Individual health insurance plan

An individual health insurance plan is the basic medical insurance plan that is a must-have for everyone. Since every individual is different with varied medical needs, one must choose individual insurance that perfectly suits their needs. 

An individual health insurance policy is designed to offer comprehensive coverage for expenses related to hospitalisation, ambulance charge, consultation fees, treatment costs etc. It helps to keep one financially secure in the event of any medical emergency. 

Features of individual health insurance

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

• Reinstatement of sum insured
  In case the base sum insured as well as the cumulative bonus gets exhausted due to claims, the sum insured will be reinstated to the extent of the health policy’s base sum insured. This goes a long way to give you the necessary backup for medical emergencies. 

• Medical tests are optional up to 45 years
  When you apply for an individual health insurance plan and are fit, active and healthy, you may not require to undergo any medical tests before the purchase.

• Cumulative bonus
  Every claim-free year gives you the advantage of a cumulative bonus. This cumulative bonus may come to you in the form of a lower premium or increased sum insured depending on your insurer.

• Lifetime renewability 
  Certain individual health insurance plans come with the option of lifetime renewability ensuring financial security in any medical emergency. One can renew the plans after it is expired at any time. 

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

Individual health insurance: Why it’s a must have

• Extensive coverage
  Individual medical insurance offers comprehensive financial coverage that helps one cope with sudden monetary outflow due to medical emergencies. It provides coverage for pre- and post-hospitalisation expenses, daycare treatments, in-patient hospitalisation charges, organ donor expenses, treatment for mental illness, AYUSH therapy costs and much 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. The total deduction limit stands at Rs.25,000.
  

Things to keep in mind when you buy individual health insurance

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

What makes individual health insurance 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 and diseases on the rise
  There has been a rise in lifestyle-related diseases due to multiple factors like stress, pollution, device addiction, unhealthy eating habits, and more making personal health insurance a must.
  
  
• Savings
  One of the most significant reasons to buy an individual health insurance plan 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. 

What's covered under individual health insurance plan

• In patient hospitalisation
  You will be covered for treatment costs during in patient hospitalisation. This includes, room rent, medication, doctor fee, tests, etc.
  
  
• Pre-and post-hospitalisation 
  Individuals will receive coverageYou will also be covered for pre- and post-hospitalisation charges for up to 30 and 90 days respectively. This duration varies for different insurers.
  
  
• Daycare treatment
  This policy covers daycare treatment charges for insured individuals within the valid policy term. The number and types of daycare treatments covered will be included in the policy document.
  
  
• Organ donor expenses
  Any expense incurred to harvest a major organ from a donor for an organ transplant procedure is also covered.
  
  
• Domiciliary hospitalisation
  Health insurance policies offer the advantage of coverage for domiciliary hospitalisation. So, in case admission to a hospital is not possible due to a specific medical condition or unavailability of a hospital bed, you can avail treatment at home. This is called domiciliary hospitalisation, which is also covered in an individual health insurance plan.

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 hospitals to claim cashless approval at the time of hospitalisation

Step 2: The insurer then approves the request and notifies the hospital

Step 3: Following which the hospitalisation can be done based on approved pre-authorisation

Step 4: At the time of discharge, the claim will be settled directly with the hospital

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