Individual health insurance is a coverage plan that provides medical benefits to an individual based on a specific insured amount for just ₹20/Day*
✅ 100% Room Rent Covered* ✅ Zero deductions at claims ✅ 7100+ Cashless Hospitals
In the world of healthcare in India, Individual Health Insurance stands as a shield against unexpected medical costs. This article explores what health insurance for individuals means in India, why it's important, and what it covers. We'll also guide you through the key things to keep in mind when considering Individual Health Insurance, helping you make informed choices for your well-being and peace of mind.
In India, Individual Health Insurance is offered by various insurance companies and is regulated by the Insurance Regulatory and Development Authority of India (IRDAI). Here's how health insurance for individuals works for you.
Premiums and Coverage: You pay a premium to the insurance company to get coverage for medical expenses. The amount you pay depends on factors like your age, health condition, coverage amount, and any additional features you choose.
Coverage Details: With health insurance for individual, your policy covers hospitalisation expenses, including room charges, doctor's fees, surgeries, medications, and tests. Some policies also include pre- and post-hospitalization costs, ambulance charges, and specific treatments. You might even have the option to add coverage for critical illnesses, maternity expenses, and more.
Network Hospitals: Insurance companies have a network of hospitals where you can get cashless treatment. If you go to one of these network hospitals, the insurance company directly settles the bills with the hospital, following the terms of your policy.
Claim Process: If you face a medical situation, you can either choose cashless treatment at a network hospital or pay the bills and then file a reimbursement claim. To do this, you'll need to provide documents like hospital bills, prescriptions, medical reports, and discharge summaries.
Exclusions: Like any insurance, health insurance in India has exclusions – certain conditions, treatments, or situations not covered by the policy. Make sure to review the policy document to understand what's not included.
Renewal: Health insurance policies in India last a year and need to be renewed for continued coverage. The renewal premium may change based on your claim history and age.
Government Schemes: Alongside private health insurance, the Indian government has introduced various health insurance schemes, like Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), to provide health coverage to economically vulnerable sections of society.
It's essential to thoroughly research and compare different health insurance policies to find one that suits your specific healthcare needs and financial situation.
Choosing individual health insurance can offer several benefits and might be the right choice for various individuals and families, depending on their specific circumstances and needs. Here are some reasons why you might consider opting for health insurance for individual:
Health insurance for individual allows you to choose a plan that aligns with your specific healthcare needs. You can customise your coverage, deductibles, and other policy details to suit your preferences and budget.
With health insurance for individual, you have the flexibility to select healthcare providers (doctors, hospitals, specialists) that you prefer. This can be especially important if you have specific doctors or medical facilities you trust or if you require access to specialised care.
If you're self-employed, a freelancer, a part-time worker, or currently unemployed, you might not have access to employer-sponsored health insurance. Health insurance for individual provides you with an option to secure coverage independently.
Individual health insurance is not tied to your employment, so you can maintain your coverage even if you switch jobs or experience changes in your career.
Individual health insurance policies often offer the flexibility to include family members (spouse, children) in the same policy, allowing you to provide coverage for your entire family.
Health insurance for individual can be purchased at any age, so it's an option for young adults who are transitioning from their parents' insurance or for those who don't have access to employer benefits yet.
Some individual health insurance plans offer optional riders or add-ons that can enhance your coverage, such as maternity benefits, critical illness coverage, dental and vision care, etc.
With health insurance for individual, you have control over the type and level of coverage you receive. You can prioritise the aspects of healthcare that matter most to you.
If you require specialised medical treatments or procedures, health insurance for individual can provide coverage for these services, subject to policy terms.
Having health insurance for individual can offer peace of mind, knowing that you're financially protected against unexpected medical expenses, accidents, or illnesses.
Buying a personal health insurance policy online offers several benefits, making the process convenient and efficient. Here are some advantages of purchasing health insurance online.
Ease of Comparison: Online platforms allow you to easily compare multiple health insurance plans from different providers. You can review coverage options, premiums, deductibles, and benefits side by side, helping you make an informed decision.
Convenience: You can browse and purchase health insurance policies from the comfort of your home or office, eliminating the need to visit insurance offices or agents in person. This is especially beneficial for those with busy schedules.
Time-Saving: Online purchasing is much quicker than traditional methods. You can complete the entire process within a short period, avoiding lengthy paperwork and wait times.
Access to Information: Online platforms provide detailed information about each policy, including coverage details, exclusions, network hospitals, and additional benefits. This transparency empowers you to make the right choice for your healthcare needs.
Instant Quotes: Many online platforms offer instant quotes based on your inputs. This helps you estimate costs and choose a policy that aligns with your budget.
Customization: Online platforms often allow you to customise your health insurance policy by adjusting coverage limits, deductibles, and additional riders according to your preferences.
Secure Transactions: Reputable insurance websites employ secure payment gateways, ensuring that your personal and financial information is protected during the purchase process.
Paperless Process: Online health insurance purchases usually involve minimal or no physical paperwork. This reduces the hassle of managing and storing paper documents.
Flexibility: Online platforms enable you to initiate the purchase process whenever it's convenient for you, whether it's during working hours or late at night.
No Pressure Sales: Online purchasing reduces the potential for high-pressure sales tactics that you might encounter when dealing with an in-person agent.
Digital Access: You can access your policy details, claims history, and other relevant information online at any time, simplifying policy management.
Individual health insurance plans in India offer coverage for a range of medical expenses and healthcare services. The coverage can vary depending on the specific policy and insurance provider. Here are some common aspects that are covered under health insurance for individual plans in India:
Hospitalisation Expenses: Coverage for in-patient hospitalisation expenses, including room charges, nursing, doctor's fees, surgery, and anaesthesia costs.
Pre-Hospitalization and Post-Hospitalization: Many plans cover medical expenses incurred before and after hospitalisation for a certain period, usually up to 30 or 60 days.
Day Care Procedures: Coverage for medical treatments and procedures that don't require an overnight stay in the hospital but still necessitate specialised care.
Ambulance Charges: Reimbursement or direct payment for ambulance services required for hospitalisation.
Emergency Care: Coverage for emergency medical treatment, including accidents and sudden illnesses.
Domiciliary Treatment: Coverage for medical treatment taken at home when hospitalisation is not possible or necessary.
Organ Transplants: Coverage for organ transplantation surgeries, including the cost of the organ, surgery, and post-operative care.
AYUSH Treatment: Coverage for treatments under Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy systems of medicine.
ICU Charges: Coverage for intensive care unit (ICU) charges, including monitoring and specialised care.
It's important to note that health insurance for individual may have exclusions, waiting periods, sub-limits, and specific terms and conditions that you should thoroughly understand before purchasing.
Individual health insurance plans in India have certain exclusions or limitations that outline what is not covered under the policy. These exclusions can vary depending on the insurance provider and the specific policy you choose. Here are some common items that are generally not covered under health insurance for individual plans in India:
Cosmetic and Plastic Surgery: Most health insurance plans do not cover elective or cosmetic procedures.
Dental and Vision Care: Routine dental and vision care, such as dental check-ups, eyeglasses, and contact lenses, are often not covered. Some plans may offer these as optional riders.
Routine Health Check-ups: Regular health check-ups, unless specified in the policy, are generally not covered.
Unproven Treatments: Experimental or unproven treatments and procedures might not be covered.
Injuries Due to Hazardous Activities: Injuries sustained during hazardous activities such as extreme sports or adventure activities might not be covered.
Injuries or Illnesses Due to Substance Abuse: Health issues arising from alcohol, drugs, or other substance abuse might be excluded.
War or Terrorism-related Injuries: Injuries or health issues resulting from acts of war or terrorism may not be covered.
HIV/AIDS and Other STDs: Some policies may exclude coverage for treatments related to HIV/AIDS and other sexually transmitted diseases.
Self-Inflicted Injuries: Injuries intentionally inflicted by the insured person might not be covered.
Injuries from Criminal Activities: Health issues resulting from criminal activities or participation in unlawful acts may not be covered.
The eligibility criteria for individual health insurance in India can vary based on the insurance provider and the specific policy you're interested in. However, there are some common general eligibility criteria that are considered when applying for health insurance for individual:
Age: Most health insurance plans have minimum and maximum age limits for eligibility. The age criteria can vary, but individuals need to be between 18 to 65 years of age. Some policies might have provisions for children and senior citizens.
Nationality: You should be an Indian citizen or a resident of India to be eligible for health insurance for individual.
Medical History: Insurance companies often require you to disclose your medical history, including pre-existing conditions, illnesses, surgeries, etc.
Medical Examination: Depending on your age and the sum insured, some policies may require a medical examination to assess your health condition before approving coverage.
Premium Payment: Eligibility also depends on your willingness and ability to pay the insurance premiums.
Disclosure: It's important to provide accurate and complete information about your health, lifestyle, and medical history when applying for insurance.
