Buying Individual Health Insurance: 10 Key Things to Know

Posted on: Nov 25, 2024 | 3 mins | Written by: HDFC ERGO Team

Buying Individual Health Insurance: 10 Key Things to Know

Choosing an individual health insurance plan is like mapping out your financial portfolio. There are a number of factors to bear in mind because if you do suffer a medical setback, the bills are astronomical in most cases.

Health insurance plans are designed to help you seek medical advice whenever the need arises, rather than when you have the money to cover the costs. The benefits of individual Health insurance plans extend beyond just surgeries. You can pay for diagnostics, dental care, and even pre and post-hospitalisation care. Therefore, choosing the right plan for you is pivotal.

10 Most important things to know which are not overlapping in nature

You need to take a closer look at the benefits of individual health insurance plans and map out the possible setbacks to your medical conditions when choosing the type of policy. Here are the most important aspects to consider when picking your health insurance policy and the subsequent add-ons:

1. The total sum insured and the premiums to pay each month

Everything about health insurance boils down to the sum insured. If the total sum insured is too low, then upon encountering medical emergencies, you will have to pay a lot of money from your pocket. That can be very hectic, especially when battling health issues.

Check the sum insured and the subsequent premium plan that you need to pay to receive that claim. Compared to the benefits of individual health insurance plans with a higher sum insured, a slightly higher premium is a drop in the bucket when it comes to medical emergencies.

2. Limits on room rent

There are different types of policies available. For some, the sum insured is targeted towards the diagnostics and procedures. This is because some people prefer more coverage for their illness and medication, especially when they have chronic disorders.

However, if you are required to be hospitalised, you will need to book a room or at least a bed. The costs associated with room charges can be quite high. Therefore, you should look for room rent coverage with your health insurance.

3. Pre- and post-hospitalisation care

Several procedures require observation and care before you are admitted to the hospital. Pre-surgery procedures can also cost a lot of money. Health insurance plans that cover these charges ease your mind when opting for treatment. You don’t have to worry about money because you paid your premiums on time and the health insurance provider will take care of your expenses.

Similarly, after being released from the hospital following a procedure, you will need to take care of yourself as per the medical practitioner’s instructions. You may even require a nurse or caretaker for a nuanced approach to your recovery. Such charges can also drain your bank account. It is best to have an individual health insurance plan that helps cover these expenses.

4. Coverage for treatments conducted within 24 hours (daycare)

Not all medical procedures require you to be in the hospital for days. Some procedures can be completed in a few hours, and are referred to as day care. Based on the results from your diagnostics, the medical professionals may conduct a quick surgery or simply an invasive examination with treatments. You are free to leave the hospital after that.

While these procedures may not be major, the physical consequences on your health and bank account are quite real. Therefore, you need to ensure that daycare is available with your health insurance plan.

5. Coverage for alternative treatment options

In this day and age, not everyone is comfortable with Western medicine and allopathic treatments. Some still prefer the natural means of treatment such as Homeopathy, Ayurveda, Siddha, and Unani methodologies. In fact, in some cases, these ancient practices show better results in treatment.

The benefits of the individual health insurance plan you choose must cover your expenses under AYUSH treatments. That way, you are free to choose your treatment plans without any restrictions.

6. What is included and excluded from the health insurance plan

You need to check what benefits of individual health insurance plans are covered in your policy. Almost all health insurance policies are not obligated to pay for claims when the insured partakes in self-harm, i.e., suicidal attempts. Also, if you opt for cosmetic procedures such as reducing obesity, plastic surgery, etc. or want to treat a venereal disease, also known as STD, health insurance does not need to cover that.

This is not a matter of exclusion, rather that these are not medical emergencies, and they can be avoided with necessary precautions. Health insurance plans are designed to help individuals in their absolute time of need to take care of their health without having to postpone necessary treatments. Always check the inclusions and exclusions of your individual health insurance plan to ensure that it covers all the necessities.

7. The wait time before a claim can be filed

Another important aspect to consider is the waiting period. When applying for health insurance, you will need to submit reports of your health checkups. If you have a preexisting disease, you may not be able to file a claim for treatments up to a certain time. Your health insurance agreement will have a pre-mentioned time frame wherein you can avail of claims for emergency services but not to treat the preexisting ailment or disease. You have to wait for the period to end and then you can claim the benefits of individual health insurance plans for those long-awaited treatments.

8. Add-ons available for the individual health insurance policy

Much like any form of insurance, health insurance also comes with optional riders. These riders, commonly known as add-ons, are extra benefits of individual health insurance plans.

Riders are beneficial in several regards, including extra coverage, claims for particular incidents, accidents, ailments, etc. You can even get riders for dental checkups, room rent (if it is not a part of your preliminary health insurance plan) bonuses, etc. Check for the kind of add-ons available with your individual health insurance plan and how they affect the premium payment plans.

9. Cashless coverage at network hospitals

You will need a wide hospital network to be covered in your health insurance plan. You never know where you will be at the time of an emergency, and it is pivotal that you can seek medical attention at the earliest at the nearest hospital or nursing home.

While government hospitals are not preferable, those are sometimes the only options, especially when visiting rural areas. Similarly, if you meet with an accident in an urban setting, you will need to rush to the nearest hospital without wasting time in traffic.

Check the hospital network associated with the individual health insurance plans. Choose the policy with the widest network but one that also doesn’t drill a hole in your bank account. Also, verify the clauses for cashless transactions. This is applicable if you need to get admitted right away but do not have the money on you. The hospital will check with your insurance provider and start diagnostics and treatments right away.

10. Benefits of No Claim Bonus

If you do not claim your health insurance during the tenure of your plan, don’t fret. Check your policy details beforehand for No Claim bonuses. It may be included or you can opt for add-ons. It ensures that in case of no claims filed during the tenure, your money paid in premiums isn’t a total waste. Instead, when renewing the health insurance policy, your sum insured will be radically increased or you may avail of other benefits.

Conclusion

The objective of individual health insurance is to ensure that in cases of medical emergencies, you are covered to pay for all the relative requirements. Be it your room charges, pre and post-hospitalisation care, diagnostics, or just about anything else, the policy should correspond to your particular needs.

While it is a good idea to get room charges covered under health insurance, it is not a necessity for everyone. Check what your priorities are and make sure that when you make a claim, you can reap the absolute benefits of individual health insurance plans.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

Why it is a good idea to opt for an individual health insurance plan after 40?

What are the Benefits of Individual Health Insurance?

How does having pre-existing diseases impact your individual health insurance premiums?

Reasons for your individual health insurance plan to get rejected

7 Things To Consider While Buying Health Insurance In 2024