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Individual Health Insurance

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What is Individual health insurance

Individual health insurance is a type of insurance policy that provides coverage for medical expenses, incurred by an individual. It is designed to help individuals, pay for healthcare expenses such as hospitalization, surgery, medical tests, and doctor visits.

Individual health insurance policies, can be purchased from insurance companies, and the premiums are usually determined based on factors; such as the individual's age, health condition, and medical history. This type of insurance is important for individuals, who do not have access to employer-provided health insurance or who wish to supplement their existing coverage.


What is Covered in Individual Health Insurance
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Inpatient hospitalization

This covers expenses for staying in the hospital, such as room charges, nursing care, and medicine.

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Outpatient services

This covers services that do not require a hospital stay, such as doctor visits, lab tests, and X-rays.

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Prescription drugs

This covers the cost of prescription medications prescribed by a doctor.

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Diagnostic tests and screenings

This covers medical tests such as blood tests, MRI, and CT scans.

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Emergency care

This covers expenses for emergency medical treatment such as ambulance services, emergency room visits, and urgent care visits.

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Add-On covers in Individual Health Insurance

Critical illness cover

This covers the expenses associated with the treatment of critical illnesses such as cancer, heart attack, and kidney failure.

Maternity cover

This covers expenses related to childbirth, including hospitalization, delivery, and prenatal and postnatal care.

Personal accident cover

This covers expenses related to accidental injuries, disability, or death caused by an accident.

Hospital cash benefit

This provides a daily cash benefit for hospitalization to cover additional expenses such as transportation and food.

No-claim bonus

This rewards policyholder who do not make a claim during the policy period by offering a discount on the premium for the next policy period.


What Is Not Covered in Individual Health Insurance

Pre-existing diseases

Most policies have a waiting period during which pre-existing medical conditions are not covered. This varies depending on the insurance company and policy.

Cosmetic treatments

Cosmetic procedures such as plastic surgery, hair transplant, and dental procedures are usually not covered unless they are medically necessary.

Alternative treatments

Treatments such as Ayurveda, Unani, and Homeopathy are not covered unless specified in the policy.

Non-medical expenses

Expenses that are not directly related to medical treatment, such as transportation costs, food, and accommodation, are usually not covered.

Self-inflicted injuries

Injuries that are self-inflicted, such as suicide attempts or injuries resulting from drug or alcohol abuse, are usually not covered.


Why do you need an Individual Health Insurance

Protection against unexpected medical expenses

An individual health insurance policy can provide financial protection against unexpected medical expenses. It can help you pay for medical bills and avoid the risk of incurring large debts.

Access to better healthcare

With an individual health insurance policy, you have access to a wider range of healthcare providers and facilities, including specialist doctors and hospitals that may not be covered by government health insurance schemes.

Coverage for pre-existing medical conditions

An individual health insurance policy can provide coverage for pre-existing medical conditions after the waiting period (in some conditions the waiting period can be waived off). This is important for individuals with chronic conditions who require ongoing medical treatment.

Tax benefits

Premiums paid towards individual health insurance policies are eligible for tax deductions under Section 80D of the Income Tax Act.

Peace of mind

Having an individual health insurance policy can provide peace of mind knowing that you and your family are covered in case of a medical emergency. It can also help you access healthcare services without worrying about the financial burden.


Key Highlights of an Individual Health Insurance policy

Sum Insured

This refers to the maximum amount that the insurance company will pay towards medical expenses during the policy period. The sum insured varies depending on the policy and the insurance company.

Premium

The premium is the amount that the policyholder pays towards the policy. The premium amount is determined based on factors such as age, health condition, and medical history.

Waiting period

Most policies have a waiting period during which pre-existing medical conditions are not covered. The waiting period varies depending on the policy and the insurance company.

Co-payment

Co-payment is the percentage of the medical expenses that the policyholder has to pay out of their own pocket. Some policies may have a co-payment clause that requires the policyholder to pay a certain percentage of the medical expenses.

