What are the 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.
No Claim Bonus (NCB)
Many insurers reward your healthy lifestyle! If you don’t make any claims during the policy year, you’re eligible for a No Claim Bonus—which can be either a discount on premium or an increase in sum insured at no extra cost. Over time, this significantly enhances your coverage.
Tax benefits
Under Section 80D of the Income Tax Act, premiums paid for individual health insurance policies are eligible for tax deductions of up to Rs. 25,000 (and up to Rs. 50,000 for senior citizens). This means you’re not only protecting your health but also saving more on taxes.
Preventive health check-ups
Many individual health plans offer annual preventive health check-ups either free or at discounted rates. These screenings help detect health issues early, enabling timely treatment and better outcomes.
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.
Tax benefits of an individual health insurance policy
Investing in health insurance not only ensures financial security during medical emergencies but also provides significant tax savings. Here’s how you can avail of the health insurance tax benefit:
- Deduction under Section 80D – Premiums paid for an individual health insurance policy are eligible for tax deductions under Section 80D.
- Tax savings for family – You can claim additional deductions for premiums paid for your spouse, children, and parents.
- Higher deductions for senior citizens – If you insure parents above 60, you can claim up to Rs.50,000 in deductions.
- Preventive health check-up benefits – Get additional deductions of up to Rs.5,000 for preventive health check-ups.
Advantages of an individual health insurance plan
Good health is essential to overall happiness—but life is unpredictable, and medical issues can arise at any time. In today’s world, where lifestyle diseases and critical illnesses like cancer, heart conditions, and respiratory disorders are increasingly common, being financially prepared is more important than ever. That’s where individual health insurance becomes crucial.
Here are the key benefits of opting for an individual health insurance plan:
- Cashless hospitalisation
Most insurers have a network of partnered hospitals where you can avail of cashless treatment. If you’re admitted to one of these hospitals, the insurer directly settles the medical bills with the hospital, reducing your out-of-pocket expenses during emergencies.
- Pre and post-hospitalisation coverage
Individual health plans cover not only hospital stays but also the medical expenses incurred before and after hospitalisation. This includes consultations, diagnostic tests, and medication. Depending on the insurer, this coverage can vary—some offer up to 60 days pre-hospitalisation and 90 days post-discharge benefits.
- No Claim Bonus (NCB)
If you don’t raise any claims during your policy term, you’re rewarded with a No Claim Bonus. This bonus can be used to either increase your coverage or reduce your future premium, depending on your insurer’s policy.
- Tax benefits
Premiums paid for individual health insurance are eligible for tax deductions under Section 80D of the Income Tax Act. You can claim up to ₹25,000 per year, which helps lower your taxable income and overall tax burden.
- Preventive health check-ups
These plans also allow policyholders to claim tax deductions for preventive health checkups—up to ₹5,000 per year under Section 80D. It’s a double benefit: you stay on top of your health and save on taxes.
Importance of individual health insurance plans in India
The significance of individual health insurance plans in India has grown considerably, given the increasing number of health risks faced by the population. Unpredictable medical emergencies are inevitable, making it crucial to choose the right health insurance plan that provides adequate coverage for medical expenses incurred during hospitalisation.
In India, healthcare inflation is rising at a rate twice that of overall inflation. This has led individuals, particularly those in their 20s, 40s, and 50s, to recognise the importance of having health insurance. The demand for individual health insurance has surged, as these plans offer the flexibility to customise benefits while keeping premiums affordable. Individuals of all age groups, from the young to the middle-aged and elderly, can benefit from an individual health policy designed to meet their specific healthcare needs. With flexible and comprehensive coverage, lower premiums, and a range of benefits, tailor-made individual health insurance policies provide a complete solution at a reasonable cost.
Having an individual health insurance plan is essential for securing substantial financial support during medical emergencies. It is a wise addition to one's financial portfolio, ensuring protection and peace of mind for the future.
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What is not covered under individual health insurance plans?
Here are some of the key exclusions under the individual health insurance plans.
- 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.
- 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.
- 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 health insurance benefits..
- 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.
- 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.
- 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.
- 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.
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.
Documents required for Individual Health Insurance
To apply for an individual health insurance policy, you’ll need to submit the following documents:
Proof of age
You can submit any of the following:
- Aadhaar Card
- PAN Card
- Voter ID
- Driving License
- Birth Certificate
- Passport
Proof of identity
Acceptable documents include:
- Aadhaar Card
- Voter ID
- PAN Card
- Passport
- Driving License
Proof of address
To verify your permanent residence, you may provide:
- PAN Card
- Passport
- Aadhaar Card
- Driving License
- Electricity Bill
- Ration Card
Medical reports
Some insurers may require a medical check-up before policy approval. In such cases, you’ll need to submit the test reports as specified by the insurer.
- Passport-size photographs
Recent passport-sized photos are also necessary for documentation and policy records.
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.
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.
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.
How many claims are allowed in a year?
There is no fixed limit on the number of claims you can make in a year under individual health insurance. You can file multiple claims as long as they fall within your sum insured and policy terms.
How to renew individual health insurance with add-on covers?
To renew your policy with add-on covers, visit your insurer’s portal before the policy expiry, choose your desired add-ons like OPD or critical illness, and proceed with premium payment. Renewal ensures continued coverage without a break.
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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
Conclusion
An individual health insurance policy is a crucial investment in your health and financial security. It provides personalized coverage, ensuring you get the best medical care without worrying about expenses. Additionally, you can enjoy tax benefits under Section 80D. Secure your well-being today—explore comprehensive individual health insurance plans and stay financially prepared for any medical emergency.
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