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Individual Health Insurance Plan in India

Team AckoOct 14, 2022

The Covid-19 pandemic has made people realize the importance of Individual Health Insurance and the financial implications of not having enough or incomplete insurance coverage during a medical emergency. Let’s take a look at Individual Health Insurance plans and how one should go about selecting the right plan.

Individual Health Insurance



What is Individual Health Insurance?

Individual Health Insurance is one of the many types of health insurance plans available in the market. Like other health insurance plans, it shields you against expenses/financial liabilities arising from unexpected/planned medical costs.

Objective: An Individual Health Insurance plan offers financial coverage to a single person i.e. the policyholder in case of health issues.

What Does it Cover?: Usually, the plan covers the cost of pre and post-hospitalisation, hospitalisation expenses, diagnostic tests, etc.

Key Features and Importance of ACKO’s Individual Health Insurance Plan

  1. Continuous Support: Be it a query related to coverage, claims, buying, etc.; our support team is there to guide you throughout the journey.

  2. Completely Digital: With ACKO, you can buy, renew and even raise claims with a tap of your finger. Now you can ditch the paperwork and tedious documentation while buying health policy.

  3. Network Hospitals: When you buy on ACKO, you can get treated at any of the 6,500+ network hospitals across the country and enjoy a cashless claims process.

Types of Health Insurance Plans for Individuals

A health insurance plan is one of the few types of insurances that can be highly customized to suit individual needs. Since it is a good idea to be covered under various health insurance policies, one can choose from the following plan types to get maximum coverage.

  1. Individual health insurance basic plan

  2. Individual health insurance with maternity coverage.

  3. Individual health insurance under the employer’s insurance plan.

  4. Individual health insurance for a critical illness.

  5. Individual health insurance with top-up and super top-up coverages.

Also, read; Best health insurance plans in India

Inclusions: What is Covered in Mediclaim Policy for Individuals

Inclusions are one of the most important aspects of a health insurance policy. These situations help you understand when you can raise a claim against your policy. Here are the general inclusions or coverages of an Individual Health insurance policy. However, this may vary for different health insurance plans.

  • In-patient Treatment: This covers the cost of hospitalisation for the policyholder. Things like room rent, nursing charges, ICU charges, doctor visits, etc. are included under the in-patient treatment.

  • Daycare Procedures: Minor surgeries like cataract, tonsil removal, or similar procedures that do not require more than 24 hours of hospitalisation are covered under daycare procedures.

  • Pre-hospitalisation: Some surgeries or medical issues require a patient to avail treatment before getting hospitalised. The cost of such treatments can be availed under health insurance as per the terms and conditions of the policy.

  • Post-hospitalisation: The cost of follow-up treatment is covered under individual health insurance plans as per the terms and conditions of the policy.

  • Domiciliary Treatment: The cost of receiving treatment at home can be covered under special circumstances for a predetermined number of days.

  • Organ Donation: The cost of medical treatment related to donating an organ is covered as per the policy terms.

  • Ambulance: The cost of hiring an ambulance for transportation to the hospital will be borne as per the terms and conditions of the policy.

  • AYUSH Benefits: The cost of availing Ayurveda, Unani, Sidha or Homeopathy (AYUSH) treatment can be claimed as per the policy document.

  • Maternity and Newborn Coverage: Coverage for the cost of childbirth and insurance coverage for the newborn baby is covered as per the policy terms.

  • Daily Cash Benefit: Normally, it comes as an add-on cover. This amount can be used to buy medicines or other things as required by you.

Exclusions: What is Not Covered in Personal Medical Insurance

Every insurance company has a set of situations where the policyholder cannot raise a claim. These situations are called exclusions. Here is a list of exclusions of individual medical insurance policy that you should know.

  • Intentional Injuries: The cost of treating intentional injuries in attempting suicide is excluded from the policy.

  • Adventure Sports: Injuries arising out of taking part in adventure sports are not covered.

  • Criminal Activities: Medical attention required because of taking part in criminal activity is not covered.

  • Cosmetic/Dental Surgeries: The cost of cosmetic and dental surgeries unless required due to an accident is excluded.

  • Infertility Treatment: Health insurance does not usually cover the cost of treatment for infertility.

  • Not Mentioned in Policy: Any other medical treatments/surgeries that are not mentioned in the policy document will not be covered.

Benefits of Buying Personal Health Insurance Policy Online

Buying an insurance policy offline or the traditional method is more time-consuming as compared to the modern online method. Buying individual health insurance policies online can give you a host of benefits as mentioned below.

  1. Compare Policies: The main benefit of buying an individual health insurance policy online is that you can compare policies from various insurers that offer similar insurance plans.

  2. Convenient: You can buy an insurance plan online from almost anywhere in the world. All you need is an active internet connection.

  3. Say Bye to Paperwork: While buying policies online, there is no paperwork involved. This means you can buy, renew and even raise claims online in a hassle-free way.

Things to Keep in Mind While Buying an Individual Health Insurance Plan

  1. Choose Coverage Wisely: Be careful while selecting coverage and not go overboard while choosing a plan. For example, selecting an appropriate sum insured for an individual health insurance policy will be fruitful at the time of hospitalisation.

  2. Consider Your Lifestyle: Opting for a very high sum insured amount will increase the premium, while opting for a lower amount will prove to be insufficient in an emergency. Choose the coverage after considering your lifestyle and financial conditions.

Eligibility Criteria for Individual Health Insurance

Almost everyone is eligible to buy a health insurance policy. Usually, health insurance companies categorise individuals based on their age and medical background.

Age Criteria: The entry age for an Individual plan is 18 year and the exit age could be 65 to 70 years depending upon the terms of the insurance company. Parents can buy a separate health insurance policy for their children above the age of 18.

Buy When You are Young: There are certain health insurance plans that specifically cater to the needs of senior citizens, however, these are more expensive as compared to health plans for someone who is in a lower age group. This is why it is advised that a person should buy an individual medical insurance plan as early as possible.

Documentation: Usually, your insurance companies will ask for the following documents when reviewing your application for buying an individual health insurance plan. These are age proof, address proof, photographs and medical history. You may have to undergo some basic medical tests to apply for an individual health insurance policy.

Individual Health Insurance Premium Calculator

Meaning: Premium Calculator is a simple online tool that helps you find the approximate cost for buying a health insurance policy.

Purpose: You can find this tool on any health insurance website such as www.acko.com. You can use it by entering your details and selecting plan type to know the approximate premium for Individual health insurance policy.

Difference Between Group and Individual Health Insurance

While individual medical insurance covers a particular person, group health insurance covers multiple people in a group, usually unrelated to each other.

In an individual health insurance policy, you have control over the policy and can customise it based on your medical insurance needs. However, your employer typically decides the policy scope in group health insurance, and you have limited control over it.

Learn more about the differences between Group and individual health insurance plans

Tax Benefits of Individual Health Insurance

Certain tax benefits can be availed under section 80D of the Income Tax Act.A benefit of Rs. 25,000 can be availed as per the current year’s rules while filing income tax. This is for an individual health insurance policy.

For those who have bought Family Floater plans in which parents are covered, an additional amount of Rs. 25,000 (Rs. 50,000 if parents aged above 60) can be claimed for tax exemption.

Note: Tax savings and exemptions are as per section 80D of the Income Tax Act are subject to changes in the tax laws.

Types of Individual Health Insurance Claims

There are two types of claim settlement process - Cashless Claim Settlement Process and Reimbursement Claim Settlement Process.

  • Cashless Claims Process: In the Cashless Process, you do not have to pay a major part of the hospital bill upfront. For example, ACKO and the network hospital settle it between themselves. You just have to pay the deductibles as per the policy.

  • Reimbursement Claims Process: In the Reimbursement Process, you have to clear the hospital bill, stack the receipts, apply for a claim and then get it reimbursed from ACKO. This process may consume a lot of time and energy.

How to File an Individual Health Insurance Claim?

A lot of people find filing an individual health insurance claim troublesome. This is where online insurers such as ACKO make the claim settlement process simpler, transparent, convenient, and quick. Also, you have to decide whether you want a Cashless Claim Process or a Reimbursement Claim Process. Here’s an overview of the claim process.

Step 1: Visit a hospital that is a part of ACKO’s network for Cashless Claims and share your Health Card or state your policy number/details. If you are not opting for Cashless Claims, then visit any hospital of your liking and inform us directly or via a Third-party Administrator.

Step 2: You will come across a Third-party Administrator (TPA) at the hospital who is a link between ACKO and policyholder. Comply with the TPA with respect to furnishing documents and sharing information.

Step 3: Go through the treatment. In a Cashless Process, you will have to pay for the deductibles or any other extra costs and the rest will be taken care by us. In case of a Reimbursement Claim, pay the entire bill and ensure to keep detailed receipts and bills from the hospital and apply for a claim.

Step 4: The Cashless Process shall be completed once you pay the residual bill while the Reimbursement Process shall be completed when you receive the settlement amount from ACKO in your bank account.

Frequently Asked Questions About Individual Health Insurance Plan

Buying Related FAQs


What is meant by an individual health insurance plan?

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 only by you i.e., the policyholder. 

Which plan is best for a health insurance plan for an individual?

A policy that offers comprehensive coverage at an affordable cost is considered to be the best health insurance plan. One can buy such a plan by considering the current lifestyle, medical history, and financial status. Also, it is important to choose a plan that suits your requirements.

How can I buy individual health insurance online?

You need to select a digital-first insurance company such as ACKO to buy health insurance online. Visit www.acko.com or download the mobile app to buy a health insurance plan. Enter your details and review coverages. Next, look at the exclusions and other terms & conditions. Also, read the fine print thoroughly before making the final payment. Do not hesitate to get in touch with us if you have any doubts. If no medical tests are required, then you might get your health insurance policy instantly at the registered email address.

How to find the best health insurance companies for individuals?

You can easily search for the best health insurance plan online. 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.

Is it a good idea to buy multiple healthcare insurance plans for individuals?

Absolutely yes. As per the new rules, you will be allowed to raise a claim with multiple insurance companies for one claimable event. 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. However, ensure that it adds value against the premium amount paid towards these policies.

Coverage and Pricing Related FAQs


Does individual health insurance come with maternity coverage?

All individual health insurance plans do not come with maternity coverage. 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 to avail of these benefits. Contact the insurance company to know more about maternity coverage.

How are individual health insurance rates decided?

The premium rate for buying an individual health insurance policy is decided based on the sum insured, medical history of the applicant, claim history (if applicable), the scope of coverage, the insurance company, etc.

Does group health insurance come at a lower price as compared to individual health insurance?

group health insurance policy is usually offered by an organisation to a group of people. Here, the employer usually pays the premium. On the other hand, an Individual Health insurance policy is purchased by a person, and he/she pays the premium. Since Group Health Insurance Policy is a standard plan, it can be cheaper as compared to an Individual policy. Again, it depends on the coverage of the policy.

How to save on health insurance for a single person?

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 smoke. Secondly, you can compare various similar health insurance plans to understand the lowest-priced policy and its inclusions.

Does an individual health insurance plan come at a lower price?

The cost of an individual health insurance policy depends upon the list of inclusions and terms & conditions of the plan. One can reduce this cost to an extent by renewing the policy on time and avoiding claims for minor incidents.

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