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Individual Health Insurance Work

How Does Individual Health Insurance Work? Read Benefits and Coverages

Health Insurance is one of the most important investments that one should include for financial security. Individual health insurance helps in safeguarding finances in times of medical emergency. In today’s time due to ever-changing environmental factors, health is getting affected making diseases an inevitable part of life. Therefore having a health insurance plan will benefit and the insurance coverage will secure the future of individuals and families.

What is Individual Health Insurance?

Individual health insurance, as the name suggests, is the health insurance coverage purchased by an individual for oneself or family directly from the insurance provider. An individual health insurance policy is purchased from an insurance provider against a sum of money paid either monthly, quarterly or annually called a premium. This premium amount is decided upon the health insurance coverage opted by the policyholder.

How does Individual Health Insurance policy work?

Under an Individual Health Insurance policy, an individual purchasing a policy for self or family must decide on the insurance coverage. Based on the amount of coverage a premium amount is decided which is being paid by the policyholder based on the frequency pre-determined by the policyholder. The frequency of the premium payment can be monthly, quarterly, half-yearly, or annually. When policyholders pay premiums the insurance provider receives the sum of money and in return, the insurer agrees to pay for the medical expenses as mentioned in the policy document. Typically these expenses include treatment charges, doctor’s fees, hospital stay bills, medications, pre and post-hospitalisation expenses, and other healthcare services. Thus, upon paying a fixed premium for pre-determined frequency and tenure the policyholder and insurer agree on medical support for covered medical expenses outlined in the health insurance policy.

Benefits of Individual Health Insurance Plan:

1. Customisation:

One of the primary benefits offered by an individual health insurance plan is that the policyholder has the freedom to customise the coverage as per their specific needs. A policyholder can choose the benefits as per his/her needs and budget. A policyholder can opt and choose insurance coverage, deductibles, and co-payment options. This customisation helps the policyholder to purchase a health insurance policy that aligns perfectly with his/her individual or family needs.

2. Portability:

Under the health insurance plan offered by the employee, an individual is tied to the terms of employment. However, if you purchase an individual health insurance policy, a policyholder can change the insurance provider without worrying about coverage or losing any benefits. Thus an individual health insurance plan offers greater flexibility and portability.

3. Access to Care:

Having a health insurance plan ensures that an individual or his family has access to the best healthcare facility. With network hospitals, one can avail of timely medical care. The best health insurance plan will offer the best network hospitals having the best doctors, specialists, and medical facilities. Thus, without bearing much out-of-pocket expense one can avail of timely medical treatment and care with an individual health insurance policy.

4. Preventive care facilities:

Many health insurance plans offer preventive care like annual check-ups, vaccinations, and health screenings. Such preventive care facilities help in the early detection of health issues thereby reducing the risk of serious health problems.

5. Financial security:

Having an individual health insurance plan for oneself or your family ensures that you have financial protection against unforeseen medical emergencies. In the event of illness or injury, individual health insurance coverage will alleviate the financial burden associated with treatment and provide peace of mind.

Who needs individual health insurance?

An individual health insurance policy is typically designed to cover the medical expenses of an individual or his/her family. The following are people who should purchase a health insurance plan:

  • 1. Individuals working part-time are not eligible for health insurance offered by the employer.
  • 2. Entrepreneurs, businessmen, freelancers, etc. who do not have one fixed employer but need affordable health insurance coverage
  • 3. Working professionals who need additional financial support
  • 4. Individuals who are the sole breadwinners of the family.

Thus, health insurance is for all and should be purchased by all to secure the financial well-being of oneself and family.

Inclusions and Exclusions of an Individual Health Insurance Plan

Inclusions and exclusions vary as per the health insurance plan opted and the insurer. Following is the standard list of inclusions and exclusions:

1. Inclusions:

  • Hospitalization
  • Pre and Post hospitalisation
  • Day-care procedures
  • Ambulance charges
  • Domiciliary Treatment

2. Exclusions

  • Pre-existing medical conditions not covered under the policy or having a waiting period
  • Dental procedures
  • Hearing and Vision related expenses
  • Cosmetic surgeries
  • Alternative Theories
  • Pregnancy and related conditions

What types of individual health insurance plans are available in India?

Numerous insurance providers provide different types of individual health insurance plans. These plans are of the following types:

1. Critical Illness Plan:

As the name suggests this health insurance policy is designed to cover the cost of medical treatment in the event of diagnosis of a critical illness plan. So, if any individual has a family history of critical illness he/she might think of buying this plan that covers all dangerous conditions outlined in the health insurance policy.

2. Senior Citizen Health Insurance:

This health insurance plan is specifically designed keeping in mind senior citizens and their medical needs. So people aged 55 years and above can purchase this individual health insurance policy. This type of individual health insurance policy covers the conditions arising due to age and offers coverage to people aged between 55 years to 80 years.

3. Personal Accident Insurance:

With the rising population, the number of bikes and cars on roads is also increasing thereby resulting in a higher number of accident cases. Therefore, to combat the medical expenses arising from accidents on the road many insurers offer personal accident insurance. This plan is specifically for individuals who travel frequently. The plan offers coverage for hospitalisation expenses and medical treatment.

Conclusion:

Individual health insurance is crucial in ensuring access to quality healthcare and providing financial protection for individuals and families. By understanding how individual health insurance works and the benefits and coverages it provides, individuals can make informed decisions about their healthcare needs and secure financial support along with peace of mind for the future.

Recommended Link: Top Benefits of Individual Health Insurance

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