| What is Individual Health Insurance? Individual health insurance is a health policy that covers just one person: you. It’s your personal safety net for medical emergencies, offering dedicated coverage that isn’t shared with anyone else. No matter if you’re self-employed, in between jobs, or seeking a plan that’s fully yours, this is a wise choice to secure your health and finances. |
Individual health insurance is a policy that pays for the medical expenses of a single person. Unlike a family floater plan where the sum insured is shared, this policy ensures the full sum insured is reserved only for you. For example, if you buy a plan with a ₹15 lakh cover, the entire amount is available exclusively for your treatments. It works best for young professionals, self-employed individuals, and senior citizens who want independent, dedicated coverage.
Still not sure what individual health insurance is? Talk to Ditto’s expert advisors today and get unbiased, personalised guidance, absolutely free.
Types of Health Insurance Plans in India
Health insurance in India comes in different forms, each designed to meet specific needs. The right choice depends on whether you are insuring yourself alone or extending protection to your family. Understanding the main types of plans can help you make a more informed decision.
- Individual Health Insurance: This plan covers a single person, offering financial protection for hospitalisation and treatments. Since the full sum insured is dedicated to one individual, it can be a good option for young professionals, self-employed individuals, or senior citizens who prefer independent coverage.
- Family Floater Health Insurance: With this plan, a single sum insured is shared among all family members under one policy. It is often more cost-effective than buying separate plans for each member. However, if one member uses a large portion of the cover, the remaining balance for others may be limited.
- Multi-Individual Health Insurance: In this plan, each family member receives a separate sum insured under one combined policy. This ensures that one person’s claims do not affect another’s coverage. It can be a balanced choice for families with different health needs, and insurers may also offer discounts on such plans, though usually smaller than those on family floater policies.
How to Choose an Individual Health Insurance Plan?
Instead of going by brand names alone, it’s important to check whether the policy offers certain must-have features:
- Adequate Sum Insured: In metro cities, hospitalisation costs for a single major surgery can easily cross ₹5–7 lakh. That’s why experts recommend choosing a policy with at least ₹10-15 lakh coverage if you live in cities like Mumbai, Delhi, or Bangalore. If you’re older or have specific health needs due to pre-existing conditions, you may need even higher coverage.
- Coverage for Day-care, AYUSH, and Related Treatments: A good plan should cover day-care procedures like cataract surgeries, dialysis, or chemotherapy that need less than 24 hours of hospitalisation, along with modern treatments such as robotic surgeries and organ transplants. It should also include AYUSH and domiciliary care, plus at least 30 days of pre-hospitalisation and 60 days of post-hospitalisation expenses for tests, medicines, and follow-ups.
- Low Waiting Period for Pre-existing Conditions: If you already have conditions like diabetes, hypertension, or thyroid issues, you’ll want a policy that covers these sooner rather than later. Most insurers have a waiting period of 1–3 years, but some plans let you reduce this with add-ons.
- Bonus and Restoration Benefits: Traditionally, insurers like HDFC ERGO Optima Secure rewarded policyholders with a No-Claim Bonus (NCB) when no claims were made during the policy year, usually by increasing the sum insured at no extra cost. For example, a ₹10 lakh plan could grow to ₹12–15 lakh over a few years of no claims. However, many modern comprehensive plans like Care Supreme now offer this bonus regardless of whether you make a claim or not, ensuring your coverage continues to grow steadily: ₹10 lakh can become ₹15 lakh and even ₹20 lakh over time. Additionally, many plans like HDFC Optima Secure, Care Supreme, ICICI Lombard Elevate, include a Restoration Benefit, where the sum insured is automatically refilled if it gets used up.
The best policies allow unlimited restorations in a year, not just for different illnesses but even for the same illness, and trigger restoration on both partial and complete exhaustion of coverage. This feature ensures you always have a financial safety net, no matter how many times hospitalisation occurs in a year. - No Hidden Limits: Always verify that the policy does not contain restrictive clauses, such as room rent limits, disease-wise sub limits, or mandatory co-pay clauses. These conditions can significantly reduce the actual benefit you receive, even if your sum insured looks adequate on paper.
Individual Health Insurance Plans That Make Ditto’s Cut
Choosing the right health insurance plan can feel tricky because each insurer highlights different features. To make things easier, here’s a look at some popular individual health insurance plans in India.
| Before we discuss the list, here’s how we decide what plans to feature. At Ditto, every health plan goes through our six-point evaluation framework. It doesn’t mean these are the only good plans, but that they stand out after being scored across all six pillars. You can learn more about how we evaluate health insurance plans here. |
| Plan Name | Key Highlight |
|---|---|
| HDFC Optima Secure | Offers up to 4X coverage growth over time, with automatic restoration of the sum insured |
| Care Supreme | ₹5L–₹1Cr coverage, wide hospital network, and flexible add-ons like OPD & maternity |
| Niva Bupa ReAssure 2.0 | Unlimited reinstatement of the base sum insured for life after the first claim |
| Aditya Birla Activ One Max | High coverage for seniors, modern treatments, and wellness rewards |
| ICICI Lombard Elevate | New-age plan with unlimited sum insured option and customisable riders. |
Estimated Annual Premiums for a ₹15 Lakh Sum Insured (Individual Plan)
When choosing health insurance, the premium you pay largely depends on your age, insurer, and location. To give you a sense of how premiums change with age, here’s an estimate for a ₹15 lakh individual health insurance plan across some of the most popular insurers:
| Age | HDFC Optima Secure | Care Supreme | Niva Bupa ReAssure 2.0 | Aditya Birla Activ One Max | ICICI Lombard Elevate |
|---|---|---|---|---|---|
| 25 | ₹14,060 | ₹15,359 | ₹11,864 | ