Individual Health Insurance Policy | Mediclaim Policy – Coverages, Features, Benefits, Exclusions, Claim Process, Eligibility Criteria, Quotes | Buy & Renew Online

What is an Individual Health Insurance Policy?

An Individual Health Insurance Policy is a type of Health Insurance Policy which provides a separate Sum Insured for each and every Insured person. The Sum Insured is applicable exclusively to the Insured Person. An Individual Health Insurance Policy provides coverage for the hospitalisation expenses, Pre and Post Hospitalisation Expenses as well as Daycare Procedures. Unlike a Family Floater Policy, the Sum Insured under an Individual Health Insurance Policy cannot be shared with other family members. An Individual Health Insurance Policy is also known as an Individual Mediclaim Policy.

What are the coverages under an Individual Health Insurance Policy?

1. Hospitalization Expenses: An Individual Health Insurance Policy covers hospitalisation expenses incurred due to Illness or Injury, including Room Rent, Boarding Expenses, Nursing, Intensive Care Unit Charges, Surgeon/Anesthetist Fees etc.
2. Pre- and Post-Hospitalization Expenses: The Policy also covers Pre and Post-Hospitalisation Expenses usually for a Period of 30-60 days respectively.
3. Daycare Procedures: Daycare Procedures are medical treatments or surgeries that do not require a 24-hour hospital stay due to technological advancement. Individual Health Insurance Policies cover Daycare Procedures such as Cataract Surgery, Chemotherapy, Dialysis, and Minor Surgical Interventions.
4. Domiciliary Treatment: Some Individual Mediclaim Policies also provide a Domiciliary Hospitalisation cover which provides coverage for treatments that require hospitalization but are carried out at home due to the patient’s condition or lack of hospital beds. The Cover includes expenses for Medical Treatments, Nursing Care, and medication administered at home and is useful for patients with mobility issues.
5. OPD Expenses: Outpatient Department (OPD) Coverage covers medical expenses incurred without the Insured getting admitted to a hospital and includes consultations, Diagnostic Tests, Pharmacy Bills, and Minor Procedures that do not require an overnight hospital stay.
6. Maternity Benefits: Some Health Insurance Policies also provide coverage for Expenses related to Pregnancy and Childbirth for both, Normal and Cesarean Deliveries. Maternity Expenses typically include expenses related to Prenatal and Postnatal Care, Delivery Expenses, and Newborn Baby Cover. Maternity Benefits Coverage under a Health Insurance Policy usually has a waiting period, ranging from 9 to 48 months and also a Sub-Limit which is usually around Rs50,000 to Rs1 lakh.

What are the Exclusions under an Individual Health Insurance Policy?

Individual Health Insurance Policies usually have the following exclusions:

1. Pre-Existing Diseases: An Individual Health Insurance Policy does not offer cover for Pre-Existing Diseases before the end of waiting period, which typically ranges from 1 to 4 years. Pre-Existing Diseases are covered only after the end of Waiting Period.
2. Self-Inflicted Injuries: Injuries or illnesses resulting from self-harm, suicide attempts, or voluntary exposure to danger are not covered.
3. War-Related Injuries: Injuries or illnesses resulting from war, acts of terrorism, civil war, or nuclear risks are excluded from Coverage under an Individual Mediclaim Policy.
4. Sexually Transmitted Diseases (STDs) and HIV/AIDS: Many policies exclude coverage for treatment related to STDs and HIV/AIDS.
5. Cosmetic surgery: Procedures such as Plastic Surgery, Botox, and other Cosmetic Treatments are generally not covered unless they are necessary due to an accident or reconstructive surgery.
6. Substance Abuse: Medical expenses arising from the use of alcohol, drugs, or other intoxicants are not covered under a Health Insurance Policy.
7. Maternity and Newborn Care: Maternity expenses are usually excluded unless the Policy explicitly includes coverage for maternity benefits. Even with coverage, there is typically a Waiting Period and Sub-Limits.
8. OPD Treatments: Outpatient Department (OPD) Treatments, which include Consultations, Diagnostic Tests, and Minor Procedures that do not require hospitalization, are generally excluded unless specifically included in the plan.
9. Dental care: Individual Health Insurance Plans usually don’t cover dental procedures like fillings, crowns, and dentures.

What are the features and benefits of an Individual Health Insurance Policy?

The key benefits of an Individual Health Insurance Policy are as follows:

