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What is a Personal Health insurance policy?

Rohit Sapra Rohit Sapra 15 November 2019

Importance of health insurance is undisputed. Given the rising medical costs, a health insurance policy and the coverage it offers can provide numerous benefits to you. If you are wondering why personal health insurance is important, this article is for you.

Personal Health Insurance Policy

Health is wealth which needs to be nourished and taken care of for the entire life. Today, where technology is reaching new levels, diseases are also on the rise. Emergency cases and expensive medical treatments have become troublesome for many. This is where the need for a personal health insurance plan arises in everyone’s life. A personal health insurance plan takes care of expenses arising from medical treatments, hospitalisation, sudden illness or injury due to an accident, and surgery during the policy term. It is a comprehensive solution for people who cannot afford quality medical treatment because of the unavailability of money.

A personal health insurance policy covers only one individual, the policyholder, who is eligible to avail the benefits offered under the plan.

Coverage offered under a personal health insurance policy

Personal health insurance policies offer a cluster of facilities to take care of the medical needs of individuals. Personal health insurance covers the pre and post hospitalisation expenses incurred around 30 to 60 days before hospitalisation and 90 days post hospitalisation. It offers cashless hospitalisation benefit through which you get your treatment done in any network hospital of the insurance company without paying anything. In case of non-cashless treatment, the expenses are reimbursed after a formal approval process. The policy also covers charges for diagnostic tests and ambulance service up to a pre-defined limit. While Daycare facilities are also covered, they are subject to certain terms and conditions. Pre-existing diseases are covered after a pre-defined waiting period. Surgeries such as Cataract, treatment of Asthma, piles, hernia, maternity-related issues or psychiatric disorders are covered after the waiting period.

Here are some key features of a personal health insurance policy

  • The personal health insurance policy offers coverage only for the insured individual.
  • The insurance company covers certain medical costs of the policyholder based upon the premiums paid.
  • A personal health insurance plan covers hospitalisation cost, including pre and post hospitalisation expenses.
  • Lifetime renewal
  • Policyholders can avail tax deductions under Section 80D of the Income Tax Act, 1961.
  • Covers surgery costs, physician’s fees, room rent and laboratory tests.

Advantages of personal health insurance policy

  • In a personal health insurance policy, the insured alone can avail the benefits of the plan.
  • The policyholder will earn the benefit of individual sum assured instead of floating sum assured.
  • It is suitable for all people.
  • Policyholders can add parents and immediate family members to the family plan.
  • Majority of the health insurance companies have no restrictions on the maximum age of the policyholder for the renewal of the policy.
  • There is no need to worry about making more than one claim in a policy year since it caters only to a single person.
  • One can avail cashless facility for claim settlement under such policies.

Personal health insurance policy is ideal for

  • Individuals and family alike as it takes care of health care expenses.
  • A single individual with family members who are already insured under another health insurance policy.
  • An individual who wants to avail the benefit of the sum assured instead of a floating sum assured.
  • Individuals who want to renew the plan without having to worry about age restrictions.
  • An individual who wants to avail higher protection than what is provided under a family floater policy.

What is a health card?

Remember the last time you or your loved one was hospitalised, the first question that has been asked is "Do you have a health card?" A health insurance card or health card is a proof of evidence that you are covered under a health plan provided by the insurer. This card contains your health insurance policy number, name of insured, and policy name with the sum insured. For health insurance policyholders, what matters the most is their health insurance card. The insurance company issues this card to the policyholder at the time of policy issuance.

Once you buy a health insurance policy, the insurance company dispatches the policy document along with the health card. Getting health insurance through cashless mode is one of the prominent features of a health card, and hence it is crucial to have a health card at the time of availing medical attention.

Advantages of having a health card

  • As a member, it becomes easy to get doctors’ appointment
  • You can avail cashless facilities at network hospitals

A health insurance card is like an identity card, which identifies you as the person who has been insured under a specific health insurance plan by your health insurance company. Your health card enables you to access network hospitals. You are eligible to avail medical treatment in the network hospital without having to pay the medical bills in cash. Your insurance company will take care of the payment. It is important to note that a health card cannot be used at non-network hospitals.

The insurance company, either directly or through a third-party administrator, has a tie-up with hospitals to provide cashless hospitalisation facility to policyholders.

The final word

Buying a health insurance policy is crucial as medical care is costly, especially in the private sector. Hospitalisation can burn a hole in your pocket and deviate your finances. It becomes even tough if the breadwinner of the family is now in the hospital bed. All this can be avoided by paying a small yearly premium which would lessen your stress in case of medical emergencies.

Whether you opt for a personal health insurance policy for your family or insure them under a family floater plan, it is best to understand your requirements along with your financial health to make an informed decision.

Recommended Link:Benefits of Personal Accident Insurance

Rohit Sapra
Written by Rohit Sapra
Rohit Sapra, a licentiate, and currently an SME, is a seasoned insurance professional with previous work experience from Kotak and Birla Sun Life Insurance.