Individual Health Insurance?

Individual health insurance plans are designed to offer comprehensive coverage for medical-related expenses. These include expenses hospitalisation expenses, ambulance charges, consultation fees, treatment costs, and more. It helps to keep one financially secure in the event of any medical emergency.

Individual health insurance provides medical coverage for one person based on a specific sum insured. Unlike family plans, it needs to be purchased separately for each member and can be tailored to personal health needs. Coverage typically includes hospitalisation, ambulance services, and more, but premiums and benefits are not shared.

Features

Specification

Network Hospitals

8000+

Expenses Covers

Covered

Tax Benefit

Covered

Free Health Checkup

Covered

Pre-existing Diseases

Covered (depending on plan chosen)

Pre & Post Hospitalization

Covered

Day Care Procedures

Covered

OPD Cover

Covered

 

Why should you choose Individual Health Insurance?

Individual health plans provide personalised coverage, ensuring financial protection during medical emergencies. They offer tailored benefits, flexibility, and a choice of healthcare providers, making them an ideal solution for securing your health and financial well-being.

1. Flexibility

Individual health insurance offers flexibility by allowing you to choose coverage options that suit your specific needs. Whether you need basic coverage or a more comprehensive plan, you can select the best policy for your health requirements and budget.

2. Choice of providers

With individual health plans, you can choose from a wide network of healthcare providers. This allows you to access quality medical care from preferred hospitals and specialists, giving you greater control over your healthcare decisions.

3. Employment status

Unlike employer-based health insurance, individual health plans provide coverage regardless of your employment status. This ensures that you remain insured even during job changes, self-employment, or retirement, offering continuous health protection.

4. Portability

Individual health insurance policies are portable, meaning you can carry your coverage with you when switching jobs or relocating. This ensures uninterrupted protection, eliminating the need to reapply for insurance during transitions.

5. Family coverage

Many individual health plans offer the option to include family members under the same policy. This allows you to protect your loved ones with comprehensive healthcare coverage, ensuring the whole family is financially secured during medical emergencies.

6. Early start

Starting an individual health insurance plan early provides long-term benefits such as lower premiums, access to better coverage, and no waiting periods for pre-existing conditions. Early coverage helps you stay financially prepared for future health needs.

7. Tailored benefits

Individual health plans offer tailored benefits, allowing you to customise your policy according to your unique health requirements. This personalized approach ensures that your plan provides coverage for specific treatments, medications, and preventive care you may need.

8. Control over coverage

With individual health insurance, you have complete control over your coverage. You can choose the level of protection, add-ons, and specific benefits that match your lifestyle and health needs, providing a personalised healthcare experience.

9. Access to specialised care

Individual health plans often grant access to specialised care, allowing policyholders to consult with top-tier specialists and receive advanced treatments. This ensures that you get the best possible care for complex or chronic health conditions.

10. Peace of mind

Having an individual health insurance plan offers peace of mind, knowing that you're financially protected against unexpected medical expenses. It helps reduce stress during emergencies, allowing you to focus on recovery without worrying about high healthcare costs.

Features of individual health insurance

Some of the key features of health insurance plans for individuals are as follows:

Reinstatement of sum insured

If the base sum insured and the cumulative bonus get exhausted due to claims, you can get the sum insured reinstated on the health policy. This goes a long way to give you the necessary backup for medical emergencies.

Medical tests are optional for up to 45 years

Considering you are fit and healthy at an early age, you do not have to undergo any medical tests before buying an individual health insurance policy.

Cumulative bonus

You get a cumulative bonus for every claim-free year. You can benefit from this bonus by increasing your sum insured without paying extra premiums. Some insurers may offer discounts on renewal premium. Hence, check with your insurer when availing the benefit.

Lifetime renewability

Some individual health insurance plans come with the option of lifetime renewability. You can renew the health plan at any time after it expires. Health insurance renewal is a completely online process and you can easily renew your policy online with minimum documentation.

