Individual Health Insurance

Individual health insurance is a policy that covers the medical needs of one person under an insured sum. This fixed amount covers eligible healthcare expenses such as hospitalisation, surgeries, daycare treatments and other medical expenses as covered by the policy.

The policyholder pays the premium on a regular basis to keep the policy active and claim the coverage for eligible treatment when necessary.

However, the coverage amount, benefits, exclusions, waiting periods, etc., usually differ from one plan to another. Therefore, it is important to understand the policy details before choosing a plan that suits you best.

Understanding the individual health insurance meaning becomes easy once it is clear how it works.

You begin by choosing a plan and deciding the sum insured. Once the policy is active, you pay premiums to keep it active, so it covers eligible healthcare expenses. This, however, depends on policy terms and waiting periods. For example, suppose Rahul buys an individual health policy with a sum insured of ₹10 lakh. After the applicable waiting period, he is admitted to a hospital for surgery. The treatment costs ₹3 lakh and Rahul files a claim with his insurer.

On receiving approval, the insurer pays the eligible amount as per the policy terms. Rahul can use the remaining ₹7 lakh for other eligible medical expenses during the policy period.

The primary reason to get health insurance is so that you do not have to pay the entire hospital bill out-of-pocket in case of a sudden medical emergency. Individual health coverage offers cashless treatment, where the insurer directly settles the eligible amount when you choose a network hospital. Besides this, here is why individual insurance is essential:

Individual health insurance covers multiple medical expenses, but it does not pay for everything. The exact coverage depends on the chosen policy. For instance, most plans pay pre and post-hospitalisation expenses, while cosmetic procedures are usually excluded. So, always read the policy details to know the inclusions and exclusions.

An individual health insurance plan works best for a single person who wants their own health cover so that they can manage it according to their needs. Thus, people who should choose this plan are as follows:

Add-ons or riders give extra benefits and enhance a basic individual health plan. However, it is important to choose only the add-ons that match your healthcare needs since adding more riders also increases the premium amount. Some essential riders are:

The main difference between the two plans is who it covers under the insured amount. An individual plan covers one dedicated person under the sum insured, while a family floater plan covers multiple members of a family under the insured amount.

Buying an individual health insurance policy online from Pluto Insurance is very convenient. You can do so in a few steps. To avoid any delay, ensure you keep certain documents ready. You will need identity and address proof (Aadhaar Card, Voter Card, etc.) and age proof (Aadhaar Card, Voter Card, Birth Certificate, etc.). Other than these, you need to upload documents such as your medical history and income proof. However, these are general and may vary with the insurer. Here’s what you need to do next:

The process of filing an individual health insurance claim depends on where you receive treatment. You can choose a cashless claim at any network hospital. A reimbursement claim is suitable for non-network hospitals where you have to pay out of pocket.