Individual Health Insurance Plans, Features, Coverage, Exclusions and Waiting Period

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Updated on Sep 27, 2022

The recent situation that surfaced globally due to the grave Covid19 pandemic has accentuated the importance of having a health insurance policy for one and all. People who were not serious about health insurance earlier are now actively purchasing or renewing their health policies to be financially secure in case of a medical crisis.

Increasing number of people in India are now signing up for government health policies or purchasing individual health insurance plans. In this blog, we are talking about Personal health insurance plans and everything related to it, like features, benefits and more.

First, let us start with understanding the concept of individual health insurance.

What Do You Mean by Individual Health Insurance Policy?

The medical coverage offered to a person on the basis of individual sum insured is called as Individual health insurance. As the name suggests, this policy can be purchased for individual purpose and thus needs to be bought for each member of the family separately. This policy allows the user to modify the coverage requirements as per his/her individual health requirements and not as per the needs of the family members.

Also Read: Family Health Insurance Vs Individual Health Insurance Plans

Features and Benefits of Individual Health Insurance Policy

Here are some of the important features of Individual Insurance.

  • It offers extensive coverage including hospitalization costs, pre-post hospitalization costs, ambulance expenses and much more.
  • It offers solo coverage to ensure that the insured money can be used by you only.
  • The individual insurance suits the elderly well who are at a greater risk of health.
  • The policy offers highest sum insured of up to INR 1 crore.
  • The policy also offers you the facility of purchasing add-on benefits like outpatient treatment assistance, cover for serious illness, maternity benefit and so on.
  • With this policy the insured person can make many claims within a single year.
  • It offers family discount for 1-2 members.
  • The policy comes with renewal option for lifetime and allows you many tax benefits.

Individual Health Insurance Coverage and Inclusions with Personal Health Insurance

The Individual Insurance policy covers the following:

  • Covid19 treatment expenses.
  • Cost of availing daycare procedure with hospitalization where you get discharged within 24 hours.
  • Expenses for in-person hospitalization.
  • Pre/Post hospitalization costs.
  • Costs for domiciliary hospitalization in case you avail the same.
  • Cover charges for emergency ambulance on road service.
  • Covers costs for organ donation.
  • Precautionary check-up facility of your health.

Exclusions of Personal Health Insurance Plans

The Personal health insurance plan doesn’t offer cover for the below:

  • Injuries inflicted by insured person by himself/herself.
  • Costs for Dental treatment.
  • Treatment for drug/alcohol abuse.
  • Treatment for obesity.
  • Treatment for infertility.
  • Treatment for cosmetic surgery.
  • Injuries caused due to participation in any unsafe sports.
  • HIV AIDS treatment.

Ways to Purchase an Individual Insurance Plan online

There are many ways of buying an Individual Insurance plan online. Here are the steps to follow for the same:

  • Go to the website of the insurance provider
  • Click on the ‘health Insurance’ tab
  • Submit your details – name, gender, age, phone number etc.
  • Select the city you live in
  • Now offer details of the diseases that you are suffering from or any history of treatment
  • You will see details of different Individual Health Insurance plans on your screen
  • Choose the best plan that suits your requirement
  • Your policy will be issued in no time

FAQs Related to Individual Health Insurance Plans in India

Q: Is Cashless Treatment Options Possible Under Personal Insurance?

Yes, it is possible to avail cashless facility for undergoing treatment with your Individual Insurance plan. In this case, your payment for hospitalization would be done by your insurance agency who can directly pay to the hospital account. However, to avail this facility, you must ensure that the hospital you are undergoing treatment should be enlisted in the hospitals available in the network of your policy provider.

Q: Is Waiting Period there in the Personal Health Insurance Policy?

Yes, there is a waiting period in Individual Insurance policy. You need to wait for a period of 30 days after the start of the plan to be able to raise a non-accidental claim. Also, there is a waiting time of 1 – 3 years before you could claim against certain diseases and surgeries like joint replacement, bariatric surgery, cataract, arthritis etc. Further, for already existing diseases the waiting time before you could claim for the insurance is 2 – 4 years, depending on the policy.

Q: Is there any coverage limit to have for Individual Health Insurance Plan? 

Most health insurance experts are of the view that you should have a minimum coverage, which could be equal to half of your annual income. In the present scenario, a minimum amount of Rs. 10 Lakh is required to cover your medical expenses and to meet the expensive treatments available for surgery, covid19 and so on.

Important things to consider before purchasing an Individual Health Insurance plan:

  • Analyze your requirements depending on your health condition and make a list of coverage that you might need.
  • While choosing the policy, check the hospitals enlisted with your insurance company. It is better if your insurance provider has a network hospital close to your location.
  • Ensure that the plan you are willing to purchase offers affordable premium.
  • Some of the health policies fix a sub-limit for some coverage. So, just ensure to go through the application sub-limits.
  • Try to understand the claim procedure before buying the insurance plan. See if the terms are easy or complicated, and how many working days they take to settle a claim.
  • Also, do check the ratio of claim settlement of the insurance provider you want to buy the claim from. Buy a plan from a company offering high claim approval ratio.

Also Read: Best Health Insurance Plans for Individuals in India

To Conclude

In the present situation where covid19 and many other new viral diseases are on the rise, it is very important for every individual to have their health insured. Moreover, an Individual Health Insurance plan is also necessary for those who have major health issues, especially the elderly people. The best part about Individual Insurance is that the amount insured can be used exclusively for your own purpose and you don’t need to share it with other family members as in the case of other health insurances. Just make sure to do a detail comparison of policies before investing your money so that you can enjoy maximum coverage.

Found this post informational? Browse PayBima Blogs to read interesting posts related to Health Insurance, Car Insurance, Bike Insurance, Term Life Insurance and Investment section. You can visit PayBima to Buy Insurance Online.

Feb 02, 2022
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PayBima Team
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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