Additional coverage

Some individual health insurance plans for individuals also offer additional coverage in the form of critical illness coverage, maternity benefit and more.

Benefits of Individual Health Insurance Plans

Here are some key benefits of buying individual health insurance plans.

Extensive coverage

Individual medical insurance offers comprehensive financial coverage that helps one cope with sudden expenses due to medical emergencies. Get coverage for pre-and post-hospitalisation expenses, daycare treatments, and in-patient hospitalisation charges. Also covers organ donor expenses, treatment for mental illness, AYUSH therapy costs and more.

Cashless treatment option

One can opt for a cashless claim during any medical emergency that requires urgent hospitalisation. The insurance company will settle the bill directly with the hospital. However, the hospital should be on the list of the network hospitals of the insurer.

Recovery benefit

There are many individual health plans that offer financial assistance to the insured individual’s family during treatment. In case, the individual stays admitted to the hospital for more than 10 days, the family is eligible for compensation.

Tax benefits

As per Section 80D of the Income Tax Act, you can claim a tax deduction for the total premium paid for individual health insurance plans. Health insurance tax benefit is applicable for a total deduction limit of up to Rs. 25,000.

Read more: Family health insurance plans in India

What are the types of Individual Health Insurance claims?

Individual health insurance claims are generally categorised into two types: cashless claims and reimbursement claims. Both processes help policyholders manage medical expenses, offering flexibility in settling hospital bills based on the treatment received.

1. Cashless claims

  • Available at network hospitals partnered with the insurance provider.
  • No upfront payment is required; the insurer directly settles the bill with the hospital.
  • Requires pre-authorisation from the insurance company, usually before hospitalisation.
  • Ideal for planned treatments or emergencies at designated healthcare facilities.

2. Reimbursement claims

  • Applicable when treatment is received at non-network hospitals.
  • Policyholders pay the medical bills upfront and then file for reimbursement from the insurer.
  • Requires submitting necessary documents, such as hospital bills, discharge summary, and prescriptions.
  • The insurer evaluates and reimburses the eligible amount as per the policy terms.

What is covered under individual health insurance plans?

In-patient hospitalisation

Covers treatment costs during in-patient hospitalisation. This includes room rent, medication, doctor fees, tests, etc.

Pre-and post-hospitalisation

Covers hospitalisation charges for up to 30 days before and 90 days after hospitalisation. The duration varies for different insurers.

Daycare treatment

Get coverage for daycare treatment charges within the valid policy term. The individual health insurance includes the number and types of daycare treatments covered in the policy document.

Organ donor expenses

Covers expenses incurred to harvest a major organ from a donor for an organ transplant procedure.

Domiciliary hospitalisation

Health insurance plans provide coverage for domiciliary hospitalisation. You get coverage for treatment taken at home under the supervision of a medical practitioner. Usually, doctors prescribe home treatment if the patient’s condition does not permit to go to the hospital or due to the unavailability of hospital bed.

Also, read: Parents Health Insurance

What is not covered under individual health insurance plans?

Here are some of the key exclusions under the individual health insurance plans.

1. Cosmetic surgeries

Cosmetic or aesthetic procedures like facelifts, liposuction, and Botox treatments are generally not covered, as they are not considered medically necessary. However, reconstructive surgeries following accidents or trauma may be covered under certain conditions.

2. Dental treatment

Routine dental treatments, such as cleanings, fillings, and orthodontic procedures, are usually excluded from coverage. Only specific dental treatments required due to accidents or injuries may be included in some policies.

3. Self-inflicted injuries/suicide

Medical expenses resulting from self-harm or suicide attempts are typically not covered under individual health insurance plans. This exclusion is intended to prevent intentional misuse of insurance benefits.

4. Treatment for any ailment due to drug abuse

Health issues arising from substance abuse, such as drug or alcohol addiction, are not covered. Treatments for illnesses or injuries directly caused by drug abuse are also excluded from coverage.

