What Does Individual Health Insurance Cover?

As people begin to understand the importance of a medical insurance plan, they are also trying to increase their understanding and awareness of the different types of health insurance available to them. It is important to choose the right type of health insurance and focus on the scope and extent of the coverage before making the purchase.

Medical costs have been rising exponentially over the last two decades. Also, most medical situations come bundled with associated non-medical costs. Hence, it is important to understand the inclusions and exclusions of a policy before signing the dotted line.

Many people buy individual health insurance as it offers cashless health insurance coverage, but that is not all. Let us find out more about Individual Health Insurance and its inclusions in detail.

What are Individual Health Plans?

As the name suggests, an Individual Health Insurance Policy offers coverage to an individual. Different types of health insurance plans are available, like family plans, group plans, etc. When you buy individual health insurance, you get an individual sum assured that covers one person only. These plans usually offer coverage for various expenses associated with a medical emergency to an individual.

Inclusions of Individual Health Insurance

Here is a quick look at the individual healthcare coverage to help you understand the inclusions of the policy:

  • Expenses relating to hospitalisation. This is applicable when the policyholder is hospitalised for at least 24 hours and includes room rent, ICU charges, the cost of medicines, etc.
  • Pre- and post-hospitalization expenses. Numerous tests and doctor consultations can be required before or after surgery or any medical treatment requiring hospitalisation. Individual health coverage usually includes all these costs.
  • Some policies also include coverage for daycare procedures where the patient is hospitalised for a few hours and discharged in less than 24 hours.
  • In some cases, the doctor might recommend the patient receive treatment at home instead of being admitted to a hospital. Many individual insurance plans include coverage for these costs.
  • Ambulance charges can vary depending on the distance of the hospital from your home. Most individual health insurance plans cover the costs of emergency ambulance services.
  • India is a land of ancient medicine and healing schools like Ayurveda, Unani, Siddha, Homeopathy, and Yoga. Many patients turn to these alternative forms of treatment and do not get hospitalised. These treatments can be costly too. Many insurance policies cover such alternative treatment costs.
  • Many individual health insurance plans cover the costs associated with preventive health check-ups for the policyholder.

While we are talking about inclusions, it is important to understand the exclusions too.

Exclusions of Individual Health Insurance

An individual health insurance policy will not offer coverage under the following scenarios:

  • Self-inflicted injuries
  • Treatment for obesity or infertility
  • Any cosmetic treatment
  • Treatment for injuries caused due to participation in high-risk sports
  • Treatment of HIV AIDS
  • Congenital external anomalies, etc.

Remember, this is not an exhaustive list and neither standardised across insurers. Every insurance provider will specify the inclusions and exclusions in the policy document. Hence, before buying the policy, make sure that you read the policy wording carefully. This will help you understand the scope and extent of the cover and choose the right plan for your needs.

Summing Up

Before buying a policy, make sure that you analyse your health requirements and medical history (individual and family). Also, go through the list of network hospitals and look for the ones close to you, as you can avail of cashless hospitalisation only at these hospitals. Go through the policy documents and pay attention to any limits or sub-limits for compensation. Look at the claim settlement ratio and compare providers and plans before finalising one.

Good Luck!

Comments are closed.