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Individual Health Insurance
The recent coronavirus pandemic demonstrated the role of health insurance plans in securing the physical well-being and financial security of people. Hence, there has been a surge in demand for health insurance plans over the past two years. Most people have either enrolled themselves in a government-initiated health insurance scheme or opted for an individual health insurance policy. ...Read More
Francis Rodrigues
Francis Rodrigues has a decade long experience in the insurance sector, and as SVP, E-Commerce and Digital Marketing, HDFC Life, manages the online sales channel, as well as digital and performance marketing. He has had hands-on experience in setting up sales channels and functional teams from scratch over a career spanning 2 decades.
Written By:
Vishal Subharwal
Vishal Subharwal heads the Strategy, Marketing, E-Commerce, Digital Business & Sustainability initiatives at HDFC Life. He is responsible for crafting and ensuring successful implementation of the overall organisation strategy.
Reviewed By:
What Is the Meaning of Individual Health Insurance?
An individual health insurance policy is a contract between an insurer and a beneficiary In it, the insurance company (insurer) undertakes to offer medical coverage in exchange for premium payments by the policyholder (beneficiary). An individual health plan covers only one person. Hence, it has to be purchased for each member of a family individually.
Please note that individual health plans are not like family floater plans where all the family members are covered under the same policy. Instead, an individual health insurance policy is highly customisable in nature where you can get a health policy tailored to your health needs.
Usually, individual health insurance plans offer comprehensive policy coverage to a beneficiary for emergency medical expenses such as hospitalisation expenses, ambulance fees, day care treatment costs, organ donor expenses, alternative treatment expenses, etc. However please note that the premium and the policy coverage cannot be shared between your family members.
Top Features of Individual Health Insurance
Solo Coverage:
The core feature of an Individual health insurance policy is that it provides exclusive health insurance coverage tailored to the requirements of an Individual.
Ideal for Aged People:
These policies are appropriate for elderly people with high health risks. These policies can be customised to provide extensive coverage needed by such individuals.
Sum Insured Limit:
The maximum sum insured can go up to Rs. 1 crore, or even more depending on the chosen policy and insurer.
Cumulative Bonus:
You are entitled to receive a cumulative bonus which is a discount on the premium if no claims are filed in the preceding policy year.
Multiple Claims:
Many individual plans allow policyholders to make multiple claims in a year, provided that the sum insured amount is not exhausted.
Comprehensive Coverage:
These policies offer a broad spectrum of coverage which includes in-patient hospitalisation, ambulance charges, pre and post-hospitalisation expenses, etc.
Benefits of Purchasing Individual Health Insurance
Tax Advantages:
You can avail tax benefits on the purchase of an individual health insurance plan. The premium payments toward this plan will allow you to avail tax deductions of up to Rs. 25,000 under Section 80D# of the Income Tax Act. The tax deductions can even be claimed upto Rs 1,00,000 under the various options available in this section for self, family & dependent parents.
Family Discount:
Usually, most individual health plans allow you a family discount if more than two family members are covered individually.
Renewals:
An individual health insurance policy comes with a lifetime renewability. Most policies offer benefits like additional sum insured and no-claim bonuses upon renewal.
No Claim Bonus:
You can be eligible for a no-claim bonus during the period of the policy if you have not made any insurance claim in the policy period.
Cashless Facilities:
Each and every insurance company has a list of hospitals which they are having tie-ups with. Hence, opting for a hospital from the list will allow you to avail cashless facilities from the hospital and the insurance company will settle the bills under the cashless terms that you have opted for.
Add-ons:
These health insurance policies allow customisation through add-ons called riders providing critical illness coverage, maternity benefits, restoration benefits, outpatient treatments, etc.
Digital Access:
Some of the best individual medical insurance plans today offer digital access that makes managing the policy and filing claims super easy and convenient. You can also easily retrieve your documents online, allowing you to manage your health insurance needs anytime and from anywhere.
Secure Transactions:
It is important to know that when purchasing or renewing your individual health insurance policy, all transactions remain secure. Advanced encryption and security protocols ensure your personal and financial information remains protected for better peace of mind.
