Individual Health Insurance

The NITI report says that around 50% of people are covered by health insurance in India through state government extension schemes and 20% of people are covered by social health insurance and private voluntary schemes. The remaining 30% of the population is devoid of health insurance.

It is apparent from the report that despite increased awareness of health insurance, it is still not viewed as a priority. Intent and actual purchase are still far apart.

Medical emergencies can strike at any time. In your youth, the chances of falling ill are low, but not zero, and accidents can also happen. A situation like this may put a significant strain on your finances. By having a good health insurance plan, you can avoid this financial blow to your savings and provide yourself with the much-needed cushion to bear the costs of doctor's visits, tests, medicines, and other procedures.

One of the most popular forms of health insurance is individual health insurance. What gives this plan an edge? Individual health insurance is dedicated to a single person. Every person is unique and so are their medical needs.

Let’s have a detailed look at individual health insurance.

What Is Individual Health Insurance?

As discussed before, individual health insurance covers a single individual. So, if you buy an individual health insurance policy for yourself, only you will be able to a claim under it.

These policies generally cover the following in-patient hospitalisation, pre and post-hospitalisation expenses, daycare procedures, ambulance charges, health check-ups, and domiciliary and home care treatments, etc. This is an indicative list and the coverage may vary across insurers.

How Does An Individual Health Insurance Plan Work?

An individual health insurance plan is basically a contract between you and the insurer. The insurer covers your healthcare expenses according to the sum insured you’ve chosen and the policy T&Cs. In return, you need to pay regular premiums.

For example, you buy a health insurance policy with a sum insured of Rs 10 lakhs. After some time, you need to undergo a basic surgery for which you will be hospitalised. The insurer will pay the hospital bills as per the policy T&Cs. If your hospital bill is Rs 4 lakhs, the insurer will settle the same with the hospital and your sum insured will reduce to Rs 6 lakhs for the rest of the policy year.

Advantages Of Individual Health Insurance

Individual health insurance plans are extremely helpful. Here’s why -

  • They Cover A Single Individual

    Since these plans offer solo coverage, this ensures that the entire sum insured can be used by only you.

  • No Stringent Rules For Age And Renewal

    Some policies can be bought no matter how old you are. Please note, children below the age of 18 years cannot be covered under an individual plan - they will have to be covered under a floater policy with their parent/s.

    And, some plans can also be renewed for a lifetime. So, you can be assured that you will always be covered.

  • Premiums Are Based On The Zone You Reside In

    The premiums charged by insurers are calculated zone-wise, i.e., the city you reside in. So, a person living in a Tier 2/3 city (like Indore, etc. .) will be charged lesser premiums than a person living in a Tier 1 city (like Mumbai, Delhi, etc.)

  • You Can Get Discounts

    Some insurers may also give you discounts on the premiums you pay if you -

    Buy multi-year plans (2-year, 3-year, etc.)

    Buy the plan online.

    Buy multi-individual plans, i.e., plans that cover family members under a single plan while ensuring individual coverage for them.

    Take good care of your health.

  • You Can Make Multiple Claims

    One of the best features of a health insurance plan is that you can make multiple claims in a year - up to your sum insured, of course. So, you’ll be covered even if you have to undergo multiple medical treatments within the same year - as long as you don’t exhaust your sum insured.

  • They Offer Tax Benefits

    An ancillary feature of health insurance plans is that you get tax benefits on the premiums you pay every year - under Section 80D of the Income Tax Act, 1961.

  • They Give You Peace Of Mind

    Health insurance plans are meant to take off the stress related to heavy medical expenses. Both unplanned and planned treatments can cost a bomb. With a good health insurance plan, you’ll always have a protective bubble against health crises.

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Exclusions Under Individual Health Insurance

Exclusions essentially mean the scenarios which aren’t covered by health insurance. We have already discussed how individual health insurance offers you wide coverage against medical treatments, but it also comes with exclusions. There are certain diseases and conditions that it won’t cover.

Some Standard Exclusions Include -

  • Self-inflicted injury

  • Injuries due to participation in high-risk activities like kayaking, skydiving, etc.

  • Substance Abuse/Alcohol/Narcotics

  • Injuries or illness due to war or nuclear attacks

  • Breach of law/criminal activity

Please Note: This is just an indicative list. Check your policy wording to understand the exact exclusions under your policy.

Along with the standard exclusions, health insurance plans do not offer coverage for medical conditions/treatments for a predefined time span, known as the ‘waiting period’. You can make a claim for these conditions/treatments only after the waiting period is over.

Here are 3 types of waiting periods you should be aware of:

  • Initial Waiting Period

    Only accidents are covered by health insurance from day 1. For all other treatments, insurers impose a waiting period of 30 days and so, any treatments/conditions will not be covered for the first 30 days after you buy the policy.

  • Specific Disease Waiting Period

    Insurers impose a 2-year waiting period for specific diseases and treatments like hernia, chronic kidney disease, spinal disorders, etc. The list of such illnesses is mentioned in the product brochure or policy wording.

  • PED Waiting Period

    A pre-existing disease refers to any condition, ailment, injury, or disease diagnosed or treated by a doctor 48 months prior to the date of issue of your health insurance policy. The insurer, depending on the policy T&Cs, will impose a waiting period of 2-4 years for pre-existing diseases.

    Note: Check your policy wording and go through the exclusions thoroughly so there are no shocks when you make a claim.

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Wrapping Up!

An individual health insurance policy covers the health risks of an individual. While it offers wide coverage against a range of medical conditions and treatments, there are certain exclusions that you should be aware of. Ensure that you read the policy document carefully so you can make an informed decision.

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