Individual Health Insurance Plans

Purchasing a health insurance policy is often considered a rite of passage as investing in a health plan is one of the cornerstones of attaining financial wisdom. A good health insurance policy will give you coverage and relieve you of the financial stress associated with treatment costs. Most people who work in offices tend to receive an insurance benefit from their employer. While it is a common practice, one of the reasons why you are a part of an employer-sponsored group health plan is because it is mandated by law in India. However, these plans often turn out to be inadequate for our needs.

1. Personal Factors

To begin with, you need to assess your health insurance needs based on your age, health, family history and income level. Some other factors that you should look out for are illnesses covered and other benefits such as pre and post hospitalization expenses, room rent, ambulance services etc. After taking into account, the above factors, your health insurance company determines the premium that you will pay on your health insurance policy.

Also, if the insured person is hospitalized and a claim is made, the first thing the insurance company does is check the reasons for hospitalization and if your health insurance policy covers it.

2. Waiting Period

Next, the health insurance company checks the holding tenure of your health plan. There are many reasons why your insurer does so. For instance, critical ailments such as heart diseases, cancer, kidney failure, etc. have a ‘holding/ waiting period’. This waiting period could range anywhere between one year and four years, depending on the ailment. The insurance benefit for such aliments only kicks in once this waiting period has been successfully completed without an insurance claim.

The insurer will also go on to seek the primary diagnosis to understand the reasons for hospitalization. They determine if there are any new health developments and not a pre-existing condition that has been kept hidden/falsified to the insurer. If it is found that the hospitalization is due to an existing and undeclared health condition, then the insurer can refuse to provide any coverage and render the health insurance policy void.

This will also make it difficult for you to get another health insurance coverage anywhere in India.

3. Cashless Hospitalization/ Reimbursement

Once the claim has been confirmed to be valid, the insurance company will determine whether the hospital providing the treatment is a part of its network of providers. Nowadays, the majority of individual health insurance plans provide a cashless hospitalisation benefit. As a result, you must enrol at a hospital that is a part of the insurer's network to get this benefit.

After that, all that is left to do is pay a small registration fee while the supplier handles the claim. They only compare the cost of the procedure to the coverage provided by your health insurance policy. You won't have to pay any more out of pocket if the invoices fall under the coverage you selected. Though, you will have to make up the difference if the expenditures exceed the coverage.

Consequently, it is advised that certain factors be taken into account while trying to obtain the best individual mediclaim policy coverage. These factors include the price of medical treatment, the pace of medical inflation, and the full range of services you might require. This makes sure that even if you pay for insurance, your finances are not negatively impacted.

Keep in mind to submit any medical invoices, including those for pre- and post-hospitalisation expenses and pharmacy receipts, to the insurance company. The insurance provider will subsequently be able to appropriately assess the individual health insurance plans' extent of coverage and reimburse the necessary sum after deducting other costs (if any).

More and more people are realising how important it is to have a healthy lifestyle and give attention to their physical well-being. However, according to WHO statistics, certain diseases are becoming more common. No matter how healthy your lifestyle is, you will always run the chance of being hospitalised for unanticipated reasons. A proper health plan is essential to avoid financial burdens in the event of illness and hospitalisation.

There are many different health plans with useful features available today. Individual health insurance plans are among the most well-liked types of health insurance coverage. These policies only provide coverage for a single policyholder. But keep in mind that the health insurance features a policy offers are a crucial factor in picking it.

Let's examine some key components of a personal health insurance plan.

1. Cashless Hospitalization

Cashless claim settlement is one of the best health insurance benefits that some individual health insurance plans offer. When an insured person is admitted to the hospital, the cashless function enables them to receive full coverage without having to pay for any services. At the hospital, he or she can readily receive medical care without worrying about upfront costs. Once the insurance provider is made aware of the hospitalisation, the hospital's expenditures will be paid directly by the insurance provider. This benefit is typically restricted to a network of hospitals on the insurance company's panel.

2. Cover

According to certain Indian research, India's yearly medical inflation rate is over 17%, which is significantly higher than the country's overall inflation rate. Therefore, the coverage that the best individual health insurance plans offer is one of the most crucial health insurance characteristics to protect yourself from any financial stress.

Some experts go so far as to say that since medical insurance for individuals offer substantial coverage, they should be preferred to family health insurance policies. In such plans, the policy's premium is determined depending on the age of the policyholder and the relevant amount insured. The insurance company pays for medical expenses up to the covered amount. The type and scope of medical expenses that are covered may vary between policies and also depend on the premium. Pre- and post-hospitalisation expenses are covered by several policies, including Niva Bupa's health companion. These specifics, however, will vary according to the plan and insurer you choose.

3. Daycare and OPD Expenses

Typically, health insurance policies demand a minimum hospital stay of 24 hours before approving any claim. However, many surgeries and treatments now take much less time because of enhanced technology breakthroughs. Therefore, a key component of many individual health insurance plans is the payment of claims for daycare costs like dialysis, chemotherapy, eye surgery, and many others. Dental care, for example, is regarded as an outpatient service, and claims for such procedures are resolved appropriately.

4. Lifetime Renewability

In accordance with IRDAI guidelines, insurers are required to provide health insurance for all people up to the age of 65. Age restrictions in health plans, however, are no longer used by many private health plan providers. However, the admission age is still restricted to 65 by publicly traded general insurers. Even if a claim was lodged in the previous year, lifetime renewability is still accessible.

5. Pre-existing Conditions

All individual health insurance policies include coverage for pre-existing conditions. There is typically a 48-month waiting time, though. Additionally, some health insurance policies provide coverage with shorter waiting periods—36 months or less. However, when purchasing the coverage, the consumer must be truthful about any medical disclosures. The claim may be denied if the insurer believes the consumer knew about the pre-existing condition at the time the insurance was purchased but failed to report it.

6. Capping

Capping is one of the most important aspects of health insurance to pay attention to. Many health insurance plans place sub-limits or constraints on specific illnesses and costs. Many individual health insurance plans include "disease-wise capping" provisions, which could cap the maximum payout for a certain set of diseases (less than the total sum insured).

The overall cost of medical care during a hospital stay may also include additional expenses like room rental, surgery fees, doctor fees, medication costs, etc. The reimbursement under each or some of these charges may be capped or limited by some health plans to a particular, predetermined level. For instance, the amount of room-rent reimbursement may be limited to 1% of the insured amount.

Personal Health insurance plans are now required by society. If you decide to choose an individual health insurance policy , be sure to conduct extensive research and carefully review the features and inclusions of your chosen plan. Don't make your purchase purely based on the premium cost. Select a package that is straightforward and provides the finest features for your needs.

The most valuable item we possess is our health. While we can keep an eye on our behaviour, eating patterns, and exercise routines, there are still some factors that are beyond our control. By offering protection against all conceivable known and unknowable hazards, an individual health insurance plan is a strategy to protect our health and financial future. Consequently, a lot of financial experts advise making a health plan investment your top priority.

There are a host of health insurance companies in India who collectively offer thousands of insurance plans, each of them with specific benefits, exclusions and terms and conditions. While the basic premise for all health insurance plans remains the same, you should look to pick a policy that suits your individual needs the best.

Things to remember before buying an individual health insurance plan in India-

1. Estimate your Health Insurance Coverage

Although there are no fixed guidelines regarding the coverage one should have, there are certain parameters to keep in mind that will impact your health insurance needs.

Primarily, your age and income levels determine your premium. This is followed by factoring in your family history and pre-existing conditions. Another thing to remember is that if you have a predisposition to certain ailments, you should consider getting extra coverage. Similarly, you also need to factor in your geographical location as the standard of living and healthcare expenses in metro cities is much higher when compared to smaller cities.

2. Keep an Eye Out for Sub-limits on the Policy

Most health insurance plans do not cover all expenses incurred in case of an emergency. A sub-limit caps the reimbursement under various cost heads and is listed in the policy wordings of your health plan. For example, your room rent or ICU charges may be capped at 1% or 2% of the total sum assured. This means that despite having adequate insurance, you may still have to pay certain expenses out of your own pocket.

None of us would want to compromise on the care we may end up needing. Hence, be careful and understand all sub-limits when going through the proposed policy document.

3. Check for Coverage of Pre-existing Ailments

All critical illnesses such as coronary problems, cancer, kidney failure, diabetes, etc. under health insurance plans come with a waiting period before which the individual health insurance plan will not cover your treatment. This time period tends to vary and can be anywhere between 12 to 48 months.

Once this waiting period has elapsed, you can make a claim to your insurance benefits.

However, you should ensure that you disclose all health issues at the time of purchasing the policy. Falsifying or hiding health issues can render you policy void and also make it difficult for you to seek another health plan from other insurance providers.

4. Find out About the Co-payment Options

In most cases, your individual health insurance plan will cover all costs, but the policy may introduce a co-payment feature where the insured party is asked to bear a certain percentage of the costs. A co-payment feature is usually present in health plans for senior citizens. Since they are a high-risk category for insurers, the premiums for senior citizens are a lot more expensive. By introducing a co-payment option, which could be anything from 10% to 30%, the cost of the insurance is shared, making the insurance plan a lot more affordable.

1. Comparison

Once you have identified your needs and the requisite insurance benefits that meet your criteria, you need to shortlist three to five individual health insurance plans from different insurers. Then, make a careful comparison between the selected plans.

There are many aggregator websites in India that provide details on each individual health insurance plan and even allow you to make assessments head to head. You can even go to the insurance providers website such as www.nivabupa.com and get a quote for the plan of your choice.

2. Inclusions and Exclusions

Before you zero in on a plan, take a close look at the list of inclusions and exclusions on the policy. Legal parlance can be confusing, so if you have any doubts, speak to your agent or a representative of the insurance company. Your top priority should be gaining absolutely awareness of the contract that you are getting into.

It is generally recommended to pick a simple individual health insurance plan with fewer conditions and restrictions.

3. Premium Costs

If you are concerned about expensive premiums, there are many tips and tricks that could help you bring the premium down on a health plan. Many insurance companies now allow you to pay for an individual health insurance plan for two years instead of the usual annual renewal. In a bid to incentive customers to sign up for a two-year policy, they also offer some discounts.

Additionally, if you are dealing with an insurance agent, he/she may be able to offer a small discretionary discount on the individual health insurance plan by letting go of some portion of their commission. However, this depends on the type of policy, as well as your negotiation skills.

Many insurance companies also have tie-ups with banks and credit card providers. Thus, you may be able to snag some value-added benefits and cashback offers by purchasing the individual health insurance plan from a partner bank.

Once you have finalised on an individual health insurance plan, fill the proposal form carefully to ensure there are no mistakes.

You may be required to take a medical test based on your age and pre-existing conditions (if any). Most insurance companies now provide doorstep service for the preliminary health check-up or will redirect you to a channel partner to make the process easier for you.

Once issued, the insurance policy should reach you shortly. Many insurance providers such as Niva Bupa provide you with a free look period, within which if dissatisfied, you can return the individual health insurance plan.