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Individual Health Insurance

Health insurance is a necessity, but until recently, it was never considered so. Before the Coronavirus pandemic hit Indians, there was a general lack of awareness about health insurance. It wasn't regarded as necessary. However, the last couple of months have seen a steady rise in Indians buying health insurance plans.

Health insurance is an agreement between a health insurance provider (the insurer) and the health insurance policyholder (the insured). The insurer commits to providing monetary assistance to the insured in case of hospitalization and illnesses.

There are different types of health insurance plans. The most popular type of plan is health insurance for individuals. Individual health insurance plans are designed to cover the medical care expenses of individuals. Every individual health insurance policy covers a single person. However, finding the best individual health insurance plan is easier said than done; and that is where you need to put in the biggest effort.

Choose your individual health insurance plan

Key features and benefits of buying an Individual Health Insurance Plan

Cost-effective

Buying an individual health insurance plan is cost-effective. Unlike a family floater health plan where the premium is calculated based on the age of the oldest member, the individual health insurance plan premium is based on the policyholder's age. Hence, if an individual buys a health plan at a young age, the premium is much lower.

Cashless treatment

Health insurance plans for individuals offer the feature of cashless treatments. In a cashless claim, the policyholder does not have to pay for the medical bills to the hospital; the insurer pays directly to the hospital on behalf of the insured. This avoids the hassle of arranging the funds upfront. This means that the policyholder does not need to worry about hospitalization expenses or arrange for money before claiming from the insurer.

Eases financial stress

Rising medical costs are the cause of stress for many. Having an individual health insurance plan can help ease financial stress. Health insurance offers coverage for a wide range of medical expenses – from hospitalization to ambulance charges to surgeries. The cost of hospitalization in larger and metropolitan cities is much higher compared to towns. Moreover, medical needs can hit you unannounced and all of a sudden. Therefore, the onus is on you to be adequately prepared. One way to keep uncertain expenses away is to buy individual health insurance plans.

Lower premium

The premium towards health insurance policies is based on age, medical condition, claims history, family health history, and the sum insured. Most often, young individuals are healthy. This means the premium of their individual health insurance plans would be much lower compared to people in a higher age group.

Hospitalization expenses

Medical insurance for individuals offers coverage for a wide range of medical expenses, including hospitalization expenses. These include doctor's consultation, diagnosis tests, room rent, ambulance charges, nursing expenses, and more. Individuals may need to get hospitalized due to illnesses and injuries. Individual health insurance plan safeguards by covering hospitalization charges. Moreover, each health insurer has a defined hospital network, which means policyholders can receive quality and timely healthcare in reputed hospitals.

Day-care hospitalization

Many health treatments do not require getting admitted to the hospital; one such case being COVID. These are treatments that can be completed within a few hours and hence do not need the patient to get admitted. Health insurance for individuals offers coverage for day-care hospitalization.

Tax benefits

Individual health insurance policyholders are eligible to avail of tax benefits under Section 80D of the Income Tax Act. Individuals under the age of 60 years can avail of up to Rs 25,000 tax deduction from the taxable income, and those above the age of 60 years can avail of up to Rs 50,000 tax deduction from the taxable income. These are annual deductions and can be claimed each year. Individual insurance is also a preferred way to reduce tax and is often included as a part and parcel of financial planning.

Lifelong renewability

Most individual health insurance plans offer lifelong renewability. This means that the individual can renew the same policy year after year and need not buy a new policy. Thisfeature helps control the premium amount and helps increase the sum insured with a no-claim bonus for the year in which the policyholder does not make any claims.

What is covered in an Individual Health Insurance Policy?

Hospitalization expenses

Medical insurance for individuals offers coverage for a wide range of medical expenses, including hospitalization expenses. These include doctor's consultation, diagnosis tests, room rent, ambulance charges, nursing expenses, and more. Individuals may need to get hospitalized due to illnesses and injuries. Individual health insurance plans safeguard by covering hospitalization charges. Moreover, every health insurer has a defined hospital network, which means policyholders can receive quality and timely healthcare at good quality hospitals.

Pre and Post Hospitalisation

Many types of ailments require treatment before and after hospitalization. The individual health insurance policy offers coverage for pre and post-hospitalization expenses. These include ambulance rent, diagnosis test expenses, doctor visits, home treatment expenses, and medicines, among others. Pre and post hospitalization costs can add up to a considerable amount, and having coverage for these expenses can ease many financial burdens.

