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Individual Health Plans

What is Individual Health Plans

Individual Health Plan as the name suggests, covers a single person as insured under a health policy. With growing stress and hectic lifestyles, people are more prone to health disorders. Individual Health Plans cover an individual against the financial, medical expenses pertaining to the hospitalization. Individual health plans are all the more important for the only bread winner of the family.Such plans provide a comprehensive coverage related to the medical exigencies to the individual.

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Why should I Buy Individual Health Insurance?

There are various factors listed below which will make it imperative to buy an Individual Health Plan:

Aggravating Medical costs

Medical inflation is rising at lightning speed. Any medical exigencies these days may dig a big hole in your pocket. Hospitalization long bills are difficult to afford for a middle-class person with single earning. Individual health insurance plan comes to rescue in the times of medical treatments or emergencies by indemnifying the expenses financially.

Tedious Lifestyle

Life has become a rat race. With so much work pressure and hectic schedules, time for taking care of health has shrunk to a large extent. Due to such lifestyle and increased level of stress, the health issues leading to lifestyle diseases has also aggravated for individuals. To take care of the health related expenses and treatments, you may rely on your health insurance plan and may customize it to suit your medical needs.

Financial Security

Health expenses have become so hard to manage. A hospitalization cost for treatment or medical emergency will certainly create a dent in your finances. If you are the only earning member of your family, it becomes all the more necessary to take an individual health insurance plan which can serve as a financial security and does not shake your finances in paying an enormous hospital or treatment bills.

What kinds of Individual Health Plans can I opt from?

Individual Health Plans are of two kinds

1. Indemnity Plans

Under Indemnity based individual health plans, the claim or payout is paid as per the actual expenses sustained by the insured for getting the treatment done subject to the health cover taken. Indemnity plans don't pay you the total sum assured under the single event of hospitalization.The insured is indemnified to the extent of actual payout.

2. Fixed Benefit Plans

Fixed benefit health plans are the plans which will offer you a fixed amount of benefits and are paid as lumpsum benefits under your individual health plan. Fixed benefit individual health plans pay you’re the complete policy sum assured on the occurrence of the insured event without taking into account the actual hospitalization or treatment expenses. Examples of such plans are Critical Illness Plans or Individual Personal Accident Plans.

What are the Benefits of Buying an Individual Health Plan?

The benefits of buying an individual health insurance plan offer you a vast coverage under your health plan which are:

Hospitalization Expenses

Individual health insurance plan safeguards the insured by paying the hospitalization expenses which include

  • Inpatient Hospitalization Expenses
  • Your individual health plan will cover the medical expenses for a minimum of 24 hours of hospitalization. Typically, your health insurer will pay for room rent, nursing, medical practitioner, anesthesia, blood, oxygen, surgical appliances, operation theater charges, medicines, drugs, consumables, and other devices required during a surgical procedure.

  • Pre Hospitalization Expenses
  • Related expenses which are covered 30 days (may vary from insurer to insurer) prior to the actual hospitalization which is related to your medical treatment under the scope of the plan which may include follow up visit charges of a doctor, medicine expenses, laboratory tests, etc.

  • Post Hospitalization Expenses
  • Related expenses for your medical treatment for 60 days post discharge from the hospital are also covered under the scope of individual health insurance policy like fees for a follow up with doctor post discharge, expenses done for diagnostic tests to ascertain the recovery of the treated medical illness, etc.

Day care Procedure

Certain treatments which do not require minimum 24 hours of hospitalization and are treated in less time because of technological innovation are also part of the individual health insurance policy. There is an exhaustive list which every insurer has of covered day care treatments under the scope of the plan.

Domiciliary Treatment

Expenses pertaining to the medical treatment done at home are also paid under the individual health insurance policy which otherwise require hospitalization for the same. This treatment can be undertaken by the undertaking given by the medical practitioner for getting it done at home due to unavailability of space I hospital or critical condition of the insured patient, etc.

Hospital Cash Benefit

A hospital cash allowance is payable on a day to day basis. The hospital cash benefit depends on the terms of the policy. A specified minimum stay in the hospital is required to avail this facility.

Organ Donor

Expenses related to the treatment of the organ donor are also paid under your individual health insurance plan in the need of organ transplant.

Cashless Treatment

By taking an individual health insurance plan, you may avail cashless medical treatment for your illness or disease if you chose to get it done under the listed framework of the network hospitals of the insured.

No Claim Bonus

You are entitled to a no claim bonus for your individual health insurance policy which is a benefit accrued in the event of claim free policy year. Your insurer will reduce your premium by the bonus amount or may enhance your health cover by same.

Tax Benefits

The premium amount you pay for your own health policy or your family’s health plan is considered for tax benefit under section 80D of the Income Tax Act 1961. These benefits are subject to change in tax laws.

Miscellaneous Benefits

Insurers also offer you to undertake free health check ups at the time of renewal of your policy or as an inbuilt add on cover with your policy. Ambulance expenses are also paid by most of the insurers under the scope of your chosen individual health insurance plan.

(Note: The benefits mentioned above may differ from one insurer to another. Read your chosen Individual Health policy wordings carefully for more details)

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How is my Individual Health Premium Calculated?

Following are the key determinants for computing the premium amount for your chosen Health Insurance Plan.

Sum Assured

The sum assured or health cover you opt for, determines the premium amount for your health plan. You should select the adequate sum assured, keeping medical inflation in mind so that you get the enough cover for your medical conditions. Higher sum assured attracts a higher premium.


If you buy a health plan at a young age (age bracket of 18-25 years), you will be charged with the lesser premium rates than those aged 40+ years. People at a younger age are less likely to face critical health issues, and thus, your insurer will charge the lesser premium.

Pre-existing Health Condition

If you have any pre-existing health condition, your insurance company will charge a premium at a higher rate. It is recommended to inform about your pre-existing condition to the insurer while buying the health plan, so you can easily get the claim afterward.

Personal Health Condition

Personal health is a vital determinant that decides the cost of the premium. If an individual is healthy, then it reduces his chances of getting hospitalized whereas if a person has any genetic disease the health insurance premium will be high or the disease would be omitted from the coverage, basis the terms and conditions laid by the insurance company. Also, if you are in a habit of taking drugs, chewing tobacco, or smoking, you are charged with increased rates of premium. These unhealthy habits directly put you at a high health risk and thus affects the premium rate.

Claim Free Years

Getting a claim free year may result to discount on the premium rates on your renewal premium or an increase in the sum assured. No claim bonus earned by you under your health plan may reduce your premium amount in the subsequent years.

Add on Covers

By taking the add on covers, the extra premium for the riders gets attached to your base policy and the final premium to be paid will be of the base policy coverage plus the rider premium.

What are Some Smart Buying Tips?

Buy Adequate Health Cover: When buying a plan, apart from judging its benefits, you also need to select the sum assured (health cover) that can easily cover the medical expenses and is adequate for health treatment expenses. If you are under-covered, you need to pay bills from your pocket, and if over-covered, you need to pay high premiums to get a health cover that you don't require at the current moment. So, be prudent in choosing the sum assured amount.

Opt for Plan with Auto Restoration Facility: Auto restoration facility health plans will restore your health cover in case the same is exhausted due to claims in the policy year without an additional cost.Opt for plans offering Auto restoration facility.

Check on Co-Payment Cause: Copayment clause refers to the agreement between the insured and the insurer to agree on a predefined percentage of the claim amount to be borne by the insured.The higher co pay amount or percentage will decrease the premium amount, but be aware that in order to save premium you did not end up paying claim expenses which are beyond your reach.

Check the Listed Network Hospitals: You should verify the list of network hospitals and make sure that those hospitals have specialty services and advanced technology, so they can easily cater for your health care needs. You can also check the distance of listed network hospitals from your home; it's helpful in case of emergency.

