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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.
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.
The key features of individual health insurance are:
The key benefits of individual health insurance are:
This plan provides monetary assistance to the policyholder in case of an accidental emergency/death/.
|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)|
This is a comprehensive plan designed to provide cover against unforeseen accidental consequences.
|What is Covered?|
|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%|
This is a mediclaim insurance plan which provides cover related to medical expenses arising out of Hospitalisation/Domiciliary Hospitalisation.
|What is Covered?|
|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|
This plan provides reimbursement of hospitalisation expenses incurred as a result of illness/disease/sickness and/or accidental injuries.
|What is Covered?|
|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|
|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|
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.
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:
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.
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.
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:
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: