Health Insurance for Individual

What is Individual Health Insurance?

Health insurance for individuals refers to the medical coverage offered to a person on an individual sum insured basis. A health insurance plan for individuals is a policy that covers a single person against the hospitalisation costs and medical bills. You can purchase it on your own for yourself, your children, your spouse, or even for your aging parents.

Also, this policy allows policyholders to customise the coverage tailored to their own requirements and not for the entire family. Most health insurance plans available for individuals provide diverse coverage for emergency medical expenditures such as daycare procedures, alternative treatment, organ donor expenses, road ambulance services, and more.

The premium rate of an individual health plan is determined by the age, medical history, and gender of the policyholder, along with several other factors. Moreover, one cannot share the coverage and premium of an individual health policy among other family members. Add-ons can be purchased to expand the policy coverage. If you're looking for a mediclaim for individual needs, these plans offer focused protection and financial security tailored to one person’s health profile.It is regulated by the IRDAI and offers flexible options and solutions in today's dynamic healthcare landscape.

According to a recent survey, medical inflation in India's healthcare sector is growing twice as quickly as total inflation (Source: The Economic Times). As a result, individuals who are in the age group of 40 & 50 and even in their 20s are looking to buy a health insurance plan and understand its significance. People are also looking to buy individual health insurance to secure themselves financially in the future.

Key Features and Benefits of Individual Health Insurance

Individual medical insurance from Star Health includes a multitude of benefits and features as outlined below:

1. Customisable Coverage Options - Health insurance for individuals offers wider coverage options and helps individuals and families with pre- and post-hospitalisation expenses, in-hospitalisation, daycare procedures, and more. From the different coverage levels to choose from, the policyholder will have the liberty to choose the coverage they need for their medical services and can avoid unnecessary out-of-pocket expenditures. These plans are ideal for those seeking individual medical coverage that aligns with their unique health needs and financial goals.
2. Tax Benefits - Purchasing individual policy offers several tax advantages, i.e., the premiums one pays under the health insurance policy can be deducted under Section 80D of the Income Tax Act, which minimises the tax liability. Please consult your tax advisor or the act for the tax details. So, you can benefit from the dual advantage of safeguarding your health and tax deductions under the old regime.
   Also, you have an added opportunity to save tax on an individual basis.
   Illustration - The person insured with this policy is eligible to get a maximum tax deduction of up to Rs. 25,000 every year on the insurance premium paid. Senior citizens can get a deduction of up to Rs. 50,000, and one gets a total deduction of up to Rs. 1,00,000 if the insured and proposer are 60 years old or above.
3. Long-term Renewability - One should not feel age as a restriction to feel protected against medical crises. With our comprehensive health insurance plan for an individual, we ensure lifelong renewability, which is a crucial factor to stay covered in the golden years, when healthcare requirements are on the rise.
4. No Claim Bonus - The earlier you choose a health insurance plan for yourself, the more you will reap the benefits. There is an option for you to enjoy a lower premium if you are eligible for a No Claim Bonus (NCB). During a policy year, when one doesn't make any claims, you are eligible for a significant no-claim bonus. This Bonus is an additional Sum insured available along with the base sum insured to claim in future.
5. Add-On Covers - You can update your policy with the option of buying add-on covers such as maternity benefits, restoration, PED Buy back, Extra Protect to improve benefits, etc. Also, you can waive off the co-payment by choosing optional waiver benefits.
6. Cashless Hospitalisation - One can choose for a cashless claim during a medical emergency and the individual health insurance policy will allow the insurer to pay the hospitalisation bill directly to the network hospital.
7. Daycare procedures/ Domiciliary Hospitalisation - A health insurance plan for individuals covers the expenses for medical treatment at home for over three days when hospitalisation is not possible or available.

Importance of Health Insurance Plans for Individual in India

In India, the number of health threats is increasing relentlessly every day.

Unforeseen medical emergencies are unavoidable, and you have to be more cautious when choosing the right health insurance plan that will be sufficient to pay the medical expenses incurred during hospitalisation.

Healthcare inflation in our country is expanding twice as quickly as the total inflation. As a result, individuals who are in the age group of 40 or 50 and in their 20s have started to understand the importance of a health insurance plan. Nowadays, individual medical insurance is gaining popularity as you can customise its benefits and enjoy a pocket-friendly premium.

People of all ages, from young to middle-aged and elderly, can opt for an individual health policy to meet their specific healthcare needs. With flexible and extensive coverage, lower premiums, and much more to utilise, tailor-made health insurance policies for individuals offer an all-in-one solution at an affordable rate. For those seeking convenience and long-term coverage, a single premium policy can be a smart choice, allowing you to pay once and stay protected for years.

This health insurance is essential to get substantial financial aid, and one must add it to the financial portfolio to secure one's future. Including a single premium policy in your plan can also simplify financial planning and reduce the hassle of annual renewals.

How to Choose the Right Individual Health Insurance Plan?

It is always advisable to evaluate the right health insurance policy at an early stage of your financial journey. So, here are a few steps to help you choose the right individual health insurance plan that will best suit your needs:

1. Define Your Healthcare Needs - Begin your research by assessing your healthcare requirements, such as the budget, specific treatments, and affordability to pay the chosen premium. Look for different health insurance companies and their policies, and consider factors like pre-existing medical conditions, age, and predicted expenditures. If you prefer a one-time payment option, consider exploring the best single premium policy that offers long-term coverage without the hassle of annual renewals.
   Also, decide whether you wish to have outpatient treatment, maternity benefits, hospitalisation coverage, critical illness, etc. With this, you will be able to narrow down the suitable plans.\
2. Evaluate Network Hospitals - Check if the insurance company has tie-ups with the hospitals that you prefer, because a wide network can help you access quality medical care without hassles. This plays a vital role in cashless hospitalisation.
3. Understand Premiums, Deductibles, and Claim Settlement Process - Compare different premium amounts and understand the deductible amount to assess how it fits within your budget. Balancing deductibles and premiums is highly essential to finding an affordable and comprehensive insurance plan. Research the insurer's claim settlement ratio to ensure timely reimbursements.
4. Read the Policy Documents - Check for the policy terms, documents, and conditions of each plan. Also, the waiting periods and exclusions play a crucial role in choosing the right health insurance plan for yourself.
5. Seek Advice - If you need guidance about certain aspects, seek advice from financial advisors or insurance experts. They can help you make an informed decision on choosing the appropriate plan.

How much coverage do you need in your Individual Health Insurance Plan?

Determining the perfect size of your health insurance coverage is not a universal strategy. Every individual has their own unique needs and situations, which means their health cover should be personalised accordingly. To find the ideal size, take these factors into account: your age, current health condition, lifestyle choices, medical inflation, preferred hospital, and family medical history.

The adequate sum insurance plan to choose relies on three factors. Firstly, the place of residence plays an important role. Secondly, the life stage of the insured person is essential to consider. Lastly, the plan should also account for the future cost of hospitalisation.

For young individuals without any pre-existing conditions, it may be suitable to opt for a lower cover initially. This enables them to take advantage of lower premiums and offers financial protection in case of unexpected emergencies or illnesses. As they age, they have the choice to increase their coverage.

Middle-aged individuals, on the other hand, may find comprehensive coverage more desirable. For families, selecting floater policies that cover the whole family proves to be more beneficial than individual policies. Also, going with a higher sum insured guarantees comprehensive coverage for the entire family.

Senior citizens often need more extensive coverage because of the increased health risks they may face. This coverage should cover pre-existing conditions, diagnostic tests, regular check-ups, medications, hospital stays, and rehabilitation services.

Furthermore, it is important to consider the potential need for assisted living or nursing care in the future, making a long-term care health insurance policy a smart choice.

Example - For individuals between the ages of 18 and 30, a simple plan that offers coverage for emergencies and essential medical expenses might be adequate. As individuals move into the age bracket of 31 to 50, it is recommended to consider a more comprehensive plan that includes maternity coverage.

As one enters the senior year, which is 51 and above, it is best to select a comprehensive coverage option that includes prescription medications, chronic conditions, and potential long-term needs.

Furthermore, health insurance plans have been particularly designed for women, providing comprehensive protection for both women and newborns. Also, there are particular plans available for individuals with particular medical conditions, such as heart disease, diabetes, and cancer, which have shorter waiting periods.

With the continuous advancement in medical technology, including the use of stereotactic surgeries, robotics, advanced oncology drugs, and advanced radiotherapies such as therapy for cancer, it is becoming increasingly important for individuals to consider higher coverage amounts.

It is also vital to have increased insurance coverage to account for advanced treatments and interventions like ECMO, TAVI, Impella, and transplantation.

It is important to consider that the ideal size of your health insurance should be aligned with your financial capacity. While it is crucial to have adequate coverage, it should not overly strain your finances.

Take a close look at your monthly budget and find how much you can comfortably allocate towards insurance premiums. The key is to choose a health insurance plan that strikes a balance between the coverage you need and what you can afford.

To find the most suitable sum insured and policy type that caters to your particular needs, it is recommended to get guidance from a financial advisor or insurance expert.

How to Buy Health Insurance Online?

Step 1: Choose the Insurance Company

When you have compared different insurance plans and insurance providers based on the important parameters such as claim settlement ratio, etc, it is time to make the final decision and choose the insurance provider. Once you are done choosing the insurance provider, visit their website to purchase health insurance online.

Step 2: Enter your Personal Details

Few health insurance companies want you to enter your personal details, like name, age, DOB, phone number and e-mail ID. The insurance agent would then contact you and assist you in buying health insurance online.

Step 3: Use a Health Insurance Premium Calculator

Most health insurance companies offer insurance premium calculators on their websites to assist individuals in purchasing health insurance online. A health insurance premium calculator gives you an approximate figure of premium based on your age, gender, medical history, and many other factors. This is especially useful for estimating individual health insurance costs and selecting a plan that fits your budget.

Step 4: Add to Cart

If you are satisfied with the health insurance premium, you can go ahead and purchase health insurance online. Just select the “Add to Cart” option and complete the payment. You will receive the policy document once the process is complete.

How do you make a claim for your Individual health insurance?

You can make a claim request under a health insurance plan in two ways: through a cashless basis and a reimbursement basis.

On a Cashless Basis: To make a claim on a cashless basis, your treatment must be only at a network hospital of the Third Party Administrator (TPA) and the insurer who is servicing your policy. You have to get authorisation to avail the treatment on a cashless basis in accordance with the procedures laid down and in the prescribed form. Even if you've opted for a single premium insurance policy, the claim process remains the same and ensures uninterrupted coverage throughout the policy term.

Please read the policy document when you receive it to familiarise yourself with the process instead of waiting for a claim to arise.

Claims on Reimbursement Basis: Read the clause associated with claims in your policy document when you receive it to ensure that you comprehend the procedure and the document needed for making a claim on a reimbursement basis.

When a claim arises, you should inform the insurance provider in accordance with the procedure. Post hospitalisation, you have to ensure that you get and keep ready documents like claim form, discharge summary, prescriptions and bills that you should submit for a claim.

Mediclaim Policy for Individual

An individual Mediclaim policy refers to a health insurance policy that offers coverage for an individual's medical expenses. This individual mediclaim plan can help with expenses for daycare, hospitalisation, and pre-and post-hospitalisation.

What is the difference between a family floater and an individual mediclaim policy?

The major difference between a family floater and an individual mediclaim policy is seen in the number of people it covers. The family floater covers many family members, while an individual mediclaim covers only one person.

If a floater or individual mediclaim is better, it will be based on your requirements, like the health needs of your family, budget, and size. Let’s discuss it.

Family Floater Mediclaim Policy

• The family members covered under this policy will share the sum insured.
• Below this single plan, the entire family will be covered.
• Family Floater Premiums are less than the individual policies.
• This is a better choice for people with low budgets.
• This plan can provide value for money for family members who make only one claim in a year as a family. Policy sum insured can be used for a claim of any member covered.
   

Individual Mediclaim Policy

• It can cover only one person.
• Each member will have separate coverage.
• Under this mediclaim policy, the premiums are based on the individual's age and medical status.
• If the family members have different healthcare needs, then this type of plan could be a better choice.
• If you prefer higher coverage limits for each and every family member, then it could be a better option.

How to choose a mediclaim policy for an individual?

Many factors help choose a mediclaim policy for an individual. Those factors which help opt for an individual mediclaim policy are:

1. Age: As you age, the Premium will be higher. This is because age is a significant factor in determining your premium amount.
2. Health Status and Past Medical History: The medical history of a policy buyer determines the Premium.
3. Pre-existing Conditions: Your pre-existing medical conditions might result in higher premiums or policy exclusions.   
4. Coverage: Your medical needs will impact the amount of coverage you need. Also, higher coverage needs higher premiums.  
5. Maternity Benefits: Also, check if the coverage for maternity is available under this mediclaim policy.
6. Claim Procedure: Understand the claim procedure while you make a claim. This will provide a better experience for you.
7. Tax Benefits: Under the individual policy, one might be eligible for tax deductions on premiums paid towards health insurance plans.     
8. New Age Benefits: Consider the benefits, such as day 1 PED cover, consumables cover, restoration benefit, and annual health check-ups.