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What is Individual Health Plan?

Individual health insurance covers all pre and post hospitalization expenses incurred around 30 – 60 days prior to and 90 days post-hospitalization.

Hospitalization plans compensate the hospitalization and medical expenses of an individual, the amount being subject to the sum insured. This plan takes care of all medical emergencies and the policyholder needs to pay a certain premium every year to avail the aforesaid benefit.

Benefits of Individual Health Insurance Policy

It is helpful and a wise decision to choose a relevant health plan. The individual plan is provided with a cumulative bonus of 5% for every claim for the year. Additionally, if one opts for family health insurance, some discount depending on the insurer and the policy you are holding is provided. A person does not require undergoing any medical test until the age of 45. In case, of people above 45, the pre-policy checkup is usually done at the insurer’s empanelled diagnostic centre. The repayment of treatment done in a non-network hospital is done in a few days and under section 80D of Income Tax Act, tax benefits can be availed on the premium paid for such insurance policy.

Exclusions of Individual Health Insurance Policy

One important point to note is that pre-existing diseases are not treated immediately after purchasing the policy. There is a pre-defined waiting period for the same. For a few illnesses, the cover amount may differ from 10% to 90% of the sum insured.


  • Ayurvedic Treatment
  • Homoeopathic Treatment
  • Non-allopathic Treatments.
  • Cosmetic Treatment.
  • Aesthetic Treatment

As well as the treatment related to intoxicating substances like alcohol is not encompassed.

Individual Health Insurance Policy Covers

The group of facilities offered in an individual health insurance policy is something every person will appreciate. All the pre and post hospitalization expenses incurred around 30 – 60 days prior to and 90 days post hospitalization are covered in the Individual health insurance. Cashless facility is provided when the insured person gets his/her treatment done in a network hospital. In case of non-cashless treatment, the amount is reimbursed after a formal approval process. The charges for ambulance, diagnostic tests up to a pre-defined limit and facilities like daycare are included in such plans as per the given terms and conditions.

Pre-existing diseases apart from injury owing to accidents are treated after a defined waiting period and this waiting period may fluctuate from months to years and maternity-related issues or psychiatric disorders, surgery like Cataract, hernia, piles among others are covered in the health insurance policy plans after a certain waiting period.

Mention health in most companies, and the cost of health insurance is what comes to mind, not how the company can invest to prevent further escalation in societal health care costs. John Quelch

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Health insurance is a type of insurance coverage that protects an individual or a group of people against medical and surgical costs against payment of regular premiums.

Mounting healthcare and surgical costs are a major strain on household budgets. Like any other insurance, mediclaim or health insurance is the best possible protection you or your family may have against any medical (usually hospitalization or surgical) costs. Health insurance also makes medical help affordable for everyone.

Mediclaim or health insurance makes you eligible for tax benefits on premium paid under 80D of the Income Tax Act.

Given the current healthcare scenario, there is no right age to get medical insurance the earlier, the better. Children can be added to either parents mediclaim policy. Many health insurance providers also have special plans for senior citizens and old age related health costs.

Most health insurance providers offer customized mediclaim or health plans. They are broadly of 4 types

  • Individual health plan
  • Family health plan
  • Critical illness plan
  • Senior citizen health plan

Accident-related medical costs are generally covered by all health insurance plans or may be taken as an add-on rider.

Health insurance costs vary depending on the following factors

  • Number of persons covered
  • Age of the person/persons assured
  • Health of the person/persons assured
  • Location (health risks in metros is deemed more than that of people residing in small cities and villages)
  • Additional riders (if any are opted for)

When a person signs up for a health insurance, the insurance company ascertains premium based on a number of criteria. Once determined, the company usually charges the same premium for that age group. The older a policy holder gets, the more the premium amount is. In the meantime, if there is a claim in any year, the premium may be hiked upon policy renewal. This is called load premium. The insurance company may sometimes offer a discount on premium, if no claim is registered for a number of years.

Mediclaim health insurance policies usually do not cover the following

  • Congenital medical conditions and diseases
  • Pre-existing diseases diagnosed prior to policy issuance
  • Medical costs arising out of self-inflicted injuries and/or attempted suicide
  • Cosmetic surgeries and/or treatments including dental treatment
  • Drunken driving related accidents
  • Cost of spectacles or contact lenses
  • Treatment of HIV/AIDS

Planned hospitalization Submit a written application with the TPA. Include doctors recommendation for hospitalization, medical records, and planned expenses. Once approval comes through go ahead with hospitalization. Notify TPA and make a claim through the hospital to avail cashless benefits.

Unplanned hospitalization/Accidents Notify TPA within 24 hours of hospitalization. Submit a notification statement with name, policy number, and known medical details. The insurer is likely to clear your eligibility details within a day or two. Stake cashless claim through the hospital to avail cashless services or pay cash and stake claim with all bills and records at the completion of treatment.