Time-Saving:
With online applications and digital tools, the process of purchasing individual health insurance has become quite streamlined. Now, you can easily compare plans, apply for coverage, and get insured within minutes — saving valuable time.
Paperless Process:
Most of the best individual health insurance plans available today have a paperless application and maintenance process. As a result, it is easy to apply, renew, and manage your policy, besides being an eco-friendly approach. It not only saves paper but also takes away the need to deal with physical documents. Thus making the whole process a lot smoother and more efficient.
What Does Individual Health Insurance Cover?
As a policyholder, you can avail the following coverage from a typical individual health insurance plan:
In-patient Hospitalisation Costs:
This is the main component of the coverage of an individual plan. These types of expenses include costs incurred on hospitalisation for more than 24 hours. It can include expenses incurred on ICU charges, room/bed charges and medicine expenses.
...Read More
Day Care Procedures:
It also covers the expenses of day care procedures i.e. medical treatment which requires hospitalisation of less than 24 hours.
...Read More
Pre / Post-hospitalisation Cost:
Individual health insurance covers any medical cost incurred before hospitalisation and it also covers any expenses after getting discharged from the hospital.
...Read More
Emergency Road Ambulance Service:
Many individual health insurance policies cover road ambulance assistance in the hours of medical emergencies on the road. It can turn out to be a lifesaver during road accidents.
...Read More
Alternative Treatment Coverage:
It also covers expenses incurred on alternative treatments obtained from alternative medical practices such as Homeopathy, Ayurveda, Siddha, Unani and Yoga.
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Domiciliary Hospitalisation:
Individual health plans also cover domiciliary hospitalisation expenses, which include expenses for medical treatments at home by the recommendation of a doctor.
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Organ Donor Costs:
By opting for some individual health insurance plans, you can get organ donor expenses covered, if there is any requirement for organ transplantation.
...Read More
What Does Individual Health Insurance Plans Not Cover?
There are certain expenses which are not covered by individual health insurance plans, which are as follows:
Alcohol/drug Consumption:
Any medical treatment arising out of consumption of alcohol or drugs is not covered under an individual health insurance policy.
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Treatment of Infertility:
Medical expenses associated with infertility treatment can’t be claimed.
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Self-inflicted injuries:
Any medical treatment expense on self-inflicted injuries such as an attempt to suicide or suicide is not covered by individual health insurance policies.
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Cosmetic Treatment:
Many people consider undergoing cosmetic surgery, any cosmetic treatment or implant; however, they are usually excluded from the coverage of an individual health insurance policy.
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Other Diseases:
There are several treatments which are not covered by most individual health insurance policies. It includes dental treatment, HIV AIDS, obesity treatments, and injuries caused due to participation in dangerous sports activities.
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Family Floater vs. Individual Health Insurance
The primary objective of a family floater policy and an individual health insurance plan is to mitigate the financial risks arising out of medical treatments. However, there are certain differences between the two, which are as follows:
Criterion |
Individual Health Insurance |
Family Floater Health Policy |
Beneficiary |
The amount of premium paid on an individual health plan and the sum insured is meant for a single beneficiary. |
The premium paid on a family floater policy is meant for all the members of the family and all of them are covered under one single insurance policy. |
Sum Insured |
The sum insured under the policy is customisable and covers one beneficiary. |
The sum insured is shared by all family members under a single policy. |
Affordability |
Usually, individual health insurance policy premiums are expensive, making it costly to cover an entire family. |
Typically, family floater policies are less expensive compared to individual health insurance policies. |
Add-ons |
Lots of options to select riders for specialised treatment based on an individual’s requirements. |
Less customisable and fewer options for add-ons compared to most individual policies. |
What Amount of Individual Health Plans Should You Have?
According to many experts, the minimum amount of an individual health insurance policy should be 50% of your annual income. The minimum coverage offered by most health insurance policies is Rs. 10 lakh for in-patient hospitalisation, daycare treatment, hospital room rent, COVID-19 treatments, bypass surgery and other associated complications.
