Individual Health Insurance Plans

Health can earn us wealth and, in our life, always health comes first. So, we must always ensure that we are taking good care of ourselves in all situations. Due to pollution and the increasing population, the number of diseases has increased tremendously. Also, as you are busy and hardworking every day, you somehow ignore your health. Sometimes people even skip their meals, giving work their major priority. This could lead to huge mental and financial burden as you could suffer from some diseases. Due to inflation, the medicinal costs have also increased drastically. So even if you go to any medical store to purchase a few medicines, it could cost you a lot. Similarly, the cost of medical procedures has also increased tremendously. So, it is always suggested to purchase Health Insurance Plans for Individuals. Through this Individual Health Insurance, one can ensure that they are protected from the financial burden which can arise in case of some disease or some injuries. Health Plan companies care for all the medicines, pre and post-hospitalization expenses, surgery expenses, ambulance cost, etc. which has occurred during the policy term. It is always suggested to people as it is not always possible to afford quality treatment due to the high cost. An Individual Health Insurance covers all pre and post-hospitalization which has occurred around 30 to 60 days before 90 days of hospitalization. One can opt for reimbursement facility in which insured will pay initially and after submitting the documents, the amount will be reimbursed by the Individual Health Insurance Company. Health Insurance Plans for individuals even provides cashless facility to insured provided the treatment is done in the network hospital. Apart from this all diagnostic tests and ambulance cost all refunded up to a certain limit. As per few conditions’ satisfaction, daycare facilities are also covered. However, for covering pre-existing diseases, there is a waiting period which could vary depending upon the Individual Health Plan you opt for. This could vary in years or months. After a waiting period, surgeries like cataract or treatment of asthma, piles, etc. are also covered. There is some Individual Health Insurance which also covers maternity-related expenses.

Eligibility Criteria for Individual Health Insurance for Individual Health Insurance Plan.

The eligible criteria for Health Insurance Plans for Individuals are as below:

Entry Age:

The acceptable entry for a policyholder for Health Insurance Plans for Individuals is a minimum of 18 years with a maximum age of 65 years (which could be 70 or above, depending upon the policy). Dependable children can get coverage is from 90 days to 18 years. The premium cost is proportional to the age, as the age increases; the premium cost also increases simultaneously.

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Family Discount:

This discount is offered if one of the other family members is covered along with you. This all depends upon the health plan.

Discount on cumulative premium payment:

There are few health insurance companies which offer discounts for Health Insurance Plans for Individuals on the criteria that you pay the premium of 2 years together.

Discount Voucher:

Depending upon the Individual Health Insurance Plan, a discount voucher is provided for purchasing medicines and for medical procedures, which would be in certain outlets.

Wellness Rewards:

Health Insurance Plans for Individuals offers Wellness rewards as well based on the condition that you remain healthy.

What Individual Health Insurance Plan Covers (Inclusions)

Health Insurance plans for individuals have various inclusions. Some of which are listed below:

1)      Day Care treatment Expenses:

A day care facility is one in which the patient doesn’t need to be hospitalized for more than 24 hours. Individual Health Insurance ensures that it provides coverage for day care as well. Examples of day care could include Cataract operation.

2)      In-patient hospitalization cost:

Health Insurance Plans for individuals covers for the medical expenses which are caused because of hospitalization which is considered as In-patient hospitalization cost.

3)      Pre and Post-hospitalization Cost:

Individual Health Plan covers medical expenses which are caused before hospitalization which is pre-hospitalization cost. Examples include MRI, X-ray, sonography, blood test, urine test, etc.

Individual Health Plan also covers medical expenses caused after hospitalization which is post-hospitalization cost. The examples include medicines or any medical test performed

4)      Ambulance Cost:

Individual Health Insurance covers ambulance cost as well for the patient. Thus, Health Insurance Plans for Individuals offers a certain amount thus giving relief from ambulance charges.

5)      Hospital charges:

Individual Health Plan provides a daily cash allowance of a certain amount. The amount is decided at the time of purchase of the policy. This cash could be used for transportation or some other use.

6)      Refill benefits:

Individual Health Insurance also provides restoring benefits in which can refill the coverage once it gets used up. This refilling is available for unrelated claims.

What individual Health Insurance Plan Does NOT Covers (Exclusions)

The Individual Health Insurance Plan does come with some of its exclusions as well. It is always recommended that you read all the terms and conditions properly, know if are excluded or included by the plan, this would help you avoid end moment surprises for Individual health plan. Below are the pointers:

Ø  Pre-existing diseases for Individual Health Plan are covered only after a definite waiting period, which depends upon the carrier and its health plan.

Ø  Depending upon the disease, Health Insurance Plans for Individuals decides the cover amount varies. It could be 10 to 90 percent of the sum assured dependable upon the Individual health insurance plan

Ø  Non-allopathic treatments like Homeopathic, Ayurvedic treatments are not covered by the Health Insurance Plans for Individuals.

Ø  If the disease is caused due to bad lifestyles like smoking or alcohol consumption, then Individual Health insurance does not encourage them for providing coverage.

Ø  Cosmetic treatment such as plastic surgery (apart from the one caused due to accident) and aesthetic treatments are not covered by the Individual Health Plan.

How to Choose the Best Individual Health Insurance Plans in India

1)     Sum Assured:

While we are unhealthy, it costs a lot when we visit a doctor. Also, if there is a procedure which needs to be performed, it could even leave our bank balance empty. So, it is always preferred to choose individual health insurance with maximum coverage. Also, if we are taking Health Insurance plans for individuals who are the senior-most, then as they are more likely to contract diseases, they must have the maximum coverage as possible.

2)     Family Floater Health Plan vs Individual Health Plan:

If you are a family of younger people including you, your wife and a child, then it is always preferred that you purchase a Family Floater health plan. Moreover, if you have parents who need to be insured, they must be given an individual health plan or Health Insurance Plans for Individuals as it provides more coverage which they may need in their old age.

3)     Less waiting period:

When you purchase a Health Insurance Plans for Individuals, you will have to keep in mind that it should have a lesser waiting period for pre-existing diseases if any. Mostly the waiting period could vary between 2 to 4 years. Choose the one lesser waiting period as you are more vulnerable to pre-existing diseases.

4)     Keep Maximum Renewal Age:

When you are younger, you may or may not need an Individual health plan. But as you grow older, you must be aware that your body might not support you all the time. So, you must have a Health Insurance Plans for Individuals which can provide renewability at least till the age of 70 or 75 years of age.

5)     Claim Settlement Ratio:

If you are confused while choosing an Individual Health Insurance, then you must check for claim settlement ratio of the company. The one with more claim settlement ratio should be chosen. This would ensure you have hassle-free claim settlements.

6)     Sub-limits:

An Individual Health Insurance must have a sub-limit which should be used for room rent, per day expense, etc. If you want to avoid removing any additional money by your pocket, then purchase an Individual Health Insurance which offers more sub-limits.

7)     Network Hospital:

If you are opting for Individual Health Plan with cashless claim facility, then you have to check whether the network hospital mentioned is within your locality.  Also, the network hospital should be expanded in different parts of India as well. This could help in case the insured is travelling to some other place.

8)     Compare Premiums:

While purchasing an Individual Health Insurance, it should be kept as a habit to compare the premiums as it could be a possibility that there are two plans offering same benefits and coverage, but one of them is with a lower premium. So, compare the plans for premium. However, Individual health plan should not only be purchased just because of a lower premium, but you must also check other benefits as well.

9)     Exclusions:

Read the terms and conditions properly to know if you are eligible for the Individual Health Insurance. If you are excluded from Health Insurance Plans for Individuals, then know it from the beginning to avoid rejection at the final stage of the claim process.

10)Feedback:

Make sure you read the reviews of the Health Insurance Plans for Individuals. This would give you more idea about the plan.

11)Riders:

Riders are purchased on top of the base plan to increase the coverage in Health Insurance Plans for Individuals. It could be helpful and would provide financial safeguard during times of accidents, critical illnesses, etc. Also, note that you must purchase rider only if it is required.

How to Compare Individual Health Insurance Plans in India?

For comparing Health Insurance Plans for Individuals, you must follow below simple steps:

Step 1: Go to an Individual Health Insurance comparing websites

Step 2: Check for your eligibility. Also, check if you are included or excluded from the plan

Step 3: Check for the coverage provided by each plan

Step 4: Check for its waiting period for pre-existing diseases, claim settlement, ratio, riders, super top-up plans, sub-limits, policy renewal facilities, some extra features, etc.

Step 5: After filtering out the plans, compare all the plans. If all the benefits and coverage are the same, then go for the one which offers the lowest premium.

Step 6: It’s a go 

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Individual Health Insurance: Check Points

One must be aware of a few points before purchasing Health Insurance Plans for Individuals. Below are the checkpoints:

Ø  Check for the coverage level before purchasing Health Insurance Plans for Individuals. Ensure that you get the maximum coverage, as medical procedure usually cost a lot and it would provide financial protection.

Ø    When you invest in Individual Health Insurance, you must have a maximum sub-limits option which you can use for your ambulance charges, room rent, etc.

Ø  Individual Health Insurance must always have a lesser waiting period for pre-existing diseases, as you are more susceptible to contract with such pre-existing diseases.

Ø  Opting for cashless claim facility within the network hospital would ensure that the treatment is provided without a penny out of your pocket up to a certain limit. Ensure the network hospitals are spread around your locality.

Ø  Check for entry age for dependent children before purchasing an Individual Health Plan

Ø  Check for exclusions in Individual health insurance policy. Only if you are eligible, you should purchase the health plan.

Individual Health Insurance Claim Process

If an individual wants to purchase an Individual Health Insurance Plan, then they must also know about its claim process from the beginning. The family members could carry on the claim process in case the insured is unwell. For the claim process of Health Insurance Plans for Individuals, usually two methods are followed:

1)     Cashless Claim Process: 

In cashless claim facility for Health Insurance Plans for Individuals, the insured must be treated in the network hospital which would be conveyed while purchasing the Individual health plan. They need to present an e-card, health insurance plan details, and any physical proof documents, etc. After approval, the insured could avail the cashless claim treatment. Also, approval would be provided only if the injury or the disease is covered under the Individual health plan. After the patient is discharged, the hospital provides all the medical bills to the health insurance company. After evaluation, the company does the payment to the hospital.

2)     Reimbursement Claim Facility:

The second type of claim process in Health Insurance Plans for Individuals is reimbursement facility. As the name suggests, the health insurance company provides reimbursement up to the sum assured for the amount which was already paid by the individual during times of accidents or mentioned illness. This facility is provided by Health Insurance Plans for Individuals for treatment not falling under the network hospitals. Here, the insured will have to bear the initial cost of treatment, then after treatment, they will have to submit all the medical bills to the Individual health insurance company for settlement of claims. If the treatment is not covered, then the claim could be rejected.  

Below documents must be kept in hand opting for this claim process:

1. i)   Claim form which is duly filled
2. ii)   Medical Certificate or form which is signed by the treating doctor.

iii)   Medical Certificate or form which is duly signed by the physician

1. iv)    Patient’s Discharge summary or original card, given by the hospital.
2. v)   Prescription, cash memos from pharmacies or hospital.
3. vi)   Original Bills and receipts

vii)   Reports of Investigation

viii)  FIR or Medico Legal Certificate, in case of an accident

Can I pay Health Insurance Premium as Monthly, Quarterly, Half-yearly?

Yes, you can pay your Individual Health Insurance premium in any of the modes like monthly, quarterly, half-yearly and annually. For Health Insurance Plans for Individuals, we have the flexibility to pay in any one of the premiums paying methods.

Individual Health Insurance Plans FAQs

1. Can I buy individual health insurance?

If you want to insure yourself and if you don’t fall under the exclusions list, then you can surely buy an Individual Health Insurance plan for yourself. Exclusion category includes working for life-risky jobs, attempt suicides or self-injuries, involved in crime, etc.

2. How much is health insurance a month for a single person?

The cost of Individual Health Insurance plan varies for a different person. For an individual with 5 lakh sum assured, they will have to pay the premium ranging between 4000 to 12000 more or less.

3. What is individual health insurance?

If you want to purchase a Health Insurance plan separately for yourself or your spouse or your parents, then such comes under Individual Health Insurance plan.

4. How much is an individual health insurance plan?

Individual Health Insurance plan varies from person to person. It can cost around 4k to 12k per person for 5 lacs coverage. So an individual health plan provides us benefits at a lower cost. If top-up’s and riders are added on top of the Individual Health plan, then the premium could increase.

 

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