Renewal Criteria: Some policies have renewal criteria, such as age limits or claim history, that can affect your eligibility for policy renewal in subsequent years.
It's essential to carefully review the eligibility criteria outlined in the policy documents and discuss any questions or concerns with the insurance provider or agent.
The amount of individual health insurance coverage you should have in India depends on various factors, including your personal circumstances, health needs, and financial capabilities. Here are some considerations to help you determine an appropriate coverage amount:
Consider the average medical costs in your city or region. Health insurance should be able to cover expenses related to hospitalisation, surgeries, etc.
Medical costs tend to rise over time due to inflation. It's wise to choose a coverage amount that accounts for future increases in healthcare expenses.
If you have any pre-existing medical conditions, you may need higher coverage to ensure adequate protection.
Consider your lifestyle, age, and associated health risks. Older individuals or those with riskier lifestyles may require higher coverage.
Healthcare costs can vary significantly between cities and regions. Living in a metropolitan area might require higher coverage due to higher medical expenses.
If you have preferred hospitals or healthcare facilities, ensure your insurance covers treatments there.
Some insurance plans offer additional coverage options like critical illness coverage, etc. Evaluate whether these add-ons are necessary for your situation.
Factor in coverage for emergencies and unexpected medical situations.
Your budget plays a crucial role. While it's important to have sufficient coverage, ensure that the premium is affordable and won't strain your finances.
Buying an individual health insurance policy online in India is a straightforward process. Here's a step-by-step guide to help you navigate the process:
Research and Compare:
Research different insurance providers and their health insurance for individual.
Compare the coverage, benefits, premium costs, and exclusions of various policies to find the one that suits your needs.
Choose a Reputable Provider:
Select a reputable and well-established insurance company that offers the coverage you require.
Visit the Insurance Company's Website:
Go to the official website of the insurance provider you've chosen.
Find the Health Insurance Section:
Navigate to the section of the website dedicated to health insurance plans.
Use Online Tools:
Many insurance websites have online tools or calculators that help you estimate the premium based on your age, coverage preferences, and other factors.
Select Your Plan:
Choose the health insurance for individual plan that best meets your healthcare needs and budget.
Customise the Plan (if Applicable):
Some plans allow you to customise coverage limits, add riders, or choose deductibles. Adjust these options according to your preferences.
Fill Out the Application Form:
Complete the online application form with accurate and complete information. This will include personal details, medical history, and contact information.
Upload Documents (if Required):
Some insurers might require you to upload documents such as identification, address proof, and medical records.
The online system will calculate the premium based on the information you provided. Review and confirm the premium amount.
Review and Confirm:
Carefully review the details of the policy, coverage, and premium before proceeding.
Pay the premium using the available online payment options, such as credit/debit cards, net banking, or digital wallets.
Receive Policy Documents:
After successful payment, you will receive the policy documents via email. These documents will include your policy number, coverage details, terms and conditions, and contact information for customer support.
Set up an online account on the insurance company's website to access your policy details, track claims, and manage your policy online.
If you have any questions or encounter issues during the online purchase, reach out to the insurance company's customer support through their provided channels.
In India, individual health insurance claims can be categorised into two main types: cashless claims and reimbursement claims. These claims processes determine how you receive financial coverage for medical expenses covered under your health insurance policy.
Cashless Claims: Cashless claims are a convenient way to avail medical treatment without having to make upfront payments at network hospitals. Here's how the cashless claims process works:
Choose a Network Hospital: Your health insurance provider will have a network of hospitals and healthcare providers. Before seeking treatment, confirm that your chosen hospital is part of the insurer's network.
Pre-Authorization: Inform the hospital's insurance desk about your health insurance coverage and provide your policy details. The hospital will then initiate the pre-authorization process with the insurance company. This involves seeking approval for the medical treatment and estimated expenses.
Verification and Approval: The insurance company's team will review the treatment plan and related documents. Once approved, the insurer will provide a pre-authorization letter or reference number to the hospital, outlining the approved coverage amount.
Treatment: Under cashless treatment, you can undergo medical procedures and treatment as recommended by the doctors. The hospital will bill the insurance company directly for the approved expenses.
Settlement: After the treatment is completed, the hospital submits the final bill to the insurance company for settlement. The insurer pays the hospital directly for the approved expenses, and you might need to cover any non-covered or excess charges as per the policy terms.
Reimbursement Claims: Reimbursement claims involve paying for medical expenses upfront and then seeking reimbursement from the insurance company. Here's how the reimbursement claims process works:
Treatment: You receive medical treatment at a hospital of your choice, which may or may not be within the insurance company's network.
Payment and Documentation: Pay the hospital bills and collect all the necessary documents, such as medical reports, prescriptions, bills, and receipts. Keep copies of all documents for your records.
Submit Claim: Submit a claim form along with the required documents to the insurance company. You can usually do this through the insurer's website or by visiting their office.
Claim Review: The insurance company will review the submitted documents and assess whether the treatment is covered under the policy terms. They may request additional information or clarification if needed.
Approval and Reimbursement: Once the claim is approved, the insurance company will reimburse you for the eligible expenses as per the policy coverage. The reimbursement amount is sent via bank transfer or check.
To ensure a smooth claims experience, follow the instructions provided by your insurance provider, keep records of all communications and documents, and seek assistance from the insurer's customer service if you have any questions or concerns.
Filing an individual health insurance claim in India involves a series of steps to ensure that you receive reimbursement for medical expenses covered by your insurance policy. Here's a step-by-step guide on how to file a health insurance claim:
Notify the Insurance Provider: Inform your health insurance provider about the hospitalisation or medical treatment as soon as possible. Most insurers have a toll-free helpline or a dedicated customer care email for claims. Provide them with your policy number, name, and details of the treatment.
Fill Out the Claim Form: Fill out the form completely and accurately, providing all necessary information such as personal details, policy number, treatment details, attending doctor's information, and hospitalisation dates.
Arrange the Required Documents: Collect all the necessary documents that the insurer requires to process your claim. These may include:
Original hospital bills and receipts
Doctor's prescription and treatment records
Diagnostic test reports
Any other relevant medical documents
Cashless Claims (if applicable): If your policy offers cashless hospitalisation, you need to visit a network hospital. Inform the hospital's insurance desk about your policy, and they will guide you through the cashless claim process. The hospital will directly send the bills to the insurance company for settlement.
Reimbursement Claims (if applicable): If you're not availing a cashless facility or if the hospital is not part of the network, you'll need to settle the bills yourself and then claim reimbursement. Submit all the necessary documents mentioned above, along with the claim form, to the insurance company within the specified time frame.
Claim Processing: The insurance company will review your claim documents and verify the details. They may contact you or the hospital for additional information if needed. This process can take a few days to a couple of weeks.
Approval and Settlement: Once the claim is approved, the insurance company will send you an approval letter or email detailing the approved amount. The settlement amount may include deductions such as policy deductibles or co-pay, if applicable.
Receive Payment: If the claim is approved, the insurance company will issue a payment either through a bank transfer or a cheque, depending on the preferred mode of settlement chosen by you.
Here are the differences between Group Health Plans and Individual Health plans.
Group Health Insurance
Health insurance for individual
Covers a group of individuals (employees, members of an organisation) under a single policy.
Covers an individual under a single policy.
Premium is often lower due to group rates and shared risk.
Premium is based on the individual's age, health, and coverage preferences.
Limited customization; coverage and benefits are often standard for the entire group.
More flexibility in customising coverage, add-ons, and riders based on individual needs.
Coverage might be lost if the individual leaves the group or organisation.
Continuity of coverage is maintained even if the individual changes jobs or organisations.
Premium Payment Responsibility
Premium might be partially or fully borne by the organisation/employer.
The individual is responsible for premium payments.
Here are some tips to keep in mind while buying health insurance for individual.
Consider factors such as age, pre-existing conditions, anticipated medical expenses, and lifestyle.
Review the coverage offered, including hospitalisation, pre and post-hospitalization, day-care procedures, critical illnesses, and maternity benefits (if applicable).
Sum Insured (Coverage Limit):
Choose an adequate sum insured that would cover potential medical expenses. Consider inflation and rising healthcare costs over time.
Check the list of network hospitals where you can avail cashless treatment. Ensure that the network includes hospitals that are easily accessible to you.
Exclusions and Waiting Periods:
Thoroughly read and understand the exclusions, waiting periods, and limitations of the policy. Be aware of pre-existing condition waiting periods and specific waiting periods for certain treatments.
Renewal Age and Lifetime Renewability:
Check the policy's renewal age limit. Opt for a policy that offers lifetime renewability to ensure coverage in later years.
Compare premiums from multiple insurance providers. Choose a policy that offers a balance between coverage and premium affordability.
Explore additional riders such as critical illness, accidental cover, and maternity benefits. Choose riders that complement your coverage needs.