The maximum coverage under an individual health insurance policy can go as high as Rs. 1 crore depending on the plan you have chosen. The ideal sum insured will depend on your age, lifestyle, pre-existing medical conditions, income and family size. Generally, the higher the risk of medical complications, the higher your coverage should be.
Individual Health Insurance: Who Should Purchase It?
In today’s fast-paced world, each and everyone must avail health insurance to mitigate the financial risk arising out of medical emergencies or critical diseases. However, it is essential to choose the right insurance policy containing the inclusions and riders you need.
Here are some categories discussed below; if you fall under any of these, you should consider opting for an individual plan:
- Uninsured Individuals with a family
- High health risk individuals
- Someone who prefers fixed-benefit plans over indemnity-based plans
- An individual with a preference to choose their policy irrespective of their age
- A policyholder looking for more coverage than a typical family floater plan
- An Individual with a preference for quick claim settlements and cashless treatments
- An individual health insurance policy is also perfect for self-employed, students and people from the age group 18 and 26 years.
Reasons to Buy Individual Health Insurance
Availing an individual health insurance policy is extremely important as it provides sufficient coverage for a medical emergency. Such plans are comprehensive and they can provide comprehensive cover to an individual based on his/her requirements and health conditions by selecting the most appropriate add-ons. Here are some reasons that make it worthwhile to buy Individual health insurance:
Customised Add-ons
You can select the most appropriate add-on based on your medical requirements. You can also determine this customisation based on your budget. You can avail comprehensive insurance coverage by adding extra coverage through riders.
...Read More
Sum Insured
Individual health plans can usually provide the highest amount of insurance coverage to an individual. It is because, in a family floater, the total sum insured is usually shared with other family members. On the other hand, the entire sum insured is dedicated to providing coverage to one single policyholder in individual policies.
...Read More
Cost-Effective
While it is a known fact that family floater plans are less expensive than individual insurance, the benefits diminish when there are several elderly members. The premium is usually decided by the eldest member of the family, which can increase the cost for other members if he/she has pre-existing conditions.
This makes individual health policies better on a cost/benefit basis. They offer better and tailored coverage for each member, which makes them more cost-effective when you want extensive coverage.
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Inflation Effect
Due to inflation the cost of medical treatment, procedures, medical equipment and medicines increase. In order to cope with the rising prices, individual health insurance can become a helpful tool due to the benefits they offer upon renewal.
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Employment Status
One of the best advantages of having an individual health insurance policy is that it is independent of one’s job status. In the case of employer-provided insurance, the policy is likely to end when one switches jobs or retires. However, personal health insurance remains valid irrespective of your employment situation. This ensures you always have coverage without worrying about losing it with a job change.
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Family Coverage
If you are a family person, you can look for individual health insurance plans that have the option to include family members under the same policy. This way, you can extend your coverage to your spouse and children. It not only makes it easy to manage health expenses for the whole family but is also a cost-effective option.
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Early Start
If you invest in individual medical insurance from early on in life, there are many advantages. Starting your policy early can help lock in a lower premium and avoid the higher costs associated with pre-existing conditions as you age. This approach keeps you protected from rising healthcare costs or likely coverage restrictions as you age.
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Tailored Benefits
One of the best benefits of personal health insurance is that policyholders can choose and tailor the benefits according to their specific needs. Unlike standard group plans, individual medical insurance allows you to select benefits that address your health requirements. This way, you get an all-encompassing and more relevant coverage.
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Control over Coverage
When you invest in individual health insurance plans, you get complete control over your coverage. You are not bound by the terms of a group policy, and there is a possibility of adjusting your plan as and when your needs evolve. Whether it is increasing your coverage limit or adding new benefits, your health insurance will always be aligned with your current health needs.
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Access to Specialised Care
With the best individual health insurance plans comes the assurance of gaining access to the top-class and a much wider network of hospitals and specialists. This helps you receive high-quality care and have more options when you are seeking specialised treatments. It is a factor that often becomes crucial in getting the best care when you need it the most.
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Why Buy Individual Health Insurance Online?
Here are some reasons why buying individual health insurance online could be a wise call:
Convenience:
It is very convenient today to buy your individual health insurance online. You can compare different plans, access different policy details without having to visit the company offices, and even complete your purchase from the comfort of your home. When you opt to buy your policy online, you can easily skip the discomfort of the hassle of in-person visits to insurance offices.
Secured Payment Modes:
Buying personal health insurance online is a financially safe procedure involving secured payment modes and gateways to complete the process. All online payment gateways today are encrypted, allowing your financial information always to remain protected throughout and even after the transaction process.
Instant Quotes & Policy Issuance:
One of the biggest advantages of buying individual medical insurance online is that one can expect to get instant quotes and even the policy itself. It is a matter of minutes before one starts receiving quotes. These are also easy to compare before the policy is eventually secured.
What You See is What You Get:
Online insurance platforms are designed to remain extremely transparent in their dealings. The insured can easily see exactly what they are getting into with their individual health insurance policy. One can go through the policy features in detail and enjoy the benefits. All terms and conditions are clearly outlined, and as a result, there is minimal chance of any misunderstandings due to hidden clauses.
Wellness & Value-Added Services at Your Fingertips:
Many online insurance providers offer additional wellness and value-added services. These might include health check-ups, fitness programs, or discounts on medical services. They are all easily accessible through their digital platforms. Such an integrated set of services always works to improve the overall health management experience.
Tax Benefits for Insurance Premiums:
Deduction in respect of health insurance premiums is governed by Section 80D of Income tax Act, 1961.
Eligibility : Individuals who have medical insurance for self, spouse, dependent children, or parents.
Member of a Hindu Undivided Family (HUF)
Deduction Limit:
Sr No |
Types of Individuals |
Age Limit |
Maximum Allowable Deduction u/s 80D |
1. |
Self + Family |
Everyone Below 60 years |
Rs. 25000 in Aggregate |
2. |
Self + Family + Parents |
Rs. 25000 + Rs. 25000 = Rs. 50,000/- | |
3. |
Self + Family + Senior Citizen Parents |
Below 60 years Above 60 years |
Rs. 25,000 + Rs. 50,000 = Rs. 75,000 |
4. |
Self + Family + Senior Citizen Parents |
All above 60 years |
Rs. 50,000 + Rs. 50,000 = Rs. 1,00,000 |
Mode of Payments Eligible for Deductions Under Section 80D
Types of Expenses |
Types of Payment Modes Allowed |
Health insurance premiums |
All modes of payment, except for cash |
Preventive health check-ups* |
All modes of payment (including debit card, credit card, UPI and cheque) |
*Preventive health check-ups are frequent medical examinations conducted to identify an illness, if any.
It is included in the deduction limit of Rs. 25000/50000 for individuals & senior citizens respectively.
Tax Exemptions under Section 80D can be claimed in every financial year.
Factors to Consider When Buying an Individual Health Insurance Plan
Here are some of the key points to remember while purchasing an individual health insurance policy:
Your Coverage Requirements:
Considering your age, existing medical conditions, and lifestyle, you will have to identify your coverage requirements before you actually begin your policy search.
...Read More
Policy Coverage Offered:
It is extremely important to go through the policy coverings such as ambulance charges, pre and post-hospitalization, hospitalisation, critical illness, etc.
...Read More
Amount of Sum Insured:
Consider opting for a policy which comes with an adequate sum insured. You should also compare the policies offered by different insurers and the sum insured, inclusions and exclusions of their policies.
...Read More
Network Hospitals:
Consider checking the list of network hospitals that your insurer is covering and ensure that these hospitals are easily accessible to you.
...Read More
Waiting Period and Exclusions:
It is extremely important to go through the policy description, waiting period and other clauses carefully. Stay aware of the waiting period and pre-existing illness clauses before you buy a policy.
...Read More
Cost of Premium:
Affordability is one of the most important factors to keep in mind while choosing a policy. Consider comparing the cost of premium of an individual health insurance policy offered by other insurers in the market.
...Read More
Add-Ons:
Consider checking add-on riders such as accidental cover, maternity benefits, critical illness, etc. Compare add-on riders offered by your insurer with other insurers in the market before making a final choice.
...Read More
Documents Required to Buy Individual Health Plans
1 Here is the list of documents required to buy an Individual Health Plan:
Proof of Age: Any one of the following: Passport, Aadhaar card, voter ID card, PAN card and driving license
Proof of Identity: Any one of the following: Aadhaar card, voter ID card, driving license, passport
Proof of Address: Any one of the following: Driving licence, PAN card, passport, utility bills, Aadhaar card
Duly filled and signed application form
Recent passport-sized photographs
Medical reports (if required)
Steps to Buy an Individual Health Insurance Policy Online
Navigate to the insurer’s website and sign in.
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Click on ‘Apply for Health Insurance’.
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Then, you will have to fill in some of the basic details such as name, contact number, gender, age, etc.
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Next, choose the city you are residing in.
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Add the details of your pre-existing diseases or surgeries.
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Read the policy terms and choose the add-on as per your requirement.
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Then confirm the above-entered details and chosen policy. Your insurance policy application request will be initiated and you will receive the confirmation of the same via. mail.
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However, it is always recommended to conduct research and compare the health insurance plans offered by several insurers to make an informed decision.
How to File an Individual Health Insurance Claim?
You can make a cashless insurance claim if you are availing the treatment from one of the cashless hospital networks provided by the insurance company. Here is the step-by-step guide to filing an individual insurance claim:
Step 1: Firstly, you will have to inform your insurer regarding the treatment beforehand if it is planned treatment. Usually, it can be 4 to 5 days in advance.
Step 2: Select a hospital from the list of cashless hospitals offered by the insurance company.
Step 3: While taking admission to the hospital you will have to furnish some of the policy documents such as a cashless card, policy number and other policy-related documents.
Step 4: Then you will have to duly fill up the pre-authorisation form (which can be downloaded from the insurer's website) and submit it to the insurer.
Step 5: Then the concerned insurance company will verify the details and notify the same to the hospital.
Step 6: The hospital will then send the healthcare receipts to the insurer, which will be settled by the insurer based on the plan terms.
Alternatively, you can file a reimbursement claim on your individual health policy. In this mode of claim submission, you have to avail medical treatment by paying out of your own pocket and then file for reimbursement from your insurer. Ensure to inform the insurer when availing treatment and keep originals of all hospitalisation-related documents.
Eligibility Criteria for Individual Health Insurance
1 The Individual Health Insurance eligibility criteria can vary from insurer to insurer.
However, here are the common eligibility criteria to avail of an individual health insurance policy:
Nationality:The applicant must be an Indian resident or citizen.
Age: Most individual health insurance plans come with a maximum and minimum age limit. It can vary from insurer to insure but typically the age limit must be between 18 to 65 years. However, there are specialised plans which offer provisions for senior citizens and children.
Medical History: Applicants are required to truthfully disclose their medical history which includes pre-existing illnesses or diseases, surgery, etc.
Medical Examinations: There are some insurance policies which may require a medical examination to assess your health conditions before the approval of the application.
Payment of Premium: Premium payment also depends on the ability and willingness to make the premium payments.
Disclosure: The applicant must provide complete and accurate information regarding certain aspects like medical history, health and lifestyle.
Criteria for Renewal: Most policies come with renewal criteria like claim history, and age restrictions which can affect the applicant's eligibility for policy renewal in the coming year.
Hopefully, by now you have got some clarity on the different aspects of individual health insurance. These policies are designed to suit the unique needs of a policyholder and provide extensive coverage. You can go through the above sections to learn how to choose the right individual policy for your health and financial needs.
FAQs on Individual Health Insurance Plans
1 What is an individual health insurance policy?
An individual medical insurance policy is a policy in which the insurance company undertakes to cover the financial risk arising due to medical treatments or emergencies. In return, the policyholder has to pay a certain payment to make claims within the sum insured limit.
2 Why should I consider individual health insurance?
There are several reasons to avail an individual health insurance policy like its customised add-ons and comprehensive coverage (as the requirement of the policyholder. One can also get more value for their money and get a higher sum insured.
