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Individual Health Insurance Plans


When it comes to health insurance there are two main types of plans you will find. One is the individual health insurance plan and the other is a family health insurance plan. An individual health plan covers only a single individual while a family floater one covers all the members of a policy under the sum insured. Let's understand the concept of individual health insurance plan.

An individual health insurance plan covers one individual under the policy. The sum insured is chosen by the policyholder and the premium depends on the insured's health risk. In the event of any medical contingency faced by the insured the claim is paid. The maximum claim that can be paid would be the level of sum insured chosen.

The premium of an individual health insurance plan depends on the medical and lifestyle history of the insured and the plan chosen. Here are the factors which determine the amount of premium charged :

Age of the insured

Since age affects the health risk, it plays the most important role in determining the premium.

Medical history

Existing illnesses or illnesses which the insured had prior to buying the policy are also important factors since they depict the individual's health.

Lifestyle habits

Height and weight and whether the individual consumes alcohol and/or tobacco also affect the premium rate. Height and weight depict the physical build which affects health and consumption of alcohol and tobacco pose serious health risks.

Coverage chosen

Premium also depends on the coverage features chosen. The comprehensive the health insurance plan is the higher would be the premium rate and vice versa.

Optional riders chosen

Individual health insurance plans also have optional coverage features which promise to enhance the scope of coverage. These come at an additional premium. So, if you choose add-on riders, your premiums would be higher.

Coverage under individual health insurance plans is provided for the following :

  • Expenses incurred before hospitalization.
  • Expenses incurred after hospitalization.
  • Expenses incurred when you are hospitalized.
  • Ambulance costs.
  • Day care treatments which do not require hospitalization for 24 hours.
  • Organ donor expenses.
  • Non-allopathic AYUSH treatments.
  • Treatments taken at home which are called domiciliary treatments.
  • Maternity expenses.
  • Expenses incurred on an outpatient basis.

There are some instances which are excluded from the scope of coverage of all individual health insurance plans. These are called exclusions and some common instances include the following :

  • Pre-existing diseases which are covered after a waiting period.
  • Dental or cosmetic treatments.
  • Injuries sustained due to attempted suicide or self-inflicted wounds, driving under the influence of alcohol or drugs, participation in hazardous activities, war or war like situations, criminal activities, defence related activities, etc.
  • HIV / AIDS infection.
  • Medical complications due to nuclear and radioactive contamination, etc.

An individual health insurance plan can be bought online or offline. Here's how :

Buying offline

You can buy a plan offline through insurance intermediaries. Agents and brokers sell health insurance plans and you can get a plan you want from them.

Buying online

The online medium is far better when buying an individual health insurance plan. You can compare the plans of different insurers and buy one which is the most suitable for you. The process is simple and you can buy the plan easily from your own home or office.

A comprehensive individual health plan provides good coverage features and should be taken to protect against the financial strain caused by a medical emergency.