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What is an individual health insurance policy?

Even if you have a company-sponsored insurance plan, you should look to cover all bases by investing in individual health insurance plans.

The best part about individual health insurance plans is that they are highly customizable and allow you to select the range of coverage against ailments, services provided and the financial liability against which the insurer will cover you. Individual health insurance plans also let you enjoy lifelong renewability and tax benefits under Section 80D of the Income Tax Act in India, which aren't available under an employee-sponsored health plan.

How does an individual health insurance policy work?

Purchasing a health insurance policy is often considered a rite of passage as investing in a health plan is one of the cornerstones of attaining financial wisdom. A good health insurance policy will give you coverage and relieve you of the financial stress associated with treatment costs. Most people who work in offices tend to receive an insurance benefit from their employer. While it is a common practice, one of the reasons why you are a part of an employer-sponsored group health plan is because it is mandated by law in India. However, these plans often turn out to be inadequate for our needs.


1.       Personal factors

To begin with, you need to assess your health insurance needs based on your age, health, family history and income level. Some other factors that you should look out for are illnesses covered and other benefits such as pre and post hospitalization expenses, room rent, ambulance services etc. After taking into account, the above factors, your health insurance company determines the premium that you will pay on your health insurance policy.

Also, if the insured person is hospitalized and a claim is made, the first thing the insurance company does is check the reasons for hospitalization and if your health insurance policy covers it.


2.       Waiting period

Next, the health insurance company checks the holding tenure of your health plan. There are many reasons why your insurer does so. For instance, critical ailments such as heart diseases, cancer, kidney failure, etc. have a ‘holding/ waiting period’. This waiting period could range anywhere between one year and four years, depending on the ailment. The insurance benefit for such aliments only kicks in once this waiting period has been successfully completed without an insurance claim.

The insurer will also go on to seek the primary diagnosis to understand the reasons for hospitalization. They determine if there are any new health developments and not a pre-existing condition that has been kept hidden/falsified to the insurer. If it is found that the hospitalization is due to an existing and undeclared health condition, then the insurer can refuse to provide any coverage and render the health insurance policy void.

This will also make it difficult for you to get another health insurance coverage anywhere in India.


3.       Cashless hospitalization/ Reimbursement

Once the claim has been verified as a legitimate one, the insurance provider will check to see if the hospital where the treatment is being offered is within its network of service providers. Most individual health insurance plans now offer cashless hospitalization benefit. Thus, to utilize this benefit, you must enroll at a hospital within the insurer’s network.

After that, all you need to do is pay a nominal registration charge while the claim is being taken care of by the provider. They simply cross-reference the cost of the treatment with the coverage offered under your health insurance policy. If the bills are within the coverage you have opted for; you don’t need to pay anything else out of your pocket. However, if the bills are more than the coverage, then you will have to pay the difference.

Hence, when looking to purchase individual health insurance plans, it is recommended to factor in certain factors. These include the cost of health care services, rate of medical inflation and the whole gamut of services that you might need. This ensures that your finances are not adversely affected despite paying for an insurance plan.

Remember to also keep all medical bills safely such as the pre-& post hospitalization bills, pharmacy receipts and submit them collectively to the insurer. The insurance company will then be able to accurately check the scope of coverage of the individual health insurance plans and reimburse the requisite amount after deduction of other charges (if any).

Contemporary individual health insurance plans not only provide a safety net against unexpected medical costs but also ensure you get the best treatment and service in the most convenient way possible. Don't waste any time and head on over to and avail services like 30-minute claim settlement for a smooth experience.

Features of an individual health insurance plan

People are increasingly becoming aware of the importance of leading a healthy lifestyle and focusing on their physical well-being. Nonetheless, statistics from the World Health Organization point to the fact that the incidents of certain diseases are increasing. No matter how healthy a lifestyle you follow, the risk of hospitalization due to unforeseen events cannot be eliminated. To stay protected from financial stress in cases of disease and hospitalization, an adequate health plan is a must.

