Individual Health Insurance, also called Personal Health Insurance, is a policy that you buy on your own instead of getting it through an employer or a government scheme. Unlike group health plans, individual policies are tailored to your personal needs and offer financial protection in case of hospitalisation, illness, or accidents. You can select the coverage amount, sum insured, and add-ons that best match your health needs and budget for yourself and your family.
Health plays a vital role in your overall happiness and well-being. Since everyone may face health issues at some point in life, it is important to be prepared. In today’s world, where serious illnesses like cancer, tuberculosis, and heart attacks are increasingly common, having a health insurance plan has become a necessity.
The various advantages offered by Individual Health Insurance plan are as follows-
Every insurer has a network of hospitals. When you, as a policyholder, get admitted to any of these network hospitals, you can avail the cashless hospitalisation facility. This means the insurer directly settles the medical bills with the hospital under your cashless health insurance policy.
Under this policy, you also get financial coverage for expenses related to pre- and post-hospitalisation. This includes costs such as diagnostic tests and medicines required before or after hospital admission. The number of covered days may vary from one insurer to another. With our policy, pre-hospitalisation expenses are covered for up to 60 days, and post-hospitalisation expenses are covered for up to 90 days after discharge.
If you do not make any claim during the policy period, you become eligible for a No Claim Bonus in your health insurance. This bonus can be used to reduce or pay off the premium for your next policy renewal.
Another key benefit of health insurance is the tax advantage it offers. The premium you pay for the policy can reduce your taxable income, helping lower your overall tax liability. Individual health insurance qualifies for tax benefits under Section 80D of the Income Tax Act, which allows a deduction of up to ₹25,000 on the premium paid. As per Section 80D of the Income Tax Act, expenses incurred on health check-ups are eligible for a deduction of up to ₹5,000. This means that along with the premium paid, the cost of medical check-ups can also help reduce your tax liability by up to ₹5,000.
Under this policy, you can also claim tax benefits on medical tests. An individual health insurance policy provides comprehensive coverage, including expenses for medicines, drugs, and medical procedures. With all these benefits combined, it not only supports your preventive healthcare but also ensures financial security during medical emergencies. So, buy individual health insurance and reap all the benefits.
| Key Features | Benefits |
|---|---|
| Platinum Plan | Super cumulative bonus of 50% per claim free year |
| Recharge Benefit | To take care of claims where the claim amount exceeds your sum insured |
| Multiple Sum Insured | Enjoy the flexibility to choose between 3 Plans variants along with the Sum Insured options ranging from 1.5 Lakh to 1 crore. |
| Covers Extended Family | This policy covers extended family members including parents, in-laws and siblings, on an individual basis. |
| Covers Ayurvedic and Homoeopathic Treatment | Under the Gold and Platinum Plans, in-patient hospitalisation expenses up to ₹20,000 are covered when treatment is taken at a recognised Ayurvedic or homoeopathic hospital, provided the hospital stay is at least 24 hours. |
| Covers Daycare Procedures | This policy covers medical expenses incurred during the treatment of listed daycare procedures or surgeries. |
| Convalescence Benefit | You will be eligible for a benefit payout of upto Rs 7500 annually, in case of continuous hospitalisation for a period of 10 days or more and provided that your hospitalisation claim is admissible. |
| Bariatric Surgery Cover | Bariatric surgery is covered under medical advice, subject to certain terms and conditions. |
| Sum Insured Reinstatement | If you completely exhaust your sum insured along with the cumulative bonus (if any) during the policy year, we will reinstate the same. |
| Covers Pre and Post Hospitalisation | This policy covers pre and post hospitalisation expenses up to 60 days and 90 days respectively. |
| Covers Road Ambulance Expenses | This policy covers ambulance expenses incurred upto Rs. 20,000 during per policy period |
| Covers Organ Donor Expenses | This policy covers expenses towards organ donor’s treatment for harvesting of the donated organ. |
| Daily Cash Benefit | A daily cash benefit of ₹500 per day is provided for accommodation expenses of one parent or legal guardian staying with a minor insured under the policy. This benefit is available for up to 10 days per policy year, for each admissible claim. |
| Maternity/New Born Baby Cover | Under the Gold and Platinum Plans, maternity expenses and medical costs for the treatment of a newborn baby are covered, subject to specific terms and conditions. |
Buying a Personal Health Insurance policy online offers several advantages:
Convenience: Easily shop for and compare plans from multiple insurers at your own pace, anytime and from anywhere.
