Unexpected medical emergencies always remain a threat. The best solution to combat them is to invest in health insurance. One of the most basic types of health insurance policy is an individual health insurance policy. Such a plan protects your well-being and prevents illnesses, critical health conditions, and other medical problems from taking a toll on your well-being. You can protect your mental and physical health with the financial backing of a personal health policy.
With an individual medical insurance plan, you enjoy the benefits of extensive coverage as the policy’s sole beneficiary. You can also customise the coverage to meet your specific needs. However, such policies are not transferrable to anybody else. Only the individual named as the policyholder can seek medical attention. If you want medical protection for your family, you can buy a separate policy for each member. Several personal health insurance companies assist with the same. Choosing the best one is about knowing your needs and budget.
Features & Benefits of Individual Health insurance
Some of the salient features and benefits of individual health insurance are as follows:
- Comprehensive Coverage
Personal medical insurance covers all the major medical expenses when you need medical attention during emergencies and planned hospitalisation treatments. You can encash the policy to cover the cost of in-patient hospitalisation, pre and post-hospitalisation expenses, day-care procedures, domiciliary care expenses, organ donor costs, and much more. The specific coverage depends on the type of policies you choose, the sum insured associated with it and the terms of the health insurance company offering the coverage.
- Cost-Effective Investment
Health insurance makes for a worthwhile investment that safeguards your finances in times of medical complications. To make it affordable, the best personal health insurance companies propose competitive offers. They provide premium discounts and let you customise your policy to match your affordability. You can compare various insurance providers and select the right one, offering coverage that meets your specific health requirements and budget.
- Lifetime Renewability
Investing in personal health insurance at a young age lets you get optimal coverage at a low premium. Contrarily, when you get older, there are high chances of contracting illnesses, which attracts a higher premium. With the lifelong renewability feature, you can renew the policy without age restrictions. As a result, you do not lose your insurance benefits when you are older, nor do you need to re-qualify for a new policy at any point in the future.
- Tax Exemptions
The government of India encourages investment in individual medical insurance by offering tax deduction benefits under section 80D of the Income Tax Act. Under this provision, you can claim ₹25,000 to ₹100,000 per annum in tax deductions on premiums paid towards the policy. The deduction you can claim depends on your age and the age of the people for whom you purchase medical insurance.
- Alternative Treatments
If you prefer to get treated beyond the traditional allopathic medication, you can do so easily with individual health insurance plans. Besides clinical treatments, your individual medical insurance policy allows you to seek alternative treatments beyond surgery. Per the Insurance Regulatory Development Authority of India (IRDAI), insurers are mandated to cover the costs associated with Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy, or AYUSH treatments. You can also seek mental illness treatment under the policy.
- Individual Sum Insured
Only you, the policyholder, can use the sum insured under personal health insurance plans. The policy benefits are not transferrable to anyone else, including immediate family members. If you need medical treatment, the insurer covers your individual expenses up to the sum insured limit. Unlike family floater policies, the sum insured is not divided among family members. Personal health insurance companies consider your age, medical history, location, etc., to determine the sum insured and premium.
Best Personal Health Insurance Companies in India
Here is a list of the leading health insurance companies in India:
Niva Bupa Health insurance (formerly Max Bupa) is a renowned insurance provider that offers a wide range of health insurance plans. With a strong network of 8600+ hospitals, 30-minute cashless claim processing, and digital solutions, it ensures your complete satisfaction. You can get all these benefits at an affordable premium. Based on your requirements, you can choose between Niva Bupa personal health insurance policies like Health Companion and ReAssure.
TATA General Insurance Limited is a joint venture between Tata Group and American International Group (AIG). Since its commencement, it has grown exponentially and partnered with 7200+ hospitals across India. You can rely on TATA AIG for a smooth cashless claim settlement process. Other reliable features of TATA AIG personal health insurance are round-the-clock assistance, discounted premiums, substantial cumulative bonus, etc. For the best protection for your individual needs, TATA AIG offers MediCare, Medicare Premier, and MediCare Protect policies.
ManipalCigna Health insurance secures your health during uncertain medical emergencies with its comprehensive coverage. You can opt for its fully loaded personal health policies like Pro Health Plus and Pro Health Protect. These expertly-curated health plans specifically target your healthcare needs at an affordable premium. They also ensure a quick and hassle-free claim settlement experience with a vast hospital network in over 600 cities. For individual health protection, you can opt for Manipal Cigna Pro Health Protect or Pro Health Plus, depending on your coverage requirements.
