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Individual Health Insurance

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India mediclaim insurance for individuals

The Individual Health Insurance plan covers only one individual, the policyholder, who will be eligible for the benefits of the health insurance plan basis the premium he has paid for this cover. This kind of health insurance for individuals offers cover only medical expenses incurred by the insured individual for benefits admissible under the chosen plan. Individual Health insurance is a contract between the insurance company and an individual wherein the insurance provider guarantees to take care of admissible medical costs of the latter based on the premium paid by the individual. All insurance companies have separate health insurance plans offering health insurance for individuals as well as insurance for family and group.

Every individual should buy health insurance and for themselves and members of their family, based on their requirements. Buying health insurance protects individuals from the sudden, unexpected costs of hospitalization (or other covered health events, like critical illnesses) which would otherwise make a major dent into household savings. Each person is exposed to various health hazards and a medical emergency can strike anyone of us without any prior warning. Healthcare is increasingly expensive, with technological advancements, new procedures and more effective medicines that have also driven up the costs of healthcare. While these high treatment expenses may be beyond the reach of many, taking the security of health insurance is much more affordable.

Though the latest NHP (National Health Protection) data do not give figures for 'out of pocket expenses’, the WHO has estimated that in 2017-18, the ‘out of pocket expense’ on Health care was 78% against a world average of 18%.This means that the penetration level of Individual Health Insurance is so low that people are paying for their medical treatment from their hard earned savings and not Health insurance. This is the largest opportunity that lies before the Indian Insurance industry.

Key Features of Individual Health Insurance

Some of the key features of these plans include:
  • This plan offers coverage only for the insured individual, the policy holder.
  • The insured individual is insured upto the specified sum insured limits defined in the policy for the benefits listed under the plan.
  • The individual remits the premium applicable for the chosen plan of the insurance provider basis which the coverage is extended to him/her. This premium paid can be on a monthly or annual basis.
  • The policy covers hospitalization expenses (following an accident or sickness) including Pre & Post hospitalisation incurred as an inpatient during the period of the policy.
  • The individual can enjoy Income Tax deductions under section 80D of the Income Tax act (see section later in this page).
  • Once the individual is enrolled under a chosen plan, he/she will be eligible for renewal of the policy for their lifetime subject to paying renewal premium on time.
  • The individual can enjoy cashless treatment at any of the network hospitals of the insurance company across India.
  • Provides coverage for Critical Illness, if opted for by the individual as an add-on. Also covers surgery costs, room rent, physician’s fee and laboratory tests.

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Advantages of Individual Health Insurance Plan

The advantages of the Individual Health insurance plan include:
  • In an individual health insurance plan, the insured alone earns all the complete benefits under the plan.
  • The individual will have the benefit of an individual sum assured rather than floating sum assured across all the members of his/her family. Hence there is no risk of another family member becoming ill and using up part or the full available sum insured, as is the case in a Family Floater plan.
  • Best suited for every individual, irrespective of their social or economic strata, but definitely for persons with higher health risks given their family history, pre-existing medical conditions and lifestyle.
  • The individual can enjoy the benefit of Lifetime Renewal, there are no restrictions on the maximum age for the members for the renewal of the policy.
  • There is no need to worry about making multiple claims in a year since the plan caters only to a single person. Also if the individual avails the Restore Benefit, then the full Sum Insured will be available for each claim.
  • For individuals who are <45, there are no medical tests required to be enrolled under a health insurance plan.

So Who should buy this plan?

The Individual Health Insurance plan is suited for the following individuals:
  • This plans is suitable for Individuals who are looking for an individual sum insured and comprehensive coverage and not for a clubbed coverage with members of his/her family.
  • It is also advisable that the elder members of the family are covered with Individual Health Insurance plans, rather than be included under the Family Floater Plans.
  • The plan is best suited for individuals with higher health risks.
  • Any employed individual who wants a separate stand alone policy apart from what is provided for by the employer given that the group insurance plan may have a low sum insured. It will also provide him coverage if he leaves the organisation later.
  • Individuals who are looking for lifetime renewal flexibility to ensure their health and financial risks are adequately covered going forward.
  • While it may not be the primary reason to purchase a Health insurance plan, but this purchase, also allows the individual to claim an Income Tax deduction under Section 80D upto ₹25,000 per year if you’re < 60 years and upto ₹50,000 for ages > 60 years.

Best Health Insurance in India

  • Available for age 3 months - 75 yrs
  • Life long renewal.
  • Suitable plan for middle class
  • Floater basis and individual basis
  • Available for age 0 - 99 yrs
  • Life long renewal.
  • Free health check up on renewal
  • Maternity up to Rs. 1Lac and new born baby coverage from day one
  • Choose sum-insured 2-60 lacs
  • Automatic policy free recharge
  • Direct claim settlement
  • Covers maternity after 4/6 years of waiting period
  • Pre-existing benefits are covered after 4 years of continuous renewal
  • Renewal for life
  • Pre-existing dieseases covered after 2/4 years of continuous renewal.
  • No Copayment, No room rent or ICU restrictions
  • No loading on renewal premium
  • Coverage for the entire family
  • Gives comphrehensive coverages
  • Available for age 3 months - 65 yrs
  • Life long renewal.
  • Available for age 90days - 70 yrs
  • Life long renewal.
  • An medical ailment or an injury can arrive at any time when you are totally unprepared. Health Insurance helps you pay for this high quality healthcare.
  • Available for age 18 years - 65 years.
  • Pre and post hospitalization expenses covered for 60 days and 90 days respectively.
  • This Insurance Policy you can be in control making medical expenses more manageable. This ensures your family's quality health and happiness.
  • Min Entry Age: Child - 91 days, Adult - 18 years
  • Max Entry Age: No limit
  • Cover Type: Individual and Family Floater
  • Policy Period: 1, 2 and 3 years
  • Universal Sompo Health Insurance provides coverage on hospitalization expenses, domiciliary hospitalization, accidental injury and provides several add on benefits..
  • Royal Sundaram provides affordable health insurance plans with a comprehensive range of benefits to take care of you and your family.
  • New India Mediclaim is a Policy specially designed to cover Hospitalisation expenses.
  • Oriental Health Insurance plans can be chosen for individuals and an entire family.
  • Health insurance is designed to cover your medical expenses and give you the freedom to avail quality healthcare.
  • Health QuBE is a comprehensive health insurance policy which gives you and your family members a complete health cover.
  • Kotak Health Care is a comprehensive individual health insurance or family health insurance plan by Kotak General Insurance.
  • A health insurance or a medical insurance is a type of general insurance that safeguards you against financial losses by covering for you when you’re faced with a health condition or medical emergency such as due to a disease, illness or even an accident.

Tax Benefits

Tax deduction is allowed for health insurance premium payments and such tax benefits can be taken by an Individual. Tax deduction under section 80D is allowed only to an Individual or HUF (Hindu Undivided Family), a Resident or Non-resident citizen of India. In terms of section 80D, tax deduction is allowed for the premium amount paid as insurance premium to cover the health of the individual, his/her spouse, children and parents. It does not matter whether children or parents are dependent on you or not. Under this section, health insurance premiums, contributions to the Central Government Health Scheme, and preventive health check-up can be claimed for a tax deduction. The premium paid against a health insurance policy is exempted from taxation. Hence it effectively:
  • Protects yourself and your family during a medical emergency by offering coverage for hospitalisation expenses and
  • Saves money for you through the income tax deductions under section 80D

Table showing Maximum Amount of Tax Deduction U/S 80D

Insured’s Details IT Deduction under section 80D IT Deduction under section 80D Total Eligible Tax Deduction
Self who is earning ₹25,000 ₹5,000 ₹30,000
Self + Spouse , (both who are earning) ₹25,000 + ₹25,000 ₹5,000 ₹55,000
Self + Spouse , (both who are earning) + Dependent Parents> 60 years ₹25,000 + ₹25,000 + ₹50,000 ₹5,000 ₹105,000

Individual Health Insurance FAQ’s

In individual health insurance plans, each member of the family is covered under their respective insurance policies upto designated sum insured; whereas in the family floater health insurance plan, the health cover with the opted sum insured is shared by all the family members included in the plan.

No. While there are no restrictions and anyone at any age can avail an individual health insurance, there are some plans which have an entry age restriction between 65 and 70 years of age.

Individual health insurance plan offers tax deductions under section 80D of the Income Tax Act.

A waiting period is the length of time you, the insured, will have to wait before the benefits under the health policy can be utilised to the extent of the sum insured. Yes, all insurance policies, have a mandatory waiting period of 30 days for all benefits (except Accidental expenses) and then other benefits/coverages come with varying waiting periods between 24 and 48 months.

No, all insurance plans normally have a Deductible of Co-pay that will need to be borne by the insured, this is an additional cost apart from the than premiums that one has to pay.

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