1. Hospitalisation Expenses Coverage: Individual Health Insurance Policies offer coverage for Hospitalization Expenses, where the patient is admitted for more than 24 hours. The Policy covers all expenses related to Hospitalisation including Room Rent, ICU charges, Nursing Fees, and other associated costs under In-Patient Hospitalisation Coverage.
2. Pre and Post-Hospitalisation Expenses Coverage: Health Insurance Policies also cover Pre- and Post-Hospitalisation Expenses, usually for a period of 30-60 days respectively. Pre- and Post-Hospitalisation Expenses constitute a significant sum and coverage for the same reduces the financial strain on the Insured.
3. Coverage for Daycare Procedures: Individual Health Insurance Plans provide coverage for Daycare Procedures, which typically do not require a 24-hour hospital stay due to technological advancement. Daycare Procedures include cataract surgery, chemotherapy, and dialysis. Coverage for Daycare Procedures helps manage the costs of short-term medical treatments, ensuring you receive timely care without the financial burden of a full hospital stay.
4. Sum Insured: The Sum Insured for Individual Health Insurance Policy is applicable for exclusively for the Insured Person under the Policy and is not shared with any family member like in a Family Floater Health Insurance Plan. An Individual Health Insurance Policy is thus extremely useful for older people as they have higher risk of hospitalisation.
5. Family Discount: Individual Health Insurance Policies offer a family discount where a discount on premium is offered to family members if 2 or more family members are covered under the Policy
6. No Claim Bonus: Individual Health Insurance Policies offer a No-Claim Bonus where the Policy Sum Insured is automatically increased without an increase in Premium if there is no Claim made under the Policy.
7. Tax Benefits of Health Insurance under Section 80D of Income Tax Act 1961: The Premiums paid for Individual Health Insurance Policies are eligible for Section 80D Tax Deductions of the Income Tax Act, 1961. Policyholders can claim deductions on premiums paid for themselves, their spouses, children, and parents.
8. Lifetime Renewal: Individual Health Insurance Policies in India allow Lifetime Renewals as long as the Policyholder pays the premiums on time. Lifetime Renewability allows Policyholders to renew their plans without any age restrictions.

What factors should you look for when choosing an Individual Health Insurance Policy?

Sum Insured

Sum Insured is the maximum amount that the Insurance Company pays for hospitalisation expenses incurred. A Policyholder must choose a Sum Insured that adequately covers potential medical costs, taking medical inflation into account. A higher Sum Insured provides better financial protection but comes with higher Premiums. Make sure that the Sum Insured is adequate to cover medical expenses for serious ailments or injuries.

Cashless Hospital Network

A strong network of Cashless Hospitals allows Policyholders to receive treatment at the hospitals without paying money out of their own pocket. The Insurance Company settles the bill directly with the Hospital. The Insured should choose an Insurance Company with a large network of hospitals, especially those near his residence. This ensures that you have access to quality healthcare facilities in emergencies without financial strain.

Pre and Post-Hospitalisation Expenses Coverage

Pre and Post-Hospitalisation Expenses coverage provides coverage for medical expenses incurred prior to hospitalisation and post discharge. Pre and Post-Hospitalisation Expenses constitute a significant percentage of Medical Expenses and Policyholders should choose a Policy offering Pre and Post-Hospitalisation Coverage of at least 60-90 days respectively.

Waiting Period for Pre-Existing Diseases

Pre-Existing Disease means any medical condition which is already existing 48 months prior to the effective date of the policy issued by insurer. Individual Health Insurance Policies have a Waiting Period of 24 months to 48 months for Pre-Existing Diseases during which any claims related to Pre-Existing Conditions are not covered by the Policy. The Insured should compare the Waiting Period for Pre-Existing Diseases amongst multiple Health Insurance Plans before finalising the Policy.

No Claim Bonus (NCB)

No Claim Bonus provides an automatic increase or addition in the Sum Insured of the Health Insurance Policy without an associated increase in Premium for every Claim Free year under the Policy. Policyholders should choose an Individual Health Insurance Policy which offers a high No Claim Bonus as it translates into increased coverage in the future.

Restoration Benefit

Restoration Benefit in Health Insurance restores the Policy Sum Insured after it is exhausted due to a Claim raised under the Policy. Restoration Benefit is important in case of chronic illnesses or diseases which requires frequent hospitalisations as the Sum Insured is more likely to get exhausted in such a case. Restoration Benefit comes to the aid in such a situation and reinstates coverage after the Sum Insured is exhausted. Policyholders should choose a Health Insurance Policy which has a Restoration benefit which can be utilised even after Partial Utilisation of Sum Insured and also one which can be used for same/related illnesses

Premium

Insurance Premium is the amount that the Policyholder pays to maintain coverage under a Health Insurance Policy. The Policyholder should purchase a Policy which balances the premium with the Coverage received. Lower premiums might be attractive but could come with Sub-Limits or other restrictions. Policyholders should compare features and benefits of different Health Insurance Plans to find one that offers comprehensive coverage at a reasonable premiums.

Claim Settlement Ratio

Claim Settlement Ratio indicates the percentage of Claims settled by the Insurer against the total Claims received. A higher ratio reflects the Insurer’s reliability in processing and paying out claims. The Policyholder should choose a Health Insurance Company with a high Claim Settlement Ratio to ensure your Claims are likely to be settled promptly.

Lifetime Renewal

Lifetime Renewal of a Mediclaim Policy ensures that the Policyholder can renew his Health Insurance Policy without any upper age limit if premium is paid on time. Lifetime Renewal of the Policy is crucial as medical needs increase with age in order to ensure that the Insurance Company does not refuse coverage at old age when you require Insurance Coverage the most.

What factors impact the Premium of an Individual Health Insurance Policy?