Day-care procedures

Many health treatments do not require getting admitted to the hospital. These are treatments that can be completed within a few hours and hence do not need the patient to get admitted. Health insurance for individuals offers coverage for day-care hospitalization.

Hospital cash

Also known as hospital daily cash allowance, this facility provides a fixed amount of cash to the insured during hospitalization. The number of days to be spent in the hospital to avail of this facility may vary for each insurance company or insurance plan. Please note that this is different from the payment for medical expenses and this is meant to just mean out of pocket expenses. This allowance can be beneficial in medical emergencies and hospitalization as one does not have to worry about the daily hospital expenses up to a certain amount.

Domiciliary treatment

Domiciliary treatments are treatments taken at home, where hospitalization is either not required or rooms are not available. Health insurance for individuals offers coverage for domiciliary treatments; popularly called domiciliary hospitalization. Claim for domiciliary treatment requires the insured to provide proof indicating the reason for not being able to get hospitalized. A pivotal point to be noted for domiciliary treatment is that most insurers limit the coverage amount. The whole sum insured cannot be utilized for domiciliary treatment.

AYUSH treatment

Many health insurance companies offer coverage for traditional treatments such as Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH) as part of the individual health plan. With a rising number of people choosing alternatives to allopathic treatments, many insurers have included AYUSH as part of health insurance plans.

Free health check-up

Most health insurance companies offer free health check-ups after the completion of a certain number of years. Many policyholders are not aware of this or forget about this benefit after purchasing a policy. It is a benefit that one must make use of as full-body health check-ups can cost anywhere between Rs 4000 to Rs 10,000 depending on the hospital and the intensity of the check-up.

No-claim bonus

When an individual health insurance policyholder does not make any claims in a year, the insurance company offers a no-claim bonus or NCB. Instead of reducing the premium, the insurer enhances your sum insured. The amount varies from insurer to insurer. Some insurance companies also provide a cumulative no-claim bonus, while some also provide a partial reimbursement of premiums in lieu of such NCB.

Organ Donor Expenses

Health insurance for individuals offers coverage for organ donor expenses, especially when the insured needs to undergo transplant of critical organs like kidneys, liver etc. These include surgery and organ storage and transport expenses.

No entry age restrictions

Most health insurers offer individual health insurance plans to all age groups and do not have any entry age restrictions. Any individual above the age of 18 years can purchase health insurance plan for individuals.

Mental healthcare

Many health insurance companies offer coverage for the treatment of mental illnesses that require hospitalization as part of a personal health insurance plan.

Things to be aware of while purchasing a personal health insurance policy

Know what exactly are your Requirements?

Determine your healthcare requirements. When individuals are young and healthy, they might not require health insurance for specific diseases. A comprehensive health insurance plan designed for individuals might be sufficient as it would provide coverage forhospitalization.

However, suppose an individual has specific pre-existing ailments, an unhealthy lifestyle, or a family history of diseases. In that case, it is essential to consider these factors when buying a health insurance plan. These would help determine the requirements based on which the individual can purchase a suitable health plan.

What is the sum insured?

Sum insured is the total amount of coverage provided by an individual health insurance plan. Individuals who have a higher probability of getting hospitalized must opt for a higher sum insured to provide sufficient coverage. The higher the sum insured, the higher the premium; hence, it is essential to consider one's budget before zeroing in on the sum insured.

Is cashless hospitalization available?

Cashless hospitalization is a feature where the policyholder does not have to pay any amount to the hospital, as long as it is in the insurer's network. The individual health insurance policyholder can get hospitalized, treated, and the insurance company directly pays to the hospital. The cashless hospitalization feature is beneficial as the policyholder does not have to worry about money to cover the hospitalization costs.

How comprehensive is the coverage?

It is essential to pay attention to the range of ailments covered in a health insurance plan for individuals. Specific key inclusions such as room rent, ambulance rent, pre and post-hospitalization costs, surgery costs, day-care procedures, and domiciliary treatment expenses can make a huge difference and can make the health policy more useful.

How easy is the claim procedure?

A long and complicated claim process should be avoided. Most insurers follow two types of claim processes: cashless claim and reimbursement claim. When buying a personal health insurance plan, one must always read reviews about the claim process and buy a health plan with the least complicated claim process.