Dependability, approachable customer care, and transparency make ICICI Lombard Health insurance one of the best personal health insurance companies in India. The company offers complete medical protection with its ICICI Health Shield policy, with sums insured ranging from ₹5 lakhs to ₹50 lakhs. You can enhance your cover value with the health booster feature. Additionally, you get a Befit Cover that settles OPD expenses on a cashless basis. ICICI Lombard provides immediate assistance with 24*7 support, quick claim settlement, and 6700+ healthcare providers. You can access the company’s offerings conveniently through the IL Take Care App.
Owing to its good claim settlement record and affordable health plans, Star Health insurance has become a household name in India. If you want financial protection to secure your individual healthcare needs, you can buy Young Star Insurance Policy by Star Health insurance. The plan comes with exceptional benefits like automatic restoration of the sum insured, no capping on room rent, mid-term inclusion of family members, wellness programme, and loyalty discount. Besides YoungStar, Star Health insurance also offers plans like MediclassicBase that cover a wide range of expenses. If you want a higher sum insured, MediclassicGold is an ideal plan for you with its super restoration benefit of 100% and automatic restoration of 200%.
SBI General Insurance lets you customise your health plan based on your health concerns. You can adjust the premium accordingly and buy affordable individual health insurance plans. To address your personal medical needs, you consider the SBI General Arogya Plus Health insurance plan. The policy comes with a flat premium rate regardless of your age and covers expenses for OPD treatments, pre-and-post hospitalisation, maternity costs, etc. You can enjoy all this and more with up to a 7.5% discount if you opt for a longer tenure policy.
Care Health insurance (formerly Religare Health insurance) offers exclusive plans for varied health risks. You can benefit from its vast range of network hospitals and its high claim settlement ratio of 95.2% for hassle-free financial assistance during medical emergencies. For all-round individual medical needs, you can choose the Care Advantage plan. With a sum insured of ₹1 crore, it ensures you never have to worry about being underinsured. You also have the option to upgrade the extensive base coverage with specific add-ons like Covid Care, No Claim Bonus Super, Care Shield, Room Rent Modification, etc.
HDFC Ergo is among the best personal health insurance companies in India because of its customer-first approach. Every service is centred around convenience. You experience this with their under-three-minutes policy buying experience and cashless claim settlement within 20 minutes. If you want to enjoy such convenience while seeking individual healthcare protection, consider HDFC Ergo’s Optima Restore plan that enables you to restore 100% of the sum insured. Other beneficial features include lifelong renewal, no geography-based sub-limits, smooth portability, etc. You can also enjoy up to an 8% discount on your renewal premium with Stay Active Benefit.
Aditya Birla Health insurance is the health insurance company for you if you like discounted benefits with extensive coverage. The Active Health personal insurance plans by Aditya Birla are designed with features that address your healthcare needs while proving all-encompassing protection. These plans come with comprehensive health coverage and a chronic management program and provide access to expert health coaches. Depending on your sum insured requirement, you can choose between variants like Essential, Enhanced, and Premiere under Aditya Birla’s Activ Health Platinum Plans.
Eligibility Requirements for Buying Individual Medical Insurance
Most health insurance companies require you to fulfil the following eligibility criteria while buying Individual medical insurance policies.
The minimum age to buy a personal health insurance plan is 18 years, and the maximum age limit is 65 years. However, the exact age range may differ from insurer to insurer. You should typically purchase the policy while you are younger to enjoy lower premiums, no-claims bonus benefits, and ride out the waiting period.
- Pre-existing Ailments
If you have existing health conditions, the premium amount gets significantly impacted. Insurance companies use it as a parameter to decide your coverage. Your request to purchase insurance may get rejected if you have chronic pre-existing conditions.
- Medical History
Your medical history gives personal health insurance companies a glimpse into your existing health concerns. Insurers use this information to decide your eligibility and finalise the premium amount. If you are aged below 40 years, you may be asked to submit a doctor’s certificate. Otherwise, you can provide your latest medical tests as proof of your good health.
Documents Required for Buying Individual Health insurance
Keep these documents handy while buying your personal health policy to get through the verification process smoothly:
- Duly filled proposal form with details like your full name, age, location, contact information, etc.
- Passport size photographs
- Identity proof (Voted ID/PAN Card/Aadhaar Card/Driving License/Passport)
- Age proof (Birth certificate, Aadhaar Card, Passport, PAN Card)
- Residence proof (Aadhaar Card/Electricity bill/Landline bill/Ration Card)
- Medical Reports (If requested by the insurer).
How to File an Individual Health insurance Claim?
You can file an individual health insurance claim in two ways.
You need to file a reimbursement claim when you seek treatment at your preferred non-network hospital. Here, you need to pay for the treatment costs on your own and file a reimbursement claim after being discharged from the hospital. Follow these steps to file your reimbursement claim.
- Inform your insurer before seeking admission in a hospital for planned treatments or within 24 hours in case of emergency hospitalisation.
- Fill out and submit the claim form along with original medical bills and other essential documents.
- After assessing the medical expenses, the insurer verifies your claim and reimburses you up to the sum insured amount.
You can seek admission in a hospital within the insurer’s network to enjoy cashless claim settlement benefits. Simply follow these steps:
- Inform the insurer about the network hospital where you intend to seek treatment.
- Fill in the cashless claim form with the essential details concerning your medical treatment.
- Submit the claim form with the medical records to the TPA.
- After inspection, TPA provides you with a confirmation letter.
- You can furnish the confirmation letter at the hospital counter to process the cashless claim request.
Note: In case of emergency hospitalisation, you can quickly fill out the cashless claim form with assistance from healthcare officials at the hospital.
Factors Worth Considering While Choosing a Health insurance Provider
Here are some essential components to check while selecting the best medical insurance company.
- Coverage Benefits
The best personal insurance companies pack individual medical insurance plans with value-added benefits. They go above and beyond the essential coverage to give you more. Such offerings include restoration benefits, wellness services, free health check-ups, teleconsultations, etc. If you find certain, specific features addressing your personal health concerns, you can use them to shortlist a suitable plan for you.
- Premium Amount
Premium is the cost you bear for seeking medical protection under the personal medical insurance plan. Insurers determine this amount based on your health profile. They factor in your age, medical history, lifestyle habits, pre-existing illnesses, etc., for the same. They also consider certain terms and conditions to determine the premium amount. You can check the coverage you are eligible for on the insurer’s website.
- Claim Settlement Ratio
Checking the claim settlement ratio of the health insurance companies is essential for comparison and shortlisting insurance providers. This ratio gives insight into an insurer’s ability to honour your claims. It informs you about the number of claims processed by a health insurance company, the pending claims, and the rejected claims. You can consider purchasing your policy from an insurer with a claim settlement ratio exceeding 90%.
- Customer Support
There could be times when you might need information about your nearest network hospital. You may also need clarification about the claim filing process. In such cases, you can contact your insurer’s customer support network. A good health insurance provider offers a 24×7 customer support network or the facilities of a SPOC (single point of contact) manager whom you can consult anytime.
- Conditional Terms
Personal health insurance companies offer coverage and other benefits under specific conditions. You must follow these terms while utilising their services. Some conditional terms include a waiting period on pre-existing illness coverage, a co-payment clause, sub-limits on medical expenses, etc. Going through such terms carefully helps you make an informed decision while choosing the right personal insurance provider.
Can I buy multiple individual health insurance policies?
You can buy more than one medical insurance plan to suit your specific healthcare needs. However, the applicable premium differs on the type of coverage you select.
Does individual health insurance coverage become active from day one?
No, you must ride out an initial waiting period of 30-45 days to start enjoying the coverage benefits. In the case of pre-existing ailments, this period ranges between two and four years before you can raise a claim.
What happens if I do not renew my personal medical insurance plan on time?
If you do not renew your personal health insurance plan before the renewal date, your insurer provides a grace period. If you still fail to renew the plan, the insurer terminates the policy, and you lose the accumulated benefits like the no-claims bonus and the completed waiting period.
I am covered under my employer's group health plan; do I still need to buy individual health insurance?
Yes, even if you are covered under your employer's group health policy, you should still consider purchasing individual health insurance since you stand to lose insurance benefits when you leave the company. Also, the coverage may be insufficient to bear critical illness expenses.
Is a medical check-up necessary before buying personal health insurance?
If you are aged below 40 years, insurers may not necessarily require you to undergo a medical check-up before buying a personal medical insurance plan. They may, however, insist on it if you are older. However, undergoing a medical check-up works in your favour as it helps you assess your health and obtain proper coverage before buying the policy.
How many personal health insurance claims can I make in a year?
There is no predetermined limit on the number of claims you can file so long as the claim amount does not exceed the sum insured.
Can I change my Individual Health insurance Company?
Yes, you can switch your existing insurer during the policy renewal via the portability facility. If you find better offers and services, you can file a portability request with a new insurer and complete the porting formalities to make the switch. However, the new insurer should agree to your porting request.
At what age should I buy Health insurance?
You should buy your personal health insurance plan when you are younger, typically in your early twenties. This is because you are less likely to fall ill while you are younger. Also, you can easily ride out the waiting periods and enhance your coverage by 50% or enjoy discounted premiums with the no-claims bonus benefit.
Can I cancel my personal health insurance plan after buying it?
Yes, you can. Personal health insurance companies allow you to cancel your insurance plan if you do so during the free-look period, which typically lasts for 15 days after the policy issuance date.