Inquire about Claims Efficiency: It is important to study the claim settlement ratio and turn around time of settling the claim by the insurance company before buying the health policy. Also, it's imperative to check the efficiency of the Third Party Administrator (TPA) involved. For medical emergencies, the need of the hour is the immediate financial support from the insurance company. Choose the insurance company with higher claim settlement ratio and fastest claim settlement turnaround time.

Compare and Buy Online: It is prudent to compare online few individual health plans regarding the features, benefits, coverage, premium before making a final decision. Online insurance plans offer lower premiums as compared to plans bought offline.

Opt for Requisite Add on’s: Don’t rush into getting all add on covers under your plan. Every individual has a different requirement based on the health condition. Choose the requisite riders, providing adequate coverage.

Is there any Add on Cover/Rider with Indivdual Health Plan?

Add-on covers attached to your health plan simply help you enhance the protection level. Listed below are the options:

1. Critical Illness Cover

Critical Illness refers to illness, disease, or sickness which even after the treatment drastically affects the lifestyle of the patient. With Critical Illness add on the cover, the insured is provided with an immediate fixed amount plus the rider cover expenses incurred during the medical procedure as well. By having critical illness cover, you are covered for a wide range of critical illnesses. Critical Illness can also be taken as a stand alone policy. Many insurers have separate Critical Illness plans under their health portfolio.

2. Hospital Cash Cover

Hospital cash rider provides for the daily cash that you may need for compensating the medical expenses during the stay in the hospital. Typically, you can claim benefits an amount depending on the nature of your stay. You can also claim a higher payout in case you are admitted to ICU. You will be eligible for the rider payout in case you are hospitalized for a minimum of 24 hours.

3. Room Rent Waiver

This add-on cover enables you to enjoy higher sub-limits for room rent in case of hospitalization. A basic individual health plan typically provides a defined sub-limit to room rent. With the help of a room rent waiver cover, you can choose an improved room for your hospitalization beyond your basic cover with this rider.

4. Personal Accident Cover

Many insurers have this as an inbuilt rider in their health plans. With this add-on cover, you are covered against the risks that may arise due to the total or partial disablement or death caused by accidents. Personal accident plans are typically offered as an add on cover by paying an additional premium amount. The Personal Accident Plan can also be taken as a stand alone policy. Many insurers have separate Personal Accident Plans under their health portfolio.

5. Top Up/Super Top Cover

A top-up health policy provides additional coverage to those who have a running health plan. This plan covers the medical expenses that may arise due to an illness/injury over and above the limit of the actual cover. A top-up health plan works by ‘single incidence hospitalization’, however, a super top-up plan looks at the aggregate claim. A super top-up health plan puts together several incidence of hospitalization to cover the medical bills. It covers a total/aggregate of the medical bills in a year, not just the single instance of hospitalization.

(Note: The rider benefit, conditions, and eligibility criteria may vary from insurer to insurer)

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What is Not included in my Health Plan?

Following are the conditions/exclusions that are not included in your Health Plan.

• Pre-existing conditions: Any illness that had symptoms or received medical treatment within 4 years of commencement of the first policy.

• First 30 days: You can’t claim for the first 30 days from the commencement of the health policy. Accident injury claims, however, don’t require a waiting period.

• First year of cover: During the first year of your policy, some specific illnesses are not covered include Cataract, Hydrocele, Hysterectomy, Fistula in anus, Benign prostatic hypertrophy, Sinusitis, and Congenital Internal diseases.

• Cost of contact lenses, hearing aids, and specs.

• Convalescence, congenital external defects, the use of intoxicating drugs / alcohol, intentional self-injury, general debility, expenses for diagnostic tests related to the disease for which the insured has not been hospitalized.

• Pregnancy or childbirth related treatments.

• Naturopathy treatment.

• Dental treatment/surgery.

(Exclusions may differ from one insurer to another and plan to plan.)