Individual Health Insurance Policy | Individual Health Coverage
Exclusions under Individual Insurance Plans
We shall not reimburse any claim amount for the following standard exclusions under individual plans:
- Act of self-inflicted injury attempted suicide or suicide.
- Any illness related directly to the consumption of Alcohol/Tobacco/Cigarettes, etc. or any sexually transmitted disease.
- Cosmetic or plastic surgeries or related treatment.
- Pregnancy, miscarriage, childbirth, maternity including C- section, abortion, or complications of any of these.
- All the treatments required due to participation in hazardous activities.
- Damage caused by a nuclear, chemical, or biological attack or weapons.
- Illness or injuries caused due to any breach of law by the insured.
Individual Covers: Eligibility, Claim Process, and Other Details
While the entry age of our wide-ranging individual plans may differ among plans, below are the standard eligibility criteria and claim process common across mediclaim for individuals
| Minimum Entry Age | 18 years |
| Maximum Entry Age | No upper age limit |
| Renewal | Lifelong renewability |
| Waiting Period |
|
| Tenure Options | 1/2/3 Years |
| Co-payment Clause | While buying or renewing the policy at the age of 61 years & above, customers will have the choice to include or exclude the co-payment feature, implying:
|
| Claim Options | Cashless and Reimbursement |
How to File a Claim?
Filing a claim under a health insurance plan for individuals is easy and quick. Remember, in case of an emergency hospitalisation, you need to intimate our claims department within 24 hours of hospital admission.If it is a planned hosptialisation, kindly intimate us 48 hours prior to the admission date. Here are the steps to follow under the cashless and reimbursement claiming processes-
| Cashless Claim Process | Reimbursement Claim Process |
|---|---|
| Step 1: Go to a listed in-network hospital. | Step 1: Submit your claim form along with other required documents. |
| Step 2: Fill out the proper forms at the insurance desk. | Step 2: You'll get an approval letter when your claim is verified. |
| Step 3: Send the completed form to our claim management team. | Step 3: Respond to queries raised by the claim management team. |
| Step 4: You'll get an approval letter when your claim is verified. | Step 4: Get approval from the claim management team. |
| Step 5: Respond to queries from the claim management team. You will receive communication about whether your cashless claim is approved or rejected within the standard TAT. | Step 5: Our claims team will contact you if there are specific reasons for rejecting your claim. |
Documents Required to File Health Insurance Claim
- A duly filled and signed claim form
- Insured person’s details like name, policy number, nature of the illness, address, etc.
- All the diagnostics and medical test reports
- Original payment receipts, hospital bills, and discharge summary papers
- Original pharmacy bills with prescriptions
- Doctor’s referral letter
- Police FIR and post-mortem report in case of personal accident
- Death certificate
Medical Insurance Plans for Individuals Vs. Family Floater Cover
Let us help you understand how an individual plan is different from a family floater cover based on the following factors:
| Factors | Individual Health Insurance | Family Floater Cover |
|---|---|---|
| Sum Insured | Under individual plans, the insured’s sum insured is intact for his own use and other family members may have their own limit of sum insured on an individual basis. | The entire family shares a common pool of sum insured. Each member or the whole family can utilise the sum insured entirely or partially. However, the shared amount keeps reducing everytime a claim is made by a member. |
| Premium | The premium depends on the age of the individual alone. | The premium depends entirely on the age of the oldest member in the plan. |
| Family Members | If elderly members are 60+ and already suffering from ailments, then you should opt for an individual cover for all the members, especially elders. | If you have a small family with young children, then a floater plan is a good option. |
Advantages of Buying Individual Health Insurance Online
In an effort to help you choose and buy best individual health insurance coverage, we have enhanced our digital portals with end-to-end support features and services, including the following facilities:
Secure Payment Modes
We back our digital portals with secure payment options, helping you complete the transaction from anywhere, any time.
Quick Chat Support
Our in-house claims and customer support team resolves all your policy-related queries instantly through our chat service.
Instant Premium Calculation
Our digital premium calculators help you estimate the policy’s cost while comparing premium rates against policies and benefits.
Convenient Policy Selection
You can easily study, evaluate, and compare individual health plans by accessing policy documents through our official website.
Value Added Services
While buying or renewing personal covers online, you can easily modify optional benefits like OPD, etc., to enhance the coverage.
Things to Keep in Mind While Buying Health Insurance for Individuals
Individual medical insurance gives you a financial cushion during a medical emergency and reduces monetary stress. Thus, it's essential to opt for a personal cover wisely. Consider these below things while buying it:
- Check the minimum age criteria to buy the policy.
- Look for a sufficient sum insured that meets your healthcare needs.
- Opt for the plan that costs you a lower premium and does not overburden your pocket.
- Check if there is a requirement for pre-medical tests to get the individual health policy.
- Go with an extensive coverage policy that includes in-patient hospitalisation, pre and post hospitalisation, ambulance, second opinion, alternative treatment, and more.
- Avail of add-on benefits such as no claim bonus, automatic recharge, global coverage, and international second opinion to enhance the coverage.
- Check the tax exemption eligibility under individual plans
Once approved, you will get the new health policy documents on your registered email address.
Disclaimer: Underwriting of claims for Individual health insurance is subject to terms and conditions.