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Individual Health Insurance

Written by - Akshatha Sajumon

August 14, 2019 4 minutes

In India, the cost of treatment is growing in double digits, and more than 80% of the population do not have access to health insurance. Out of pocket health expenditure is higher in India. The burden of the high cost of health is pitched towards the poor.
There are plenty of reasons why health insurance is not just a good idea but also necessary. Many people face a financial crisis when they have to fund for medical treatment and medical costs. So people dive into their savings and drain it. In such situations, a health insurance plan could be a real “life-saver” because it covers your hospitalization expenses.

Let’s talk on Individual Health Insurance:

Costly treatments and unseen medical emergencies made individuals to understand the need of having health insurance. Individual health insurance covers both pre and post hospitalization expenses, including ambulance charges and diagnostic test charges.
Daily cash plans are also covered under individual health insurance but are subjected to specific terms and conditions. Even pre-existing diseases except for injuries due to accidents are treated only after the completion of a defined waiting period.

Eligibility for individual health insurance:

  • Entry age is 18 years to 65 years
  • Entry age for child is three months

Features and benefits of an individual health plan:

  1. Access to cashless facility
  2. Covers expenses of all daycare treatments
  3. Life long renewable option
  4. Till the age of 45, do not require to undergo any medical test
  5. Even covers homeopathy and ayurvedic hospitalization expenses (depends on the insurance company policy)
  6. Free primitive health checkups
  7. Reimbursement is done for non-network hospitals. A non-network hospital is an option, only in case of unavoidable emergencies.
  8. Under section 80D of the Income Tax Act, tax benefits can be availed on the premiums paid.

(Network Hospitals: Health insurance companies are very much aware that private hospitals will charge more from patients with a medical cover as opposed to those without it. Thus, it would be a loss to insurance companies because this will have an impact on their customers. So to guarantee profits and to avoid unnecessary expenses, health insurance companies tie up with specific hospitals, makes them as a part of their network).


  • Pre-existing diseases are not treated as soon as you purchase of the policy
  • A waiting period of at least three years is applicable
  • For a few conditions, the amount assured to pay may vary around 10%
  • Treatment for the use of intoxicants (alcohol and drugs) are not included
  • A waiting period of 6 years for maternity/newborn baby expenses
  • A waiting period of 3 years for bariatric surgery (Bariatric surgery is an operation that is performed to help such individuals lose weight)

Do keep in mind:

  • The disadvantage of individual health insurance is the “cost.” Paying premiums becomes difficult for those who are already having a health insurance plan with employers.
  • Paying premiums regularly is a challenging task for low/middle-income group people.
  • Another disadvantage would be people having pre-existing diseases. The policyholders have to undergo at least four years of a waiting period for any pre-illness to be covered.

Everybody’s needs for medical care and concern varies from one another. It is always wise to watch out for the terms and conditions for any health insurance policy to make sure you have understood all the clauses. Choose insurance plans that suit your need, financial situation, and medical background. Keep an eye on the consequences of choosing a policy. Make sure you educate yourself sufficiently about health insurance and do not hesitate to take advice from friends or experts. After all, what matters is your health.

“Your happiness is a reflection of your health.”

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