Cashless hospitalization

Many individual health insurance policies offer cashless hospitalization, which means that the policyholder can get medical treatment without having to pay out of their own pocket. The insurance company settles the bill directly with the hospital, subject to the terms and conditions of the policy.


How To Buy Online Policy from PolicyLeader

1. Visit the PolicyLeader website

Go to the PolicyLeader website (www.policyleader.co.in) and select "Individual Health Insurance" from the list of insurance products.

2. Provide personal details

Fill in your personal details such as name, age, and contact information. You may also be required to provide details about your medical history.

3. Choose a policy

PolicyLeader offers a range of individual health insurance policies from various insurance companies. Review the policy details, coverage, and premium amounts to choose a policy that best meets your needs.

4. Compare policies

Use the comparison tool to compare policies from different insurance companies based on factors such as premium, coverage, and exclusions.

5. Customize your policy

You can customize your policy by adding or removing riders (add-on covers) to suit your specific needs.

6. Pay the premium

Once you have chosen a policy, pay the premium online using a debit card, credit card, or net banking.

7. Receive the policy documents

After the payment is confirmed, the policy documents will be emailed to you. The policy documents will contain all the details of your policy, including the coverage, exclusions, and terms and conditions.


How to file an Individual Health Insurance Claim

1. Notify the insurance company

As soon as you are aware of the need to file a claim, notify the insurance company by calling their customer service or through their website. Provide details such as policy number, name of the insured person, date of hospitalization, and reason for hospitalization.

2. Submit the claim form

Fill in the necessary details and submit it along with the required documents to the insurance company.

3. Provide necessary documents

The insurance company may require documents such as hospital bills, medical reports, discharge summary, prescription receipts, and diagnostic reports to process the claim. Ensure that you have all the necessary documents and submit them along with the claim form.

4. Wait for claim approval

The insurance company will review the claim and verify the documents submitted. If the claim is approved, the insurance company will reimburse the medical expenses as per the terms and conditions of the policy.

5. Cashless claims

If the insured person has opted for cashless hospitalization, the insurance company settles the bills directly with the hospital. However, ensure that the hospital is part of the insurance company's network and follow the necessary procedures for cashless claims.


Documents Required for Individual Health Insurance

  • Identity proof: PAN card, Aadhaar card, passport, voter ID, driving license, etc.
  • Age proof: Birth certificate, school leaving certificate, passport, Aadhaar card, etc.
  • Address proof: Aadhaar card, passport, driving license, utility bills, etc.
  • Medical reports: Reports related to pre-existing medical conditions, if any.
  • Income proof: Salary slips, ITR statements, bank statements, etc.
  • Policy application form: Filled and signed policy application form.
  • Passport-sized photographs: Recent passport-sized photographs of the policyholder.
  • Cancelled cheque: For policy premium payment through ECS.
  • Other documents: Any other documents as requested by the insurance company.

Why should you choose PolicyLeader for buying Individual Health Insurance

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Instant claim support

PolicyLeader offers instant claim support to ensure that the policyholders can receive timely assistance in case of any medical emergencies. They have a dedicated customer support team that is available round-the-clock to assist with claim-related queries and guide the policyholders through the claim settlement process.

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Schedule a home visit with our advisors

PolicyLeader provides the convenience of scheduling a home visit with their advisors to discuss the policy options, understand the individual's needs, and help them choose the best policy that suits their requirements. This service is particularly beneficial for those who are not comfortable with online transactions or prefer face-to-face interactions

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Customised 1:1 planning

PolicyLeader offers customized 1:1 planning to ensure that the policyholders get the best possible coverage as per their specific requirements. Their experienced advisors analyze the policyholder's needs, assess their risk profile, and suggest the most appropriate policy options that offer comprehensive coverage at affordable premiums.

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Multiple Insurers Under One Roof and Insurance Brokers in Gujarat and around the country

PolicyLeader has tied up with multiple insurers and offers a wide range of policy options under one roof. This ensures that the policyholders can compare and choose from the best policies from leading insurers. Additionally, they have a strong presence and experienced insurance brokers in Gujarat and around the country, providing personalized and professional service to the policyholders.

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