Individual Health Insurance

With an impulsive surge in medical costs clubbed with annual healthcare inflation in the range of 15-25%, hospitalization on account of any grave illness can cost you not less than Rs. 3 lakh. In the absence of a proper health insurance cover, rest assured, you’ll be either digging into your hard earned savings or will be running into some serious debts.

Most first time buyers are puzzled as to opt for an individual health insurance for each family member or the family floater insurance plan. In this article, we will discover the nitty-gritties related to individual health insurance for families.

What is Individual Health Insurance?

In simple terms, an individual health insurance policy means a separate policy for each of the family member with individual sum insured. To make things easier, let's consider Gupta family from Mumbai. Mr. Gupta (50) has recently bought Apollo Munich individual health insurance for himself, his wife (30), daughter (20) and son (18) for a coverage of Rs. 3 lakh each.

Although Mr. Gupta paid a whopping amount of approx. Rs. 24,500 towards the premium, there are few things he considered before investing in the plan. As Mr. Gupta has recently undergone gall bladder surgery, he wanted to ensure that his medical condition doesn’t unreasonably lead to waiting period for the rest of the family members. Also, he wanted to block a dedicated sum insured for each family member. These reasons encouraged him to decide on the individual health insurance for the family. While we are at it, let’s delve deeper into some pros and cons for opting the individual health insurance for the family members.

Pros:

  • The sum insured remains solely for the insured members. Even though the total claims raised by any member exceeds his own sum insured, he cannot dig into any additional sum insured and hence every insured has a guaranteed coverage amount at their disposal whenever required
  • Even parents and in-laws can be a part of this coverage at additional premium
  • Suitable for older families as they are prone to greater health risks
  • If any insured member has a pre-existing condition as per policy guidelines, the rest of the members need not wait to claim until the waiting period ends
  • Discounts on premiums if more than two members
  • There is no maximum age for renewal

Cons:

  • The individual insurance for the families works out to be costlier than the family floater
  • The individual coverage is not suitable for younger families

Features and Benefits of Individual Health Insurance

Features of Individual Health Insurance

The key features of individual health insurance are:

  • Provides comprehensive cover for the individual policyholder and his/her family
  • Lifelong Renewal - There is no maximum age for renewal
  • Offers discounts if two or more family members are enlisted in a single policy
  • Suitable for senior citizens and older families with greater health risk
  • Some policies provide the feature of covering in-laws as well
  • The sum insured is available on an individual as well as family floater basis

Benefits of Individual Health Insurance

The key benefits of individual health insurance are:

  • Suitable for individuals with greater health risks
  • Includes pre and post hospitalization expenses
  • Covers critical illness
  • Includes in-patient hospitalization expenses
  • Premiums paid towards a health insurance are eligible for tax deduction under Section 80D of the Income Tax Act, 1961

List of Individual Health Insurance

ICICI Lombard Personal Protect Insurance

This plan provides monetary assistance to the policyholder in case of an accidental emergency/death/.

Benefits
  • No prerequisite medical check-ups
  • Can be purchased individually
  • Avail customized coverage with Sum Insured options ranging from Rs 3 lakhs up to Rs 25 lakhs
  • Easy and hassle-free claim process
  • Accidental Death In case of death due to an accident, the family will be compensated with the sum insured
    Permanent Total Disablement The sum insured will be payable
    Accidental Hospitalisation Expenses Reimbursement Option for an additional cover to compensate expenses in case of a minimum 24-hour hospitalisation
    Accidental Hospital Daily Allowance Per day allowance for each day of hospitalisation, not exceeding 30 days of hospitalisation, with a deductible of 1 day
    Eligibility 18-65 years of age (i.e. spouse, children and/or parents)

    Bajaj Allianz Individual Personal Health Guard

    This is a comprehensive plan designed to provide cover against unforeseen accidental consequences.

    What is Covered?
  • Death
  • Permanent Total Disability
  • Permanent Partial Disability
  • Temporary Total Disability
  • Children’s Education Bonus
  • Medical Expenses
  • Hospital Confinement
  • The sum insured is paid in any of the cases mentioned above
    Discount 10% on premium for family members
    Flexible Flexible premium computation and payment option
    Cumulative Bonus 10% for every claim-free year up to a maximum of 50%
    Age
  • Entry age for Proposer and Spouse is 18 years to 65 years
  • Dependent children can be covered from 5 years to 21years
  • Oriental Individual Mediclaim Policy

    This is a mediclaim insurance plan which provides cover related to medical expenses arising out of Hospitalisation/Domiciliary Hospitalisation.

    What is Covered?
  • Sudden Illness
  • Accident
  • Surgery required during the policy period
  • Discount
  • 5.5% in premium if TPA services not opted for
  • Family discount of 10% (including on PA cover) if more than one person is covered under the policy
  • Hospital Cash Provided in case of more than 2 days of continuous hospitalisation
    Personal Accident Cover On an optional basis for SI from Rs. 2 lakhs to Rs. 10 lakhs
    Free Look Period 15 days from the date of receipt of the policy
    Age
  • Any proposer between the age of 18 to 65 years
  • Maximum Entry age for any member is 65 years, however, this can be extended up to 70 years
  • Star Medi Classic Individual Insurance Policy

    This plan provides reimbursement of hospitalisation expenses incurred as a result of illness/disease/sickness and/or accidental injuries.

    What is Covered?
  • In-patient hospitalization expenses for a minimum of 24 hours
  • Emergency Ambulance Charges
  • Day Care Treatment
  • Lifelong Renewal
  • Pre and Post Hospitalization
  • Non-Allopathic Treatments Covered up to 25% of the sum insured subject to a maximum of Rs. 25,000/- per policy period.
    Bonus 5% of the basic sum insured for every claim-free year subject to a maximum of 25%
    Pre-existing Condition Pre-existing diseases are covered after 48 months of continuous insurance with any Indian Insurance Company
    Eligibility Any person aged between 5 months and 65 years

    What is Covered under an Individual Health Insurance Policy?

    • Medical Expenses
    • In-Patient Hospitalization
    • Pre and Post Hospitalization Expenses
    • Day Care Procedures
    • Cashless Facility
    • Lifelong Renewability
    • Dependent children covered up to 25 years of age
    • Domiciliary Hospitalization
    • Road Ambulance/Emergency Ambulance
    • Organ Donor Expenses
    • Alternative Treatment - AYUSH
    • Pre-existing conditions post waiting period

    What is Not Covered under an Individual Health Insurance Policy?

    • War or any act of war, invasion, an act of foreign enemy, warlike operations
    • Biological/Chemical/Radioactive/Nuclear fallout
    • Self-inflicted injuries
    • Mental conditions
    • Breach of law/criminal activity
    • Participation in military operations
    • Participation in extreme sports
    • Substance Abuse/Alcohol/Narcotics
    • Treatment of Obesity
    • Cosmetic Surgery
    • Dental Treatment
    • STDs/HIV/AIDS
    • Infertility

    What is the difference between Individual Health Insurance/ Health Insurance/Family Health Insurance?

    Individual Health Insurance Health Insurance Family Health Insurance
    It is available for an individual It is an individual health policy It is taken on a family floater basis
    Covers a single policyholder Covers a single policyholder Self, spouse, parents, children, parents-in-law
    It is a comprehensive health plan Covers only accident-related emergencies It is a comprehensive health plan
    The sum insured is for a single policyholder The sum insured is for a single policyholder The sum insured covers all members of the family
    Covers pre/post hospitalization expenses Does not cover pre/post hospitalization expenses Covers pre/post hospitalization expenses

    How the Premium is Determined in Individual Health Insurance?

    Cost towards premium is one of the major deciding factor while opting for any insurance policy. Below are few deciding factors on the premium calculation:

    • Administrative and Promotional Costs: Designing of policy, underwriting costs, marketing and advertising costs, brokers’ commission are some of the costs involved under this canopy and where do you think they are recovered from? Of course, through the premiums paid.

    • Savings from Investments: When you pay the premium towards the insurance policy, the insurance company put that money into various public investments. Health insurance premiums are calculated basis returns from these investments.

    • Medical Underwriting: This is where the risk evaluated and crucial decisions are taken to prevent the insurance company from making any losses.

    • Rate of Mortality: The rate of mortality varies for different age and income bands and is usually high for older customers. For example:

    A. Premiums are more if sum assured is higher

    B. Premiums are higher as one grows old

    C. Premiums are inflated for those suffering from lifestyle illnesses like blood pressure or diabetes

    • Personal Medical History: Insurance companies may or may not require you to undergo a medical check-up before the insurance policy is issued. However, your medical history also decides policy premium you would be required to pay. Keep in mind, habitual smoking and drinking summons higher premiums.

    • Community Rating: The geographical location, lifestyle habits, overall development of the region along with the trade activities and political stability of the place are few other influential factors that decide the premium amount.

    • Band Rating: Under this segment, the insurance company settles on a base rate to be charged for a specific set of people with the similar attributes. These include aspects like group size, geographical location, gender, age, etc. For example: a young and healthy family will pay less premium as compared to a family comprising of senior citizens.

    How to make a Claim?

    There are two ways to make a health insurance claim - reimbursement or cashless. For both the methods, you need to intimate a claim to the insurer immediately or within 24 hours in case of an accident. You need to download the claim form and submit the same with the following documents:

    • Duly filled claim form
    • Medical Certificate/ Form which is signed by the treating doctor.
    • Discharge summary or card (original), availed from the hospital.
    • All bills and receipts (original)
    • Prescription and cash memos from pharmacies/ the hospital.
    • Investigation report
    • If it is an accident case, then the FIR or Medico Legal Certificate (MLC) is required.

    What's the Right Choice? Individual or Floater? Let's find out!

    As a first time buyer, one of the key challenge is to decide between the individual plans for the family or opt for a family floater insurance policy. As both options carry their own pros and cons, it’s best to evaluate your individual needs, age bracket, family income, medical history to arrive at an informed decision. With the availability of online portals like Coverfox.com, you can compare different plans and combinations to choose the cream of the crop.

    Also Read: Choosing Between Family Floater and Individual Health Insurance

    Best Individual Health Insurance Plans of 2018-19

    • ICICI Lombard - Personal Protect Insurance Policy

    • Bajaj Allianz - Individual Health Guard

    • Oriental Health Insurance - Individual Mediclaim

    • Star Health Insurance - Medi Classic Insurance

    How To Compare and Find the Best Individual Health Insurance Plan?

    • Research thoroughly regarding the features and benefits offered by an individual health insurance plans from across insurance companies

    • Browse through the list of network hospitals to check whether it includes some of the hospitals that are in your vicinity or those that you visit

    • Compare the premium quotes

    • Decide whether you prefer low premium and comparatively lower coverage, or higher premiums and higher coverage

    Documents Required for Purchasing an Individual Health Insurance Policy

    • Proof of Age: Acceptable documents are Birth Certificate, PAN Card, Voter’s ID, Driving License, Passport, School or College Certificate, etc.

    • Photo Identity Proof: Aadhaar Card, PAN Card, Driving License, Passport, Voter’s ID, etc.

    • Proof of Address: Acceptable documents are Ration Card, Telephone Bill, Electricity Bill, Passport, Voter’s ID, Bank A/C Statement, etc.

    • Proof of Income: Salary Slip, Employer’s Certificate, Form 16, etc.

    • Medical Check-up: If asked by the insurance company

    • Passport size photograph

    The Finale Word

    Whether you opt for individual policies for your family or insure them under family floater plan, as mentioned prior, it’s best to assess your requirements coupled with your financial health to take a perfect decision. While an individual plan could make sense for a young family, a family floater will be the right choice for someone with older kids. In addition to this, room rent sub limits, cashless hospitalization tie ups, pre-post hospitalization cover and other benefits on offer should also form crucial part of your deciding components.

    FAQs on Individual Health Insurance

    I Am Already Covered by Employer's Insurance, Should I Still Opt for Individual Cover?

    With the medical costs soaring the sky, a decent health insurance cover is what we need today. As group medical insurance policies come with a stern limit on coverage amount, supplementing it with an individual policy cover would be an ideal situation to ensure a sizable sum insured in case of any major hospitalization.

    I Have Just Undergone Hysterectomy. Can I Still Opt for an Individual Policy?

    Yes, you certainly can. However, as most health insurance policies are armed with waiting period to cover any pre-existing diseases, any expenses/hospitalization triggered by your medical history will not be covered during this period.

    Can I Include My Parents and In-Laws on Individual Health Policies?

    Well, technically yes, you can. However, depending on their age, there are other options especially tailor made for them. If they are beyond the age of 60 years, customized plans for senior citizens can be considered.

    Can I buy individual health insurance plan online? If yes, please explain how?

    Yes, you can purchase your preferred individual health insurance plan online by following these simple steps:

    • Research thoroughly regarding the features and benefits offered by individual health insurance plans from across insurance companies • Browse through the list of network hospitals to check whether it includes some of the hospitals that are in your vicinity or those that you visit
    • Compare the premium quotes
    • Decide whether you prefer low premium and comparatively lower coverage, or higher premiums and higher coverage
    • Purchase the individual health insurance plan of your choice from the official website of the insurer or from a third party broker website that offers the policy

    How much does individual health insurance cost? Explain zone wise pricing with an example?

    Apart from varying in terms of insurance companies and coverage offered, premium rates for individual health insurance also varies on the basis of zones or the location an individual belongs to. There are three zones – Zone 1, Zone 2 and Zone 3, with premiums for each zone being 10% lower than the previous zone. For instance, if the premium for a certain individual health insurance plan is Rs. 5,000 for a resident of Zone 1, the premium for the same plan for a resident of Zone 2 will be Rs. 4,500. Similarly, for someone from Zone 3, the premium eligibility will be Rs. 4,050.

    How do I apply for individual health insurance online and offline?

    For purchasing an individual health insurance plan online, you can follow the below steps:

    • Research thoroughly regarding the features and benefits offered by individual health insurance plans from across insurance companies
    • Browse through the list of network hospitals to check whether it includes some of the hospitals that are in your vicinity or those that you visit
    • Compare the premium quotes
    • Decide whether you prefer low premium and comparatively lower coverage, or higher premiums and higher coverage
    • Purchase the individual health insurance plan of your choice from the official website of the insurer or from a third party website that offers the policy If you prefer the offline process, you can visit the branches of various insurance companies to assist you with the features, benefits and premiums on their individual health insurance. You can compare between them and then take a conscious decision.
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