Anand is a young professional from Bangalore. He is covered under a group mediclaim plan offered by his employer. However, Anand has been reading a lot about the importance of having a separate health cover. Thus, he purchased an individual health insurance that will offer him continued coverage through regular renewals, unlike the group mediclaim that would be valid so long as he works for his current employer.
Anand had already purchased a senior citizen health policy for his ageing parents who live in another city. As he lives independently, he estimated his medical needs and opted for a suitable plan.
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21 April 2025
Like Anand, we must ensure that we have a safety cushion in the form of an individual medical insurance policy that would take care of various medical expenses.
This article tells you everything about an individual health plan and the need to buy one.
Why should you Buy Individual Health Insurance?
- Option to Customise:The flexibility to customise anindividual health policy based on your unique healthcare needsis noteworthy. From choosing the preferred sum insured to selecting add-on cover, customisation is easily possible. Moreover, you can also add family members to the policy.
- Tax Benefits: Having an individual health cover allows you to claim tax deduction up to Rs 25,000 on the premium paid, as per Section 80D of the Income Tax Act. This is a major advantage for salaried individuals who look to achieve savings in the best possible way.
- No Limitation: As far as policy renewal is concerned, an individual does not have face any restriction with respect to maximum age of members. Also, as the entire sum insured is available for an individual, he or she has no worries when it comes making multiple claims in a year.
What are the Benefits of Individual Health Cover?
When a medical emergency strikes, an individual may incur huge expenses that may not be just limited to hospitalisation. In fact, there could be associated costs like ambulance charges, medication, diagnostic tests, etc. Paying for such expenses can damage one’s hard-earned savings. An individual health insurance ensures financial protection by offering benefits such as:
- Hospitalisation cover: A good health plan offers hospitalisation cover including in-patient care, domiciliary care or day care treatment and associated expenses such as room rent, ICU charges, etc.
- Pre-and-post hospitalisationbenefits: The benefits involve coverage for various expenses an individual may incur before getting admitted in hospital and after discharge from hospital. This will be available for a specified period as mentioned in the policy terms and conditions.
- Cashless Hospitalisation: Under this feature, an individual can avail cashless treatment at any network hospital and stay worry-free about payment of bills. The insurer is responsible for settling the expenses directly with the hospital, based on the policy terms and conditions.
- Automatic Rechargeof Sum Insured:The policyholder need notworry if the sum insured is exhausted within a policy year. Under this feature, the entire sum insured is restored and can be used for future medical expenditures.
In addition, an individual health insurance offers cover for specific ailments and pre-existing diseases after the specified waiting period is over. Other benefits available for an individual health policy entail ambulance cover, maternity cover, alternative treatment cover, organ donor cover, annual medical check-ups and no claim bonus.
Exclusions in Individual Health Policy
A health policy also includes certain permanent exclusions where an individual may not get coverage for the specified scenarios. Here are some general policy exclusions:
- Dental treatment
- Congenital diseases
- Self-inflicted injuries
- In vitro fertilization and infertility treatment
- Hospitalization as a result of war, riot, strike or nuclear weapons
Some useful tips when Buying Individual Health Policy
- Make sure you understand the procedure for filing a claim. For cashless procedures you would need a health card. Check the list of documents you need to submit for filing reimbursement claim.
- Know the amount of premium you need to pay. Avoid cash payment and choose payment modes like net banking, debit/credit cards, etc. so that you can easily avail tax benefits.
- Find out the nearest network hospitals of your insurer where you can avail cashless treatment.
- Remember to renew your policy on time so that you get coverage without any interruption.
