' Reason Why Individual Health Insurance is a Must

why individual health insurance is mustYou may be doing everything right to stay healthy; like eating clean and exercising right. Even then, a medical emergency can arrive unannounced. Hospitalisation and treatment at such times could be a financial burden if you are not prepared. The answer to being prepared lies in health insurance. Although Health Insurance is a discretionary financial product, we highly recommend people to invest in their health policy, so as to avoid dipping into their savings to fund health emergencies.

Given the fact that healthcare costs are high due to medical inflation in India, the absence of health insurance can throw one’s financial balance and life plans off track. Statistical evidence proves that lack of health plans has resulted in disastrous economic consequences for families in India. According to a study conducted by the World Health Organisation, 31-47%[i] hospital admissions in India were financed either through the sale of assets or through loans. This is because merely 15% of the population in India has medical coverage under individual health insurance plans.

What do health plans cover?

A health plan is imperative and should be a must in every Indian’s portfolio as it covers the following medical expenses:

  • Pre-hospitalisation investigation costs such as medical tests and consultation fees of doctors
  • Cost of availing ambulance services
  • In-hospitalisation charges such as surgery costs, room charges and post-operative medication.
  • Post hospitalisation costs including doctors’ visits, post-operative care and medication.

Pre-existing Diseases

Individual health insurance plans provide coverage for pre-existing illnesses, but there’s a waiting period in place to avail claim for the same. In case you have an existing ailment at the time of applying for health insurance online or offline, you are required to submit a detailed medical report with a specific mention of the existing ailments. It is a good idea to check with your insurer on your chosen policy and the waiting period concerning existing illnesses before applying for an individual health insurance plan.

How does a health plan work?

Generally, individual health insurance plans are renewed on an annual basis. There are two ways you can claim benefits from health insurance. These include:

  • Cashless benefit
  • Reimbursement

CashlessCashless benefit:

As a policyholder of a health insurance plan, you have a wide choice of selecting a hospital (as per your convenience) from the network provided by your insurer and submit the claim intimation details to the selected hospital at the time of hospitalisation.

All hospital services covered under the policy are treated as cashless transactions. This is because the insurer pays the claim amount directly to the hospital. However, if any services do not come under the purview of the selected health plan, you may be expected to make a payment on specific services at the time of discharge.

Insurers like Reliance Health Insurance provide a cashless card as a part of the policy kit that comes with the individual health insurance plan. During emergencies, a hospital may request for a deposit that a cashless card cannot provide. However, you can claim reimbursement on the emergency deposit from the insurer.


In case you are admitted in a hospital which is not a part of your insurer’s network you can continue to claim the policy’s benefits. In such a scenario, you must settle all the bills paid, post your discharge from the hospital. Once you have completed all the formalities, you would need to submit the original documents along with the claim form to the insurer to claim benefits on health plans. On complete assessment of your claim request and the documents submitted, you will receive the amount, through a direct bank transfer into your bank account.

Presently, with changes in lifestyle and rise in medical costs as well as life expectancy, health insurance is imperative for all. Given the unpredictability in life, a health cover can offer you much-needed solace at the critical moment..

Source[i]: www.iosrjournals.org/iosr-jbm/papers/Conf.17037-2017/Volume-7/10.%2049-52.pdf

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Why Individual Health Insurance is a Must

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