Individual Health Insurance Policy Premiums depend on the following factors:

1. Age: Older people are at a higher risk of health issues, so Health Insurance premiums for older people are higher than for younger people.
2. Sum Insured: The higher the Sum Insured, higher is the premium for a Health Insurance Policy.
3. Medical history: People with Pre-Existing Conditions, such as asthma, diabetes, or heart conditions, while have higher premiums for their Health Insurance Policies than people with no Pre-Existing Conditions.
4. Type of Coverage: Health Insurance Plans with wider coverage will have higher premiums than plans with narrower coverage.
5. Policy Duration: Multi Year Health Insurance Policies have higher premiums than a single year policy.

How to claim Individual Health Insurance?

The Claim Process for an Individual Health Insurance Policy is the same as any other Health Insurance Policy. A Policy holder can make a Claim in 2 ways

Cashless Claim Settlement

The Policyholder has to just show the Health E-Card to the Insurance Desk at the hospital. The Health Insurance Company settles the bill directly with the hospital and the Policyholder does not have to bear any expenses out of his own pocket.

Reimbursement Claim Settlement

Under Reimbursement Claim Settlement Process, the Policyholder pays the hospital bill out of his own pocket first and then claims a Reimbursement under the Health Insurance Policy by submitting the required documents to the Insurance Company

What are the documents required to make a Reimbursement Claim under an Individual Health Insurance Policy?

In order to make a reimbursement claim under your health insurance policy, you need to submit the following documents to your insurance broker

1. ID Proof: A copy of the Patient’s ID proof (e.g., Aadhaar Card, Pan Card, Passport).
2. Claim Form: Duly filled and signed Claim Form provided by the Insurance Company.
3. Hospital Discharge Summary: A Discharge Summary mentioning the Treatment received and the duration of hospitalization.
4. Hospital Bills and Receipts: Original Hospital Bills and Payment Receipts, including break-up of charges.
5. Pharmacy Bills: Original bills for medicines purchased, along with prescriptions.
6. Doctor’s Prescription and Consultation Papers: Prescriptions and Consultation Papers from the treating doctor.
7. Pre- and Post-Hospitalization Bills: Bills and Receipts for expenses incurred before admission and after discharge from the hospital, as per the policy terms.
8. Diagnostic Reports: Original Diagnostic Test Reports (e.g., X-rays, blood tests, MRI scans) along with receipts.
9. Bank Details: Bank Account details for reimbursement, often including a canceled cheque.

What is the need for an Individual Health Insurance Policy?

We live in times where lifestyle diseases are increasingly common. Due to sedentary lifestyles, most people are suffering from hypertension, diabetes etc. Critical Illnesses like cancer are also becoming increasingly prevalent on account of air pollution, smoking etc. A report in WHO estimated that 1 in 10 Indians likely to suffer from cancer during their lifetimes. Average Treatment Cost of Cancer can easily exceed a couple of lakhs while that of a Bypass Surgery can exceed 5 lakhs. Such unplanned expenses can put a big dent in your savings and impact lifestyle. It is thus necessary to be prepared for such emergencies by opting for an Individual Mediclaim Insurance Policy.

How to Buy an Individual Health Insurance Policy with Qian?

Qian Insurance is one of the top 10 insurance brokers in India with tie-ups across a wide range of Health Insurance Companies in India. The dedicated team at Qian will assist you in comparing Health Insurance Plans across multiple plans as well as with the entire Health Insurance Claims Process . If you wish to purchase a Health Insurance Policy, you can reach out to us via email at insurance@qian.co.in or call us on 📞 022-35134695 .

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How to Renew an Individual Health Insurance Policy with Qian?

Individual Health Insurance Policies offer lifetime renewal. Hence, your Insurer cannot discontinue the Policy at any time except in the cases of fraud or missing of premium payment. Policyholders need to follow the below-mentioned steps to renew their Health Insurance Policy :

1. Contact Customer Service: Contact Qian Customer Service by at insurance@qian.co.in or call on 📞 022-35134695 to renew your Policy. If you wish to port your Health Insurance Policy , intimate the same to the customer service.
2. Renewal Notice: Qian will send a Health Insurance Policy Renewal Notice mentioning the renewal premium.
3. Renew Policy: You can renew the Policy online by paying the Premium via the payment link sent by Qian.
4. Receive Policy: Once the Premium is paid, you will receive the Policy Copy via email and the hard copy will also be dispatched to the given address.

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Compare and Get the Best Health Insurance Quotes with Qian!

An Individual Health Insurance Policy offers peace of mind by ensuring that you are financially protected against unexpected medical emergencies. The Policy also helps you in managing the rising costs by covering a substantial portion of medical expenses, including hospitalization, surgeries, and medications Qian Insurance has tie-ups with leading Health Insurance Companies so that you can choose from a range of Policies depending on your budget and requirements. We will assist you with appropriate coverage as well as the entire Claim Settlement Process for your Health Insurance Policy. Get the Best Quote for Health Insurance Policies with Qian. You can get in touch with us at insurance@qian.co.in or call us at- 📞 022-35134695 . We would be glad to assist you.

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