Is the cumulative bonus offered?

When an individual health insurance policyholder does not make any claims in a year, the insurance company offers a no-claim bonus, added to the sum insured. The amount varies from insurer to insurer. Some insurance companies also provide a cumulative no-claim bonus, which helps policyholders to increase the sum insured.

How does an Individual Health Insurance Policy work?

Personal factors

The personal factors play a vital role at the time of buying a personal health insurance plan. The policy's premium depends on age, personal health history, family history, and claims history. An individual with pre-existing health conditions would have to pay a higher premium than healthy and fit individuals. Lifestyle habits of the individual are also considered when insurers underwrite policies as it adds to their risk.

Waiting period

The waiting period is a clause in individual health insurance plans that limit the policyholder from making claims before completing a pre-defined period, which is also called waiting period. A policyholder can make claims only once the waiting period is over. The waiting period differs from plan to plan and insurer to insurer.

Difference between Cashless and reimbursement claims

There are broadly two types of claims that can be made with an insurer:

Cashless claim

A cashless claim is an agreement between the insurer and the network hospitals to allow policyholders treatments without any payment by the policyholder at the time of admission to the hospital. In this type of claim, the insurer pays directly to the hospital. The policyholder does not have to make the payment and then get it reimbursed from the insurance company.

Following are the key steps involved in the cashless claims process:

  1. Get treatment at a hospital part of the network of the insurance policy
  2. Submit a health insurance policy claim form at the hospital at the time of admission
  3. The insurance company sends an approval to the hospital or raises a query in case of missing information

Reimbursement claim

In this type of claim, the policyholder has to make the payment to the hospital, which is then reimbursed by the insurer as per the extant reimbursement process. The process is normally as follows:

  1. The policyholder is required to fill a claims form and submit to the insurer along with the medical and hospital bills
  2. The insurer then investigates the documents and sees if the entire medical notes, bills, surgical costs; doctor’s fees are in order.
  3. If the claim is approved, the insurance company sends an approval letter. In case of rejection, a rejection letter and the reasons are shared with the policyholder.
  4. If the claim gets rejected, the insured can reapply to the insurer giving the additional information sought.

What are the most important reasons to have an Individual Health Insurance Policy?

Lifestyle diseases

Lifestyle diseases have been on the rise. Even the healthiest and fittest of people could have some kind of lifestyle related ailments. With rising medical expenses, it is essential to prepare financially for any unforeseen health issues. Health insurance for individuals is one way of safeguarding oneself from high medical treatments for lifestyle diseases.

Inadequate insurance

Many people have a group health insurance provided by their employers. However, group health insurance may give limited benefits. The sum insured in group health plans are usually not sufficient. Individuals must buy a personal health insurance plan with an adequate sum insured to meet high medical expenses in such cases. Also group covers only last till the date of your resignation from the job.

Beat medical inflation

Medical inflation has been on the rise. The cost of hospitalization and treatments has been increasing year after year. Technological advancements have also added to the cost of high tech medical treatments. One way to beat medical inflation is by purchasing a personal health insurance plan.

Big savings

Buying health insurance for individuals has many benefits, over and above the financial support for medical expenses. Health insurance can help individuals in financial planning, as well. Having a health insurance plan means policyholders do not have to spend money from their savings towards sudden hospitalization expenses. This allows them to save more money.

Tax benefits

Individual health insurance policyholders are eligible to avail of tax benefits under Section 80D of the Income Tax Act. Individuals under the age of 60 years can avail of up to Rs 25,000 tax deduction from the taxable income, and those above the age of 60 years can avail of up to Rs 50,000 tax deduction from the taxable income in each financial year. Individual insurance is also a preferred way to reduce tax and is often included in individuals' financial planning.

Exclusions in an Individual Health Insurance Policy

Pre-existing diseases

A policyholder might have certain diseases before buying a health insurance plan. These are called pre-existing diseases and are excluded from health insurance plans for individuals or waiting. The definition of pre-existing varies from one insurer to another.

Coverage amounts may vary for few diseases

The coverage amount for different diseases may vary. These clauses are predefined and mentioned in the policy document of the personal health insurance plan.

Treatment-related to alcohol

If a policyholder is hospitalized due to injury or illness caused by alcohol consumption, the individual health insurance policy does not cover such expenses. This is an explicit exclusion from almost every health insurance policy.

Cosmetic and aesthetic treatment

Health insurance plans for individuals do not include coverage for cosmetic treatments. At times, insurers include cosmetic treatment coverage only when necessary for other treatments and surgeries.

How to calculate Individual health insurance premium?

Comparison of health plans

It is essential to consider key factors necessary for your healthcare needs and zero-in on plans that ensure a perfect match to your unique needs. Here are some factors to compare: premium payable, add-on coverage, pre and post hospitalization coverage range, illnesses and diseases covered, flexibility-portability option, the possibility of adding a new member, increasing or decreasing sum insured, etc. Claim settlement ratio of the company, network hospitals, the waiting period for pre-existing diseases, exclusions and co-payment, and sub-limit clauses.

How does the premium calculator work?

Using an online health insurance premium calculator is easy. Here’s how it works:

  • Search for your choice of health insurer’s corporate website
  • Most insurance companies have an online premium calculator on their website
  • Find the calculator and fill in the details as required
  • Select options according to your requirement – type of plan, number of members, age and sum insured etc.
  • Share your contact details
  • Click on calculate the premium
  • The insurance company will share the premium amount on your contact details

Process of selecting a Plan

Comparison

When buying a health insurance plan, bring the coverage components under the microscope. The kind of coverage a plan offers would determine how helpful the plan can be to your family members and you. Here are some factors to compare: premium, add-on coverage provided pre and post hospitalization coverage range, illnesses and diseases covered, and flexibility – portability option, the possibility of adding a new member, increasing or decreasing sum insured, etc. Claim settlement ratio of the company, network hospitals, the waiting period for pre-existing diseases, exclusions and co-payment, and sub-limit clauses.

Inclusions

  • Illnesses and medical problems covered
  • Pre-existing diseases
  • Option for coverage for critical illness (usually it’s an add-on)
  • Pre and post-hospitalization cover
  • Maternity benefits (usually it has a sub-limit)
  • The number of day-care procedures
  • Ambulance and room rent limits

Premium

The health insurance premium is the amount of money, which a policyholder pays towards a health insurance policy bought from an insurance company. Health insurance premiums are usually paid on an annual or bi-annual basis. The premium for health insurance for individuals varies from plan-to-plan. It is essential to calculate the estimated amount of the premium before purchasing a health plan.

Faqs

Why do I need an Individual Health Insurance Plan?

Individual health insurance plans can safeguard an individual from expenses arising out of illness and hospitalization.

When should I start my first Health Insurance?

The earlier you start, the better it is. Experts advise that you should buy a personal health plan as soon as you start earning money.

If I am already covered under my parents’ health insurance, do I need a separate health cover?

Yes, it is advisable to have a separate personal health insurance plan even if you are covered under a family floater or a group health insurance policy.

Do online health insurance calculators provide correct estimates?

Yes, most often online health insurance premium calculations are correct and provide tentative results close to the actual amount that one would have to pay towards a personal health insurance plan. These estimates are just approximations to give you an idea.

Is there a minimum and maximum age for buying a personal health insurance plan?

Most health insurance companies in India have an age bracket for entry and exit and maximum buying age. However, this depends on the type of health insurance plan.

How much personal health insurance sum insured is ideal?

The sum insured requirements for different people are different, depending on the age, health conditions, and medical history of the policyholder.

What documents are required to buy a personal health insurance plan?

Typically, insurance companies ask for proof of identity documents which could be passport, Aadhaar card, driving license etc. The insurer will also insist on proof of age, which could be birth certificate, school leaving certificate; as well as proof of address. The PAN card will be required other than the above documents.

How do I know if a health insurance plan is good for me or not?

There is no one-best or one-good health insurance plan as it is subjective. For finding and buying the best plan for you, you will have to research, gather information about the insurance plan and the insurance company, compare different plans and then select the
plan that is most suitable to your healthcare needs.

Why should one buy personal health insurance with OPD cover?

OPD Cover is Out Patient Department Cover, which means coverage for expenses such as doctor’s consultation fees, pharmacy bills, dental treatments, and health check-ups and diagnostics tests. Individual health insurance plans that offer coverage for OPD expenses
compensate for the above-mentioned expenses.

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