Individual Health Insurance

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In individual health insurance policies, every insured person is supposed to be paid a certain amount of money at the completion of the policy or in case of another situation as specified in the contract between the insured and the insurer.

Individual health insurance - pros and cons

One of the major advantages of an individual health insurance policy is that the benefits are often available to family members such as in-laws or parents. These policies are great for families where the members are of a higher age group and where the chances of health risks are more.

Normally in the individual health plans there are zero limits as far as the upper age limit for the members is concerned. Discounts and loading benefits can also be availed in case there are lapses. However, if a family has a low health risk then these policies turn out to be costly options.

Need of individual health insurance

The basic reason for taking an individual health insurance is that if a person suffers from an accident or a major ailment, he will not need to pay the expense on his own. In case of private hospitals this cost also includes a substantial pre-admission deposit.

Healthcare treatment expenses can totally drain away the savings and also make one bankrupt. Yet another important reason in this context would be that without insurance one might have to be satisfied with public healthcare benefits and wait for treatment with hundreds of people.

With individual health care plans coverage is available for critical surgeries and operations, which also is a very important reason for availing these plans. Following are some disadvantages of not having health insurance:
  • Delayed analysis of critical disease and thus greater possibility of a quicker death
  • Increased mortality rate if the patient is suffering from diabetes
  • Often people without health insurance do not visit a doctor or use prescribed medicines. They normally go for over-the-counter drugs even if their situation demands better treatment
  • Substantial medical bills that the patient cannot afford to pay. This can also contribute to changes in lifestyle that are not wanted by a patient
  • Majority of these people have often been observed to use only emergency care as their medical facility. This means that they only seek treatment when their condition becomes serious
  • Hospitalization for ailments that could have been negated with proper medical care and earlier detection

Types of individual health insurance

Fee-for-Service Plans: The fee-for-service policies are often referred to as indemnity plans. In case of these plans, the insurers pay the fees for the services received by an insurer. These plans normally provide an insurer with the maximum flexibility as well as options when it comes to deciding healthcare facilities and doctors.

However, these plans also have a major downside. In these plans, the insured needs to make the payment for the services right at the start. Afterwards they need to submit forms with the insurer and recover the payments.

These plans are ideal options if the insured is looking for a large pool of doctors and healthcare facilities to choose from. The payment for these policies by the policyholders involves the following:

  • Premium
  • Coinsurance
  • Deductibles
These policies also come with yearly caps that restrict the medical expenses for that year.

Health Maintenance Organizations (HMOs): The HMOs are good options if the insured is willing to let go some flexibility in deciding the healthcare provider or doctor. These are primarily prepaid plans where the insured pays a certain amount of premium every month and the insurer takes care of the insured and their families.

In most of these plans, the insured are offered a doctor or a hospital that is in the HMO's network. Copayment is also offered usually in case of each visit to a doctor or a healthcare process.

However, the advantage in these plans is that the payment need not be done right at the start or claim forms do not have to be admitted for regaining the medical costs. The service provider normally takes care of these issues.

Preferred Provider Organizations (PPOs): The PPOs are combinations of the HMOs and the fee-for-service plans. Like an HMO, only a limited number of doctors and hospitals are included in the PPOs. The providers in these plans are referred to as in-network providers. The policyholders in these cases normally go for the network members as they are less expensive.

However, the insured may also avail doctors or hospitals that are not part of the network. In such instances, the insurance only covers a certain part of the services but the payment made by the insured is normally higher.

How to compare individual health plans

When it comes to comparing various individual health plans on offer, people should first look at the requirements of their family as well as themselves. If they want to opt for and then continue with a doctor or a hospital then it is no use bothering with an HMO. However, the HMOs are the best option if costs are a major issue.

Once a decision has been made regarding what type of individual health policy may be availed further research has to be done for a comparative analysis of the plans available. Following are some factors that have to be kept in mind:

  • Premium price
  • Cost coverage of prescribed medicine
  • Co-pays
  • Maximum amount covered for expenses made by the insured in a year

Right time to take individual health insurance

As per experts, the right time to take an individual health plan is during youth when people are expected to be in the best health. If someone is planning to embark on a career as a business owner or self employment, it is advisable to avail the health insurance at the initial stages.