Network Hospital Availability:
Ensure that there are network hospitals in your city or area. This will make it convenient to access cashless treatment.
Customer Support and Reviews:
Research the insurer's customer support quality and read reviews from existing policyholders to gauge their satisfaction level.
Understand the free-look period during which you can review the policy terms and conditions. If unsatisfied, you can cancel the policy and receive a refund.
Know the policy renewal process and ensure that you renew the policy on time to avoid a lapse in coverage.
Disclosure and Honesty:
Provide accurate and complete information in your application. Failure to disclose pre-existing conditions can lead to claim rejections.
Read the Policy Document:
Thoroughly read and understand the policy document before making the purchase. Seek clarification on any terms or clauses you don't understand.
The cost of an individual health insurance policy depends upon the list of inclusions and terms & conditions of a health insurance company. One can reduce this cost to an extent by renewing the policy on time and avoiding claiming for minor incidents.
Yes, there are waiting periods under individual health insurance plans. These waiting periods are specific periods during which certain coverage benefits, such as coverage for pre-existing conditions or specific treatments, are not immediately available after purchasing the policy. The duration of waiting periods varies between policies and insurance providers.
Yes, cashless treatment is available under many individual health insurance policies. Policyholders can receive medical treatment at network hospitals without having to make upfront payments, as the insurance company settles the bills directly with the hospital. It's important to ensure that you choose a policy that offers a wide network of hospitals in your area for convenient access to cashless treatment.
Yes, an individual can have more than one health personal insurance policy from different insurance providers to enhance coverage and manage healthcare expenses. This is known as "dual insurance" or "multiple policies." However, coordination between the policies and adherence to terms and conditions are important to avoid potential issues during claims settlement.
One can consider doing a couple of things while trying to save money on an individual health insurance policy. For example, you can improve your lifestyle to reduce the number of claims. Consider quitting smoking if you are a smoker. Secondly, you can compare various similar health insurance plans to understand the lowest priced policy and its inclusions.
A policy that offers an all-round coverage is considered to be the best health insurance plan. One can buy such a plan by taking into account the current lifestyle, medical history, and financial status. Then choose a plan that suits your requirements.
An individual health insurance plan offers health insurance coverage to a single person. The sum insured of the policy is not shared among other people and can be used by the policyholder. The policyholder can enjoy certain discounts if a claim is not raised during the policy period.
The eligibility for health insurance for individual includes being an Indian citizen or resident, within a certain age range (usually 18 to 65 years), and meeting the insurer's underwriting criteria. Pre-existing conditions and medical history may also affect eligibility and coverage terms.
You need to select a digital-first insurance company like Acko to buy health insurance online. Visit the insurance company's website and search for Individual health insurance plans. Enter your details and review coverages. Next, take a look at the exclusions and other terms & conditions. Also, read the fine print thoroughly before making the final payment. Don't hesitate to get in touch with the insurance company if you have any doubts related to their insurance policy. If not medical tests are required, then you might get your health insurance policy instantly at the registered email address.
All individual health insurance plans do not come with maternity coverages. You need to buy a separate cover with the base plan. Remember that there could be a waiting period for availing maternity benefits. Some insurance companies may enforce a waiting period of a few months to a few years of these benefits. Contact the insurance company to know more about maternity coverage.
You can easily search for the best health insurance plan when you intend to buy it online. This way you can compare policies and take a look at the social media handles of insurance companies for understanding the credibility of the company. Choose a plan that is most suitable for your requirements. Next comes the premium amount. Select a plan that has all the benefits and is priced lower than other plans with similar coverage.
The premium rate for buying an individual health insurance policy is decided based on the medical history of the applicant, claim history (if applicable), the scope of coverage, the insurance company, etc.
A group health insurance policy is usually offered by an organization to a group of people. For example, Employee health insurance benefits. Here usually the employer pays the premium. On the other hand, an Individual Health insurance policy is purchased by a person, and he/she pays the premium. So yes, a Group Health Insurance plan can be cheaper compared to an Individual policy.
Absolutely yes. As per the new rules, a policyholder will be allowed to raise a claim with multiple insurance companies for one claimable event for example cost of treatment arising out of an accident. This is how it works. Suppose Mr A has bought two separate health insurance plans, and he met with an accident. The first insurance company paid 80% of the total cost of treatment. Mr A can approach the second health insurance company to make a claim for the remaining 20% of the expenses. Thus, it is a good idea to build a solid health insurance portfolio by buying multiple plans.
Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.