What is individual health insurance?

There is a lot of truth in the adage Health is Wealth. If you have good health, you can conquer the world and face adversities. However, due to poor lifestyle choices and eating habits, today, diseases have become common and widespread. So, if you fall ill, treatments and possible hospitalization can wipe out your savings. That is why you need to think seriously about health insurance.

One of the most popular health insurance plans is the individual health insurance plan. As the name suggests, this type of insurance offers coverage to one person and takes care of that person’s treatment and hospitalization, when the need arises.

Importance of individual health insurance

If you go to a private hospital for simple treatment, it will set you back by thousands. So, imagine if you meet with an accident or fall seriously ill? You could end up paying lakhs, especially if you need to be hospitalized and/or require surgery. That is why you need individual health insurance. Some of the major benefits are:

● No financial burden on you or your loved ones.

● Flexibility to choose the type of cover you want

● Enjoy cashless treatment at empanelled hospitals

● Avail tax benefits under Section 80C of the Income Tax Act

Thanks to the changes in the regulation, individual health insurance is portable and when you switch the insurer, you don’t lose out on any benefit.

Best individual health insurance plans offered by top insurance companies

If you are looking for some of the best individual health insurance policies offered by top insurers in India, they are as follows:

1 . CICI Lombard:

Name of Policy: Personal Protect Insurance Policy

This individual health insurance does not mandate a health check-up before the policy is issued. It also allows you to claim if you are a victim of an act of terrorism. It offers coverage against death or permanent disability.

Entry age for the policy is 18 years to 60 years and the term can be anywhere from one year to five years. The claim process is easy, with minimal documentation. It provides coverage in any corner of the world.

2. Bajaj Allianz:

Name of the Policy: Individual Health Guard

The policy has more than 3,700 hospitals across India in its network and it covers 60 days pre-hospitalization and 90 days post-hospitalization. It also covers the cost of ambulance for up to INR1,000. In addition, the health insurance covers almost 130 daycare procedures.

It offers coverage ranging from INR1.5 Lakh to INR 10 Lakh for individuals aged 3 months to 55 years; and INR1.5 Lakh to INR 5 Lakh for individuals aged 56 years to 65 years. The entry age is 18 years to 65 years.

3. Oriental Health Insurance:

Name of Policy: Individual Mediclaim

This policy offers cashless treatment and reimbursement treatment. It provides 30 days cover pre-hospitalization and 60 days post-hospitalization. It covers up to INR5,000 or 1 percent of the sum insured for hospital charges, like nursing, room, and boarding. It also covers ambulance, consultation and surgeon charges. For intensive care unit, it will cover up to 2 percent of the sum insured or up to INR 5,000, depending on which amount is lower.

The entry age for this individual health insurance is 18 years to 65 years. It provides sum insured ranging from INR 50,000 to INR 5 Lakh.

Important points to remember while buying individual health insurance

When buying individual health insurance, these are the few things you should remember before finalizing the purchase:

  1. health insurance is a must:

Opt for an individual health insurance even if you are accorded coverage under employer-sponsored health insurance. Choose a plan offering a comprehensive coverage. If you have a chronic disease, like heart problem or diabetes, it is recommended not to depend solely on corporate group health insurance.

  1. the sum insured carefully:

Select the sum insured based on your healthcare needs and cost of treatment. For example, if you are in a small town or a tier 3 city, the chances are the cost of medication is going to be lower when compared to a metro. A point of note – check the sum insured on a regular basis to and increase the cover periodically. This will help you stay ahead of medical inflation costs in the future.

  1. is never too late to get insurance:

There is no minimum age to get an insurance cover. It is advisable to get individual health insurance as early as possible. When you opt for individual health insurance before 40, the chances of filing a claim are low. This means you can take advantage of the ‘no claim bonus’, which will further ensure you enjoy lower premiums.

  1. for individual health insurance with lifetime renewability:

Remember as you age, your healthcare is more than likely to increase. Hence, always opt for a health cover that comes with lifetime renewability. This way, you will have health care protection when you need it the most.

  1. away from a claim loading policy:

Refrain from buying a claim-loading individual health insurance. In the future, long-term care may be required for serious illnesses. The premium to keep the policy going may keep increasing. The downside could be an increased cost, beyond your budget.

  1. to opt for a policy that offers to restore limit or super top-up:

Though unfortunate, there may be times in your life, when you may exhaust the limitations of your insurance policy. In such cases, restore limit or super top-up allows you to restore the sum insured without incurring any additional cost. It is especially beneficial if have an unforeseen ailment requiring expensive treatment.

  1. compare individual health insurance policies:

Don’t let the premium dictate your choice. Instead, look for an individual health insurance that caters to your healthcare needs and provides you a comprehensive cover.  Of course, it should also fit your budget. The best way is to compare health insurance policies online at Paybima. This will give you a better understanding of the features and benefits of each plan, thereby easing your buying decision.

  1. take into account the waiting period for pre-existing diseases:

Most insurers cover pre-existing diseases, but there is a waiting period clause. This can vary from 2 to 5 years. If you are already suffering from a disease, ask explicit questions with regards to the waiting period. Be sure you are comfortable, before investing your individual health plan.

How to choose the best fit individual health insurance plan

There are several insurance companies in India offering individual health insurance plans. Some are renowned national brands, while others are known in regional areas. So, how do you decide which one is the best fit for you? You follow the below-mentioned tips.

What are your needs?

Ascertain your needs and accordingly choose a plan. Take into account your age, health and marital status to calculate your insurance requirement. There are several online tools available to help you calculate. As stated earlier, with advancing age, your insurance needs will change. The first step is, therefore, identifying your health needs – and then deciding on the coverage amount.

Which company should you buy from?

Choosing the company carefully is as important as choosing a sum-insured amount. What are the features of the policy they offer? How quick is their response rate? Are they open 24-hours, in case you seek medical treatment at odd hours?  This will give you a clear picture of both the plan and the company, making the decision easier.

Find out the claim settlement ratio

Ask the insurer for their claim settlement ratio. This will indicate the ethics code – whether the insurance provider honors claims or not. In addition, learn more about the company and how long it has been in the business. An experienced insurance company will be able to cater to different needs and that allows you buy the best fit individual health insurance plan.

Check the hospital network

Find out the empanelled hospitals where you can get cashless treatment and hospitalization. Opt for an insurance provider that has a vast network of reputable hospitals. Specialized hospitals to treat different ailments and diseases should be part of the network.

Key Benefits & Features of Individual Health Insurance Policy

The key features of an individual health insurance policy are as follows:

  • Only the insured person gets covered by the policy
  • Medical and hospitalization costs cover is based on the premium paid
  • Most plans cover pre- and post-hospitalization treatment, medication, and expenses
  • Plans usually cover cost of surgery, physician’s fees, room rent and lab tests
  • You can avail tax deduction under Section 80D of the Income Tax Act
  • Some Individual health insurance may offer coverage for critical illnesses
  • Individual health insurance usually has a waiting period for pre-existing diseases. As mentioned earlier, this period can vary from two years to five years
  • Daycare treatment is covered by most individual health insurance policies, but subject to certain terms and conditions
  • Most insurance plans do not cover the cost of alternative treatments, ayurvedic, naturopathy and homeopathy treatments
  • Does not offer cover for alcohol and other addictions and treatment
  • Cover for cosmetic and aesthetic surgeries and treatments is not provided
  • Only a few individual health insurance plans cover maternity and newborn care
  • Mental illness treatment is not offered coverage under the plan

Advantages of individual health insurance plan are as follows:

  • You are entitled to utilize the entire sum assured for your ‘covered’ treatments
  • Individual health insurance is necessary for all, as it can cover even simple hospitalizations.
  • It is ideal for people with high health risks
  • Add parents and immediate family to the plan based on the policy of the insurer

Eligibility/documentation required for individual health insurance policy

Every insurance policy requires certain eligibility

  • You have to be between 18 years and 65 years
  • Present proof of age, like voter’s ID, driving license or passport
  • Have an identity proof, like Aadhar card, passport, PAN card, voter’s ID or driving license
  • Many insurance providers also look for address proof, such as telephone bill, ration card, passport or electricity bill
  • If your insurer mandates a medical check-up, you will need to present the medical certificate from an authorized health center

Steps to buy individual health insurance cover online

It is very easy to buy individual health insurance policy online. Just follow these simple steps and you will be able to buy the cover within no time:

1. Fill out your full name, age, city of residence and marital status into the fields provided.
2. Mention your occupation and annual income
3. Ask the insurance provider to send you a quote
4. Compare different policies to shortlist around three policies
5. Now further compare the three shortlisted policies to finalize one that you think best suits your needs and budget
6. Fill out the health declaration form honestly along with the other details requested
7. Pay the premium using your credit card, netbanking or debit card
8. Get a digitally signed copy of your individual health insurance
9. Take a printout of the policy and keep it in a safe place. It is advisable to save to the cloud platform also and make it accessible to your immediate family

Benefits of individual health insurance plan renewal

There are many reasons to renew your individual health insurance plans, and some of them have been highlighted below:

  • Renewal ensures you don’t have to worry about the waiting period. Remember, during the waiting period, you cannot get reimbursed for treatments or file claims. Thus waiting period reduces with each renewal
  • When you renew your health plan, you get no claim bonus if you have not made a claim during the previous year. The bonus can bring down your premiums or you can use it to increase the sum assured
  • You never have to worry about the policy lapsing and leaving you without a cover
  • Online renewal is quick, hassle-free and convenient. You can do it any time of the day or night, based on your schedule and convenience

Individual health insurance claim procedure

Most insurance providers allow you to enjoy cashless treatment at their partner or empanelled hospitals. For this type of treatment, you have to present your policy details at the hospital for verification. Once the insurer has completed the verification process, you can get cashless treatment and hospitalization in case of unplanned treatment. The hospital will send the relevant documents to the insurance company and the company will directly settle the claim with the hospital.

Planned Treatments

If you intend having a planned procedure or treatment, inform your insurance company in advance. This should be done a minimum of four days before the treatment.

  • Fill out the cashless claim request form and submit it to your insurance provider via email, post or fax
  • The insurer will send you a confirmation letter and also notify the empanelled hospital that the procedure is approved
  • Carry the letter from your insurer as you would have to present it at the hospital

Emergency Treatment

In case of an emergency, if you go to a hospital that is not part of the empanelled hospital network, you will not be able to avail cashless treatment and hospitalization. Under such circumstances,

  • Retain all original bills, receipts, and reports
  • Send them to the insurance company to get reimbursed

Usually, reimbursement will take place after the insurer checks the bills and ensures that your treatment is accorded cover by your policy.

Documents required for processing of the claim in an Individual Health Policy:

If you want to make a claim against an individual health insurance policy, you would have to fill out the reimbursement claim form. Along with the form, you are required to submit the following documents:

  • A medical certificate signed by the doctor treating you
  • Original discharge letter by the hospital
  • Original bills and receipts
  • Original prescriptions
  • Original cash memos from the chemist
  • Laboratory tests and investigations
  • If you had to undergo emergency treatment due to an accident, you would need to submit the copy of the FIR filed by the police and/or Medical-Legal Certificate
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