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individual health insurance plan coverages

Best Coverages of an Individual Health Insurance Plan

The world is currently witnessing a sharp change in the course of things and the way people see and live life. The exponential rise in the number of cases due to the Coronavirus has deeply affected all sectors across the globe. The impact of this has been profound in the minds of people. Nationwide lockdowns have halted all business operations and lead to “Working from home” becoming the “New normal”.

Also, as operations have nearly stopped or businesses forced to shut down, the unemployment levels have reached a staggering level. Most developed countries failed to tackle the continuous uncertainty despite having the best healthcare and medical delivery system. People are struggling to make ends meet and run into deep uncertainty with the growth of sedentary lifestyles. 

The growing awareness has made people realize the importance of maintaining a balanced healthy lifestyle and have some sense of security when it comes to being called ‘rightfully fit’. Though health insurance covers have existed since ages, the driving force behind their rapid growth has been due to the debilitating nature of the current pandemic. 

What is Individual Health Insurance Plan?

Health insurance not only safeguards the policyholder at the time of need but also protects our finances. As it mitigates the risk of unexpected financial emergencies, it is the most cost-effective way to balance our requirements and get secured under a plan. Individual health insurance plan is one of the most widely recognized health insurance covers. As the name suggests, it is a health cover that an individual opts-in for himself/herself – be it a parent, spouse or a child covered after due consideration of certain factors. The benefits by way of a sum assured is duly realized by the policyholder only. 

The distinguishing factors in case of every policy are the age of the insured person, medical history (types and severity of illnesses either individually or hereditary). These essential points define the extent of coverage, and the premium amount to be charged is worked out post the above consideration. The sum assured is invested keeping in mind the affordability. However, many times insurance companies provide specific discounts if more than one member of the family is insured simultaneously. 

What are some of the best coverages of an Individual Health Insurance Plan?

  1. Renewability: An individual health insurance policy in most of the cases offers lifetime renewability. One can start at an early age and get it renewed year after year without any age limit. This becomes an essential factor because as we grow older the health complications increase. Also, getting a cover at an advanced age, may be quite demanding. Hence, starting early not only helps avoid that risk but also provides extensive benefits. 
  1. Hospitalization charges: Insurers offer pre and post-hospitalization charges for up to a specified number of days depending on the sum assured. Let’s say, in case of a sum assured of Rs.5 lakhs, the coverage of these pre and post expenses may go up to 60 days. All charges incurred during this period is solely borne by the insurer and makes it very convenient for the patient / policyholder to not stress about the same. 
  1. Regular medical check-ups: Prime advantage in case of all policies is that they allow regular medical check-ups at network hospitals. This may be availed on an annual or bi-annual basis depending on the coverage. This assures the insured of their latest health condition by helping them keep a strict track of their bodily functions. In case they feel that anything is amiss, immediate action can be taken. 
  1. Tax benefits: Under section 80D of the Income Tax Act, 1961, an individual is allowed to claim tax benefit is a health insurance policy that protects the individual. The premium amount charged by the insurers can be claimed as an exemption from total taxable income under the act. This is one of the most lucrative reasons why people opt for a health cover as it allows them to enjoy tax benefits while being protected at the same time. If one starts at an early age, they want more tax savings for a far more extended period as compared to the one beginning at a middle-age. However, it is advisable that you don’t predicate your health insurance decision purely on the tax benefits but treat it as an adjunct benefit. 
  1. Avail Bonus: If tax benefit was one, availing bonus is another such alluring aspect of an individual health cover. During the years when there are no claims made against any medical ailment, one can avail a ‘no claim bonus’ for that particular year. In other words, it is offered when one does not make any claim from the insurance company. It ranges from 20% to 50%. Usually, NCB is being provided as a discount on the premium cost of the consecutive years or else given as a hike in the sum assured. Either way, if a policyholder is hale and hearty and does not make any claims, they do tend to benefit from this clause. 
  1. Cashless claim settlement: This is a process where all expenses are directly settled between the hospital and the insurer without the patient having to pay for it. At the time of admission to the hospital, the patient presents the e-card or any other physical proof of health insurance taken. This facility is available at the network hospitals and post-discharge, they send all the bills to the insurance company, which they further evaluate before settling it. This provides enormous relief to the policyholder as they do not have to be burdened by the action point of clearing dues while being in the middle of some critical treatment. 
  1. Inclusion of Family Members: Few insurers provide the option to add/include family members under the same policy. This has its share of pros and cons like – 
  • The insurer will most likely charge a higher premium cost.
  • Benefits may get divided amongst all members covered under the plan. 
  • Restrictive limits may be placed over expenses (E.g. earlier room rent to be claimed would be Rs. 5000 for an individual and now decreased to Rs. 2500 for two; leading to most likely compromise on the quality of room)
  • The benefit is that just some extra premium cost would help secure a family member entirely. 
  • Hassles of having to manage separate policies for every member are absent. 

Miscellaneous expenses: In most of the policies, the following costs are taken care of –   

  • Ambulance charges
  • Doctor’s consultation fees
  • Room and boarding expenses
  • Medical examinations
  • Laboratory & emergency services
  • Meals expenses (+1 for a family member in some cases)
  • Nursing charges
  • Intensive Care Unit (ICU) charges – up to a specific limit 

The end goal

Buying an insurance plan is a long term investment. It’s actually can be utilized as an asset even to avail a loan; although that is only applicable in the case of endowment or money-back policies and not in the case of pure risk covers. An individual health insurance plan is nothing but a dedicated fund covering several benefits at large. Unlike most other types of insurance, it helps customize our plan and also enhances the cover at any given point in time. Here one has complete control over the policy.

The policyholder can make the most of it by starting early. It isn’t a task to find the right plan if one is crystal clear about their genuine needs and requirements. The end goal is to remain stress-free by being financially secure during times of medical emergency. Hence a wise decision of choosing the right insurance has to be made only after analyzing the terms and conditions being offered and our suitability. 

Individual Health Insurance Coverage

What are some of the general exclusions of Individual Health Insurance Plans?

1. Certain diseases like piles, hernia and cataract are covered only after some time gap
2. Maternity coverage is provided after a brief period of around 1-2 years
3. Pre-existing diseases may be subject to a waiting period of a couple of years
4. Naturopathy treatment – Ayurveda, Homeopathy, Unani; unless mentioned
5. Dental treatment
6. Restrictions in hospital costs like – room rent, doctor’s fees, ambulance charges
7. Permanent exclusions could be – HIV, congenital diseases, intentional injuries
8. Surgeries like – joint replacement or cosmetic surgeries

What are some of the top insurers providing Individual Healthcare Insurance?

1. Bajaj Allianz – Individual Health-Guard
2. ICICI Lombard – Personal Protect Insurance Policy
3. Star Health Insurance – Medi Classic Insurance
4. Oriental Health Insurance – Individual Mediclaim

Who should consider buying an Individual Health Insurance Plan?

1. An individual has higher health risks
2. Single individuals who may have their family already separately insured by another policy
3. People who would like to enjoy the benefits of an individual plan rather than family floater viz. dedicated sum assured for their own-self with undivided services
4. Policy seekers looking for prolonged tax benefits in terms of premium costs considering their age factor
5. Young individuals are seeking self-security for lifelong willing to prevail benefit of lifetime renewability

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