These days, a variety of health plans with beneficial features are available. Among some of the most popular health insurance policies are individual health insurance plans. These plans cover only a single individual policyholder. However, keep in mind that a key parameter for choosing any policy is the health insurance features it offers.


Let's look at some important features of an individual health insurance plan.


1.  Cashless hospitalization: One of the most beneficial health insurance features offered by some individual health insurance plans is cashless claim settlement. The cashless feature allows the insured who is admitted in the hospital to avail treatment without making any treatments, i.e. get full coverage. He/she can easily get medical attention without worrying about upfront payments at the hospital. When the insurance company is informed about the hospitalization, it will directly settle the bills with the hospital. This benefit is generally only allowed in a network of hospitals that are on the panel of the insurance provider.


2.  Cover: As per some Indian studies, the annual medical inflation in India is about 17 per cent, which is much higher than the general inflation level. Thus, to protect yourself from any financial burden, one of the most important health insurance features of individual health insurance plans is the coverage it provides.

Some experts even suggest that one can consider individual health insurance plans over family health plans since they provide extensive coverage. In such plans, the premium of the policy is decided based on an individual's age and respective sum insured. The insurance provider covers the medical costs up to the sum insured. The nature and extent of medical costs covered could differ across policies and also depend on the premium. Many policies, such as Max Bupa's health companion also cover pre- and post-hospitalization costs. However, these details will depend on the plan and insurance provider you pick.


3.  Daycare and OPD expenses: Usually, health plans require a minimum hospitalization of 24 hours for any claim to be considered. However, with increased technological advancements, many surgeries and procedures take much lesser time. Hence, several individual health insurance plans include an important feature – settlement of claims for day-care expenses such as dialysis, chemotherapy, eye surgery and many more. Certain procedures such as dental care are is considered as out-patient procedures and claims of such procedures are settled accordingly.


4.  Lifetime Renewability: According to IRDAI regulations, it is mandatory for insurers to offer health insurance for all individuals up to 65 years. However, a lot of private health plan providers have done away with age-limits in their health plans. Although, the state-owned general insurers still limit the entry age at 65. Lifetime renewability is available even if a claim is made in the earlier year.


5.  Pre-existing ailments: Pre-existing ailments are covered by all individual health insurance plans. However, there usually exists a 48-month waiting period. Certain health plans also offer coverage with reduced waiting periods of 36 months or lesser. However, a buyer has to make all medical disclosures while buying the policy honestly. In case the policy providers suspect that the customer was aware of the pre-existing disease when the policy was bought and failed to disclose, the claim can be rejected.


6.  Capping: One of the most prominent health insurance features to keep an eye on is capping. Many health plans set sub-limits or caps on various diseases and expenses. A ‘disease wise capping’ feature is incorporated in many individual health insurance plans, under which the maximum payout for a certain set of conditions could be limited to a amount (less than the total sum insured).

Additionally, the total medical cost during a hospital stay may include various elements such as room rent, surgery charges, doctor fees, cost of medicine etc. Some health plans may cap or limit the reimbursement under each or some of these costs to a specific pre-defined level. For example, reimbursement of room-rent may be capped at 1 per cent of the sum insured.

Health plans in the current times have become a necessity. If you decide to opt for an individual health insurance plan, make sure you do thorough research and check the inclusions and features of your chosen plan carefully. Don’t base your buying decision solely on the premium amount. Choose a plan that is simple and offers the best features suited to your needs.

What should I do to get an individual health insurance plan?

Our health is the most precious asset we have. While we can monitor our actions, dietary habits and exercise; there remain certain variables that are not in our control. An individual health insurance plan is a way to safeguard our health and financial future by providing coverage against any possible known and unknown risks. Therefore, many investment professionals say that investing in a health plan should be your priority.

Things to keep in mind when scouting for the right health plan

There are a host of health insurance companies in India who collectively offer thousands of insurance plans, each of them with specific benefits, exclusions and terms and conditions. While the basic premise for all health insurance plans remains the same, you should look to pick a policy that suits your individual needs the best.


Things to remember before buying an individual health insurance plan in India- 


1.  Estimate your health insurance coverage: Although there are no fixed guidelines regarding the coverage one should have, there are certain parameters to keep in mind that will impact your health insurance needs.

Primarily, your age and income levels determine your premium. This is followed by factoring in your family history and pre-existing conditions. Another thing to remember is that if you have a predisposition to certain ailments, you should consider getting extra coverage. Similarly, you also need to factor in your geographical location as the standard of living and healthcare expenses in metro cities is much higher when compared to smaller cities.


2.  Keep an eye out for sub-limits on the policy: Most health insurance plans do not cover all expenses incurred in case of an emergency. A sub-limit caps the reimbursement under various cost heads and is listed in the policy wordings of your health plan. For example, your room rent or ICU charges may be capped at 1% or 2% of the total sum assured. This means that despite having adequate insurance, you may still have to pay certain expenses out of your own pocket.

None of us would want to compromise on the care we may end up needing. Hence, be careful and understand all sub-limits when going through the proposed policy document.


3.  Check for coverage of pre-existing ailments: All critical illnesses such as coronary problems, cancer, kidney failure, diabetes, etc. under health insurance plans come with a waiting period before which the individual health insurance plan will not cover your treatment. This time period tends to vary and can be anywhere between 12 to 48 months.

Once this waiting period has elapsed, you can make a claim to your insurance benefits.

However, you should ensure that you disclose all health issues at the time of purchasing the policy. Falsifying or hiding health issues can render you policy void and also make it difficult for you to seek another health plan from other insurance providers.


4.  Find out about the co-payment options: In most cases, your individual health insurance plan will cover all costs, but the policy may introduce a co-payment feature where the insured party is asked to bear a certain percentage of the costs. A co-payment feature is usually present in health plans for senior citizens. Since they are a high-risk category for insurers, the premiums for senior citizens are a lot more expensive. By introducing a co-payment option, which could be anything from 10% to 30%, the cost of the insurance is shared, making the insurance plan a lot more affordable.

Process for selecting the right individual health insurance plan

1.  Comparison- Once you have identified your needs and the requisite insurance benefits that meet your criteria, you need to shortlist three to five individual health insurance plans from different insurers. Then, make a careful comparison between the selected plans.

There are many aggregator websites in India that provide details on each individual health insurance plan and even allow you to make assessments head to head. You can even go to the insurance providers website such as and get a quote for the plan of your choice.


2.  Inclusions and Exclusions- Before you zero in on a plan, take a close look at the list of inclusions and exclusions on the policy. Legal parlance can be confusing, so if you have any doubts, speak to your agent or a representative of the insurance company. Your top priority should be gaining absolutely awareness of the contract that you are getting into.

It is generally recommended to pick a simple individual health insurance plan with fewer conditions and restrictions.


3.  Premium costs- If you are concerned about expensive premiums, there are many tips and tricks that could help you bring the premium down on a health plan. Many insurance companies now allow you to pay for an individual health insurance plan for two years instead of the usual annual renewal. In a bid to incentive customers to sign up for a two-year policy, they also offer some discounts.

Additionally, if you are dealing with an insurance agent, he/she may be able to offer a small discretionary discount on the individual health insurance plan by letting go of some portion of their commission. However, this depends on the type of policy, as well as your negotiation skills.

Many insurance companies also have tie-ups with banks and credit card providers. Thus, you may be able to snag some value-added benefits and cashback offers by purchasing the individual health insurance plan from a partner bank.

Once you have finalised on an individual health insurance plan, fill the proposal form carefully to ensure there are no mistakes.

You may be required to take a medical test based on your age and pre-existing conditions (if any). Most insurance companies now provide doorstep service for the preliminary health check-up or will redirect you to a channel partner to make the process easier for you.

Once issued, the insurance policy should reach you shortly. Many insurance providers such as MaxBupa provide you with a free look period, within which if dissatisfied, you can return the individual health insurance plan.