5. Deaddiction treatment

Costs related to rehabilitation or de-addiction programs for substance abuse are excluded. This includes both inpatient and outpatient services aimed at overcoming addiction to drugs, alcohol, or other substances.

6. HIV/AIDS

Most individual health insurance policies do not cover the treatment of HIV/AIDS or related conditions. Some newer policies may offer partial coverage for HIV/AIDS treatments, but this remains an exclusion in many traditional plans.

7. Injuries or illness due to war

Injuries or health conditions arising from participation in war, acts of terrorism, or civil disturbances are not covered. This exclusion also applies to injuries sustained during participation in military activities or riots.

How does an Individual Health Insurance policy work?

An individual health insurance policy works by providing financial coverage for medical expenses incurred by the policyholder. After purchasing the policy, you pay regular premiums to maintain coverage. In the event of hospitalisation or medical treatment, you can either opt for cashless services at network hospitals or file for reimbursement if treated at non-network facilities. Individual health insurance plans cover a range of healthcare costs, such as hospitalisation, surgeries, and medication, depending on the policy terms. These plans ensure you are financially protected against unexpected medical expenses, offering peace of mind and access to quality healthcare.

Additional benefits of Individual Health Insurance

1. Wellness benefits

Many individual health insurance plans offer wellness programs that encourage healthy lifestyles, such as fitness memberships, nutrition counseling, or rewards for maintaining good health metrics.

2. Portability benefits

With the portability feature, policyholders can switch between insurers without losing their accumulated benefits, like waiting periods or No Claim Bonuses, ensuring uninterrupted coverage.

3. Discounts on policy

Insurers often provide discounts for longer policy tenures, adding family members, or maintaining a claim-free record, reducing the overall premium cost.

4. Preventive health check-ups

Most individual health insurance plans cover regular preventive health check-ups, helping detect potential health issues early, ensuring better long-term health management.

Eligibility criteria for individual health insurance

Given below are the common criteria for individual health insurance:

1. Age:

Generally, individual health insurance policies are available for people aged 18-65. However, some insurers extend coverage to older individuals, offering senior-specific plans with tailored benefits.

2. Health status:

Pre-existing conditions are often subject to waiting periods or exclusions. Many insurers impose a waiting period of 2-4 years before covering chronic illnesses or conditions diagnosed prior to purchasing the policy.

3. Residency:

To qualify for an individual health insurance plan, one must be a resident of the country where the policy is being offered, ensuring access to local healthcare facilities.

4. Medical history:

Some insurers may require a medical check-up or submission of a health declaration to assess the risk level and determine premium rates or exclusions based on existing medical conditions.

What makes health insurance plans for individuals necessary?

Considering the increasing healthcare expenses, and changing lifestyle, individual health insurance becomes a crucial investment that secures you during medical emergencies. Health insurance policies for individuals ensure you can access high-quality medical care when required.

Here is why health insurance plans for individuals are necessary.

Skyrocketing medical inflation

The cost of medical treatment has been on a drastic rise over the last few years. Individual health insurance lets you stay financially secure against any sudden expense caused due to medical emergencies.

Lifestyle-related diseases on the rise

Increasing lifestyle-related diseases due to stress, pollution, device addiction, and unhealthy eating habits make personal health insurance a must.

Savings

One of the most significant reasons to buy an health insurance plans for individuals is that it helps keep one’s savings intact in times of medical emergencies. There are no out-of-pocket expenses as the policy offers the necessary financial coverage.

Secure your family

Having an individual health insurance plan for family members will ensure complete security for them. Ageing parents or growing children are most vulnerable to illnesses. A medical insurance plan will ensure they access the best quality healthcare services without worrying about funds.

How to claim your individual health plan

At the time of an emergency, you can claim your individual medical insurance by following the set of steps given below:

Step 1: Fill up the pre-authorisation form at the network hospital to claim cashless approval at the time of hospitalisation.
Step 2: The insurer will approve the request and notify the hospital.
Step 3: Following which the hospital procedures will begin.
Step 4: The insurer will settle the bills directly with the network hospital at the time of discharge.

A similar set of steps can be followed to claim other individual health insurance plans.

Also, read: Maternity Health Insurance

Documents required for Individual Health Insurance

  • Identity proof: Government-issued ID such as a passport, driver’s license, or Aadhaar card to verify personal details.
  • Address proof: Utility bills, rental agreement, or bank statements to confirm your current residential address.
  • Medical history: Records or declarations of any existing medical conditions or recent health check-ups.
  • Age proof: Birth certificate or passport to confirm the applicant's age.
  • Income proof: Salary slips, tax returns, or bank statements to assess affordability and eligibility.

Is cashless treatment available under Individual Health Insurance Policy?

Yes, cashless treatment is often available under individual health insurance policies. This means you can receive medical care at network hospitals without paying upfront, as the insurance provider settles the bill directly with the hospital. It simplifies the process and reduces financial strain during emergencies, provided you obtain pre-authorisation from the insurer.

Are there any waiting periods under Individual Health Insurance plans?

Yes, individual health insurance plans typically include waiting periods. These include an initial waiting period for coverage to start, often 30 days, and specific waiting periods for pre-existing conditions, usually 2-4 years. During these waiting periods, claims related to pre-existing conditions or certain treatments may not be covered. It's important to review the policy terms to understand these periods and their impact on coverage.

Does the individual health insurance policy offer cashless treatment?

Individual health insurance plans generally offer cashless treatment. Given below are a few key aspects related to the same:

  • Individual health insurance policies often offer cashless treatment options, providing policyholders with the convenience of availing medical services without upfront payment.
  • These individual medical insurance plans typically involve tie-ups with a network of hospitals where policyholders can avail cashless treatment.
  • Cashless treatment under individual health plans eliminates the need for reimbursement hassles, offering peace of mind during medical emergencies.

Determining the ideal coverage for individual health insurance: What's right for you?

  • Assess your healthcare needs and budget to determine the ideal coverage for individual health insurance.
  • Consider factors like age, pre-existing conditions, and lifestyle habits when choosing individual medical insurance plans.
  • Evaluate coverage options offered by various insurers, including hospitalisation, outpatient care, and preventive services.
  • Look for additional benefits like maternity coverage, wellness programs, and telemedicine services in individual health plans.
  • Compare premiums, deductibles, and co-payments to find the most suitable individual medical insurance plan for your needs.

How to buy an individual health insurance policy online?

You can easily buy an individual health insurance policy online. Given below are the key steps involved in the process:

1. Research plans:

Compare various individual health insurance policies online to identify the best options. Look at coverage details, premiums, exclusions, and benefits to find a plan that matches your specific health needs and financial situation.

2. Choose coverage:

Select the coverage amount and benefits that best address your health requirements. Consider factors like sum insured, coverage for pre-existing conditions, and additional benefits such as maternity or critical illness coverage.

3. Fill application:

Complete the online application form by providing accurate personal and medical information. This includes details about your age, health status, and any pre-existing conditions to ensure proper evaluation and coverage.

4. Submit documents:

Upload the necessary documents, including identity proof, address proof, and medical records. Ensure all documents are clear and up-to-date to facilitate smooth processing and approval of your health insurance application.

5. Make payment:

Pay the insurance premium through secure online payment gateways. Choose a payment method that is convenient for you, such as credit/debit cards or net banking, to complete the purchase of your health insurance plan.

6. Receive policy:

After approval, you will receive your policy document via email. Review the document carefully to confirm the details, coverage, and terms, ensuring everything aligns with your selected plan.

How much coverage under individual health insurance should you have?

Usually, it is advised that you must have 50% of your annual income value as health insurance coverage. This means if you earn Rs. 5 lakh per annum, get health insurance coverage up to Rs. 2.5 lakh. However, considering the medical inflation every year, you must have sufficient health coverage to stay adequately covered during medical emergencies. You get coverage up to Rs. 2 crore on health insurance plans for individuals. The premium for individual health insurance policies depends on the coverage chosen. Hence, buy an individual health insurance that fits your budget and requirement.

Read more: Buy critical illness insurance policy online.

What is the difference between Group and Individual Health Insurance?

Aspect

Group Health Insurance

Individual Health Insurance

Coverage

Offered through employers or organisations, covering multiple people

Tailored to the individual, with customised coverage and benefits

Premiums

Typically lower due to group rates

Usually higher, as it's based on individual risk factors and health status

Flexibility

Limited options for customisation

Highly customisable based on personal health needs and preferences

Portability

Coverage often ends with employment or organisation membership

Portable; coverage continues regardless of job changes or location

Eligibility

Generally guaranteed for all members of the group

Subject to underwriting and individual health assessments


Also, read: Group Health Insurance Policy

Things to keep in mind when you buy individual health insurance

Here are some key pointers to keep in mind when buying individual health insurance.

Coverage

It is essential to assess the coverage that the health plan offers. Make sure you get comprehensive coverage to meet all your needs comfortably.

Affordability

If you find the premium high for your budget, you have the option of choosing to co-pay the claim. This means that you will pay a share of your final bill yourself. With the co-pay option, you can expect to pay lower premiums.

Network hospitals

It is wise to check if the insurer has a vast chain of network hospitals. One can get a cashless claim settlement facility at any of these hospitals.

Waiting period

The insurance benefits will not come into effect until the waiting period is over. One should look for individual insurance plans that have lower waiting periods for critical illness.

Sub-limit

Sub-limit is a cap placed on the claim amount for hospital room rent, post-hospitalisation charges, and others. It is wise to choose a plan having a lower sub-limit.

Who should buy Individual Health Insurance?

  • Self-employed individuals: Those who do not have access to employer-sponsored health coverage should consider individual plans to ensure comprehensive medical protection.
  • Freelancers and contract workers: People with non-permanent employment need individual insurance to secure health coverage.
  • Individuals with specific health needs: Those requiring tailored coverage for pre-existing conditions or specific treatments.
  • High-income earners: To benefit from customised plans and additional coverage options not available in group policies.

Frequently asked questions

Which is better a family floater or individual health insurance?

Family floater health plans cover the entire family in a single policy, whereas personal health insurance secures individuals. The premium varies for both types of health insurance plans as depends on the coverage offered. The best strategy would be to focus on ensuring all family members and getting maximum advantages from both plans. Choose a health insurance plan that suits your requirement and budget, giving you adequate coverage during a medical emergency.

When should I buy an individual health insurance plan?

The earlier you purchase, the better. Generally, you must buy a health insurance plan during your early twenties, when you have just begun working. You are less likely to fall ill or claim the benefits of a health insurance policy at this age. This helps you get a cumulative bonus, i.e., bonus accumulated for every claim-free year. You can use the benefit to increase the sum insured without paying any extra premium on policy renewal. Health insurance policies for individuals also aid in financial planning and provide comprehensive coverage at a lower price.

Is individual health insurance expensive?

The premiums of health insurance policies differ from insurer to insurer. You can compare and choose the right insurance plan that fits your requirements and budget. Bajaj Finance along with leading insurers offers a wide range of comprehensive health insurance plans at affordable premiums. With the growing medical inflation, it is imperative to have health insurance that keeps you financially secure.

What should I do if I cannot afford a health insurance plan for an individual?

Digitalisation has boosted the health insurance sector. Most health insurers now offer health insurance policies online. You can simply visit your preferred health insurance provider’s website to check different policies and coverages offered. You will find multiple health insurance plans with extensive coverages at reasonable prices. Different insurers have different premium and coverage offerings. Many health insurance companies offer the option to pay the premium in instalments. Hence, compare and buy health insurance policies online. You can also choose a family health insurance plan that covers your entire family under one plan. Look for a wide range of health insurance plans available at affordable premiums on Bajaj Finance Insurance Mall.

What is multi-individual health insurance?

Multi-individual health insurance, also known as family health insurance, covers multiple individuals under a single policy. This type of insurance typically includes primary policyholders, such as spouses and dependent children, providing comprehensive healthcare coverage for the entire family unit.

Which policy is better, floater or individual?

The choice between a floater and individual health insurance policy depends on your specific needs. A floater policy covers multiple family members under one sum insured, while individual policies offer dedicated coverage for each insured person, providing more personalised protection.

What is individual health insurance?

Individual health insurance is a policy that offers medical coverage to one person, providing benefits such as hospitalisation, emergency services, and more. Each family member must purchase their own plan, tailored to their specific health needs.

What is an individual plan?

An individual plan is a health insurance policy purchased for one person, offering customised coverage based on their unique health requirements. It includes benefits like hospitalisation, diagnostics, and outpatient services, independent of other family members' coverage.

How much is health insurance a month for a single person in India?

The monthly premium for individual health insurance in India varies based on coverage, age, and health status, typically ranging from Rs. 500 to Rs. 2,500. Premiums increase with age and comprehensive coverage options.

Are there any waiting periods under Individual Health Insurance Plans?

Yes, individual health insurance plans often include waiting periods, such as a 30-day initial waiting period and 2-4 years for pre-existing conditions. This means some conditions may not be covered immediately.

What is the eligibility for an individual health insurance plan?

Eligibility for individual health insurance typically requires being within a specified age range (usually 18-65), being a resident of the country, and meeting health and medical criteria set by the insurer.

How many claims are allowed in a year?

The number of claims allowed in a year varies by policy. Most individual health insurance plans do not limit the number of claims but may have annual or lifetime sum insured limits.

Is there any income tax exemption under Individual Health Insurance?

Yes, premiums paid for individual health insurance qualify for tax deductions under Section 80D of the Income Tax Act, offering exemptions up to Rs. 25,000 for individuals and Rs. 50,000 for senior citizens.

What if I want to renew individual health insurance with add-on covers?

When renewing individual health insurance, you can typically choose add-on covers to enhance your policy. Check with your insurer for available add-ons and adjust your premium accordingly to include the additional benefits.

Is OPD benefit covered under Individual Health Insurance?

OPD (Outpatient Department) benefits are not always included in standard individual health insurance plans. Some policies offer OPD cover as an add-on or optional benefit, so review your policy details for inclusion.

What exactly are pre-existing conditions in an Individual Health Insurance?

Pre-existing conditions are health issues or ailments that were present before purchasing an individual health insurance policy. These conditions often have waiting periods before they are covered, as specified in the policy terms.

How is the insurer going to pay my hospital bills?

Insurers pay hospital bills either through cashless treatment at network hospitals or via reimbursement for out-of-network treatments. For cashless claims, the insurer directly settles the bill with the hospital.

Are there any tax advantages to purchasing Individual Health Insurance?

Yes, purchasing individual health insurance offers tax benefits under Section 80D of the Income Tax Act. Premiums paid qualify for tax deductions, reducing taxable income and offering potential tax savings.

Why should I need Personal Medical Insurance?

Personal medical insurance provides financial protection against high medical costs, ensuring coverage for hospital expenses, surgeries, and treatments. It also offers peace of mind and access to quality healthcare when needed.

What's the best age to purchase Individual Health Insurance?

The best age to purchase individual health insurance is early in adulthood, ideally in your 20s or 30s. Early purchase often results in lower premiums and better coverage options, with fewer health issues to disclose.

What are the advantages of purchasing Personal Medical Insurance online?

Purchasing personal medical insurance online offers convenience, easy comparison of plans, and often better pricing. It allows for quick policy selection, application processing, and immediate access to policy documents without the need for intermediaries.

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