Comparison Tools: Make use of online comparison tools to easily evaluate coverage options, features, and premiums in one place.
Time-Saving: Skip lengthy agent visits and complete the application process efficiently.
Potentially Lower Premiums: Buying insurance online can sometimes result in lower premiums because insurers save on administrative and operational costs.
Paperless Process: Experience a quick and eco-friendly process with digital applications and policy documents.
The process of applying for an individual health insurance policy involves the following steps:
Log on to the insurance company’s website.
Click on the button advertising, “buy health insurance.”
Enter all the details like name, date of birth, city of residence, email Id, annual income, etc. Once the details are filled click on the “Submit” button.
Thereafter, a health insurance plan that is best suited to your requirements will be displayed.
Select the sum insured and the tenure that you require.
Once, you know how much premium you will require to pay for the given sum insured, click on “continue buying process.”
To process your purchase, a customer service representative will get in touch with you.
Finally, make an online payment through your debit card/credit card/bank account, etc.
If you prefer the offline buying process, you can visit the insurance company’s branch, where you can get all the information regarding the benefits, features and the premium amount of your individual health insurance policy.
The first step to file a claim is to inform the insurance company. For this, you can contact the company on their toll-free number.
Cashless Claims
At the time of hospitalisation, you need to submit the claim form provided by the hospital, duly filled. You can also download this form from the insurance company’s website. The hospital will then forward your medical reports along with the completed claim form to the insurance company.
If the claim is approved, the hospital is directly paid by the insurance company as per your eligible sum insured.
Reimbursement Claims (At Non-network Hospitals):
Post-hospitalization, you must submit the filled up claim form to the insurance company along with receipts and bills of medical treatments, reports, etc.
In case of claim approval, the insurance company will reimburse you based on your eligible sum insured.
Exclusions refer to situations, diseases, or conditions that are not covered under a health insurance policy. While individual health insurance provides broad coverage for many medical treatments, it also has certain limitations. This means some illnesses and conditions are excluded from coverage.
Some Standard Exclusions Include -
• Self-inflicted injury
• Injuries due to participation in high-risk activities like kayaking, skydiving, etc.
• Substance Abuse/Alcohol/Narcotics
• Injuries or illness due to war or nuclear attacks
• Breach of law/criminal activity
Please Note: This is just an indicative list. Check your policy wording to understand the exact exclusions under your policy.
In addition to standard exclusions, health insurance plans also have a predefined time period during which certain medical conditions or treatments are not covered. This is known as the waiting period. You can raise a claim for these conditions only after the waiting period has been completed.
Individual health insurance is best suited for:
• Individuals who wish to benefit from the comprehensive sum insured instead of floating sum insured.
• Individuals with greater health risks.
• Individuals whose family members are already insured.
• Individuals who are looking for higher protection than a family floater health policy.
• Individuals seeking health insurance that can be renewed without concern for the maximum age limit.
Generally, you can file multiple claims under an individual health insurance policy. However, the total coverage is limited to the sum insured and the scope of the policy. In other words, you can make unlimited claims during the policy year, but the insurer will cover expenses only up to the sum insured.
The premium paid for health insurance in your name, or for your spouse, parents, or dependent children, is eligible for a tax deduction under Section 80D of the Income Tax Act, 1961, up to ₹25,000.
At the time of policy renewal, you can easily add extra covers to expand your existing coverage beyond the base policy. Simply click on the renewal link, select the add-on benefits you want, and make the payment online.
Yes OPD treatment is covered under your health insurance policy at an additional premium. It is an add-on that covers doctor consultation fees, prescribed medicines and diagnostics.
SBMFA Insurance Broking Private LTD
IRDAI License No : 1137
IRDA Direct Broker Code : IRDA/DB 1243/2025
Valid till : 22/01/2029
CIN : U66220RJ2025PTC099741
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