Experts say if for ladies looking to start a family the options are limited in case they are pregnant. There are several individual health plans where a certain amount of waiting period is required for covering any and every condition related to pregnancy. However, this is only applicable for policies that cover pregnancy.

How to file individual health insurance claims?
The following documents have to be submitted while filing the claims for an individual health policy:
  • Claims form properly signed and filled by the applicant
  • Certificate from attending doctor that specifies the operation's nature and the receipts and bills for the same
  • Discharge certificate provided by hospital
  • Bill, diagnosis certificate, and receipt from attending anesthetist, consultant or specialist
  • All ailment related documents such as doctor's discussion reports
  • Attending doctor or surgeon's certificate ascertaining the complete recovery of the patient
  • Receipts, cash memos, and bills from the hospital - these have to be supported with authentic prescriptions
  • Previous policy details if the third party administrator already does not have them - however accidents will be exempted
  • Reports and receipts of analytic examinations - these have to be complemented by notes from the concerned surgeon or physician that justify the judgment

Individual Health Insurance Policies

Company Plan
ICICI Prudential ICICI Pru Health Saver
ICICI Pru Crisis Cover
Bajaj Allianz Individual Health Guard
Max Life Insurance Max Life LifeLine MediCash Plan
Max Life LifeLine Wellness Plus Plan
Max Life LifeLine Safety Net Plan
HDFC Life HDFC Critical Care Plan
HDFC SurgiCare Plan
SBI Life SBI Life - Hospital Cash
Tata AIG Insurance MediPrime
Wellsurance Executive
Accident Guard
Maharaksha Personal Injury Plan
Individual Accident & Sickness Hospital Cash
Tata AIA Life Tata AIA Life Health First
Tata AIA Life Health Protector
Tata AIA Life Health Investor
Aviva Aviva Health Plus
Aviva Health Secure
Future Generali Future Health Suraksha - Individual
Future Criti-care - For Individuals & Family
MetLife Met Health Care
Met Health Cash
Bharti AXA Life Bharti AXA Life Triple Health Insurance Plan
Bharti AXA Life EasyHealth
Aegon Religare Aegon Religare Health Insurance
IDBI Federal Healthsurance
IndiaFirst Life Insurance IndiaFirst Money Back Health Insurance Plan
Apollo Munich Health Insurance Easy Health Individual
Maxima Health Insurance
ICICI Lombard Health Advantage Plus
Critical Care
Personal Protect
Health Care Plus
National Insurance Company Mediclaim Policy
Overseas Mediclaim
Royal Sundaram General Insurance Total HealthPlus
Hospital Cash Insurance
Star Health Insurance Medi Classic
Super Surplus
Star Health Gain
Star Unique Health
Star Criticare Plus
Diabetes Safe
Star Netplus
IFFCO TOKIO General Insurance Individual Medishield
Critical Illness Policy
New India Assurance Mediclaim 2007 Policy
Personal Accident Policy
Oriental Insurance Bhavishya Arogya
Flight Coupon
Gramin Accident Insurance
Individual Mediclaim Policy
Janata Personal Accident Policy
Nagrik Suraksha Policy
Oriental Bank Mediclaim Policy
Overseas Mediclaim Business and Holiday
Overseas Mediclaim Employment and Study
Personal Accident - Individual
PNB - Oriental Royal Mediclaim Policy
Universal Health Insurance Scheme
Cholamandalam MS General Insurance Top Up Healthline
Hospital Cash
Critical Healthline
Individual Healthline
Individual Health
HDFC Ergo Critical Illness
Universal Sompo General Insurance Individual Health Insurance Policy
Individual Personal Accident Policy
Bharti AXA General Insurance Smart Health Insurance
Smart Health Critical Illness Insurance
Smart Health Essential Insurance
Smart Health High Deductible Insurance
L&T Insurance my:health Personal Accident Insurance
my:jeevika Personal Accident Micro Insurance

Last Updated on 08/08/2012

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