3 What are the advantages of health insurance to individuals?
There are certain advantages of availing a health insurance policy some of which include: extensive coverage for a small payment, cashless claim, no claim bonuses, tax deductions, family discounts, etc.
4 What do health insurance plans for individuals typically cover?
The following are the inclusions provided by most individual health insurance policies: pre / post-hospitalisation costs, In-patient Hospitalisation costs, domiciliary hospitalisation, emergency road ambulance service, day care procedures, etc.
5 How do I choose the right individual health insurance plan?
To choose the right policy first, you will have to look for the most appropriate policy which can provide wide coverage, and check for the waiting period clause. Also, consider choosing a plan with lifetime renewability and check the room rent limit. You can get a private or semi-private hospital room or a shared room depending on the policy.
6 Are there different types of individual health insurance plans?
Yes, individual health plans can be further subdivided into four types, which are: Personal accident insurance, maternity health insurance, senior citizens health insurance and critical illness insurance.
7 Is cashless medical care covered by individual health insurance?
Yes, most individual health plans offer the cashless medical care facility if the treatments are done at one of the network hospitals of the insurer. For non-network hospitals, you usually have to file reimbursement claims.
8 Is individual health insurance tax-deductible?
Yes, you can avail tax deduction of up to Rs. 25,000 on the amount of premium paid on individual medical insurance under Section 80D of the Income Tax Act. This amount can be claimed for paying insurance premiums for yourself, spouse and dependent children. For paying premiums for senior citizens parents, you can claim up additionally upto to Rs. 50,000/-
9 When is the best time to buy individual health insurance?
The perfect time to buy an individual health insurance policy is when you are in your mid-twenties or early thirties. This is because during this time most people remain free from major family responsibilities and it is most likely that you are in your best health condition.
10 Can I customise my individual health insurance plan?
Yes, you can customise your individual health plan by opting for the most appropriate add-ons (riders) to your base policy. You can customise your individual health insurance plan as per your health requirements.
11 What is a 'free look period'?
A free look period is a particular period after the purchase and delivery of an insurance policy. During this time, the policyholder can thoroughly go through the policy documents and must understand all its aspects well. If the policyholder feels that the policy does not meet his or her expectations, they can return the policy and get a full refund.
12 What are the waiting periods under individual health insurance plans?
The waiting period for non-accidental claims is typically the first 30 days from the date of commencement of the policy. Specific diseases such as joint replacement surgery, arthritis, bariatric surgery etc., are usually covered after a waiting period of 1 year to 3 years based on the chosen plan.
13 Do individual and family health plans include No Claim Bonus?
Yes, you can get a No Claim Bonus from individual and family floater policies. Here, the sum insured is increased by a certain percentage for not making claims in each year. However, many companies offer discounts on premiums in the subsequent years.
14 What is the annual allotment of claims?
Usually, there is no restriction on the number of claims you can file in a year unless specified by the insurer. The maximum amount of claim that one can make in a year is limited to the amount of sum insured.
15 What happens if I change jobs or move to a different state with individual health insurance?
When you move from one state to another, you may have to find new health insurance plans if you are switching a job or looking for better opportunities. However, if you are continuing your job under the same employer, a policy change may not be necessary.
16 Does individual health insurance cover OPD benefits?
Yes, an OPD treatment is covered under many health insurance policies though some only offer it as a rider. The riders may cover prescribed diagnostics and medicines and doctor consultation fees for such treatments.
17 What is a pre-existing disease?
A pre-existing illness refers to a particular medical condition or illness that the policyholder already possesses before they apply for an individual medical insurance policy. According to IRDAI norms, any diagnosis of illness within the first three months of buying a policy is classified as a pre-existing medical condition.
1. Annual Premium amount ₹ 1869 for Male aged 35 years, Base Benefit, 10 years term, Regular Pay option, Sum Assured=10 lakhs, excluding Taxes & levies as applicable.
#Tax benefits & exemptions are subject to conditions of the Income Tax Act, 1961 and its provisions. Tax Laws are subject to change from time to time. Customer is requested to seek tax advice from his Chartered Accountant or personal tax advisor with respect to his personal tax liabilities under the Income-tax law.
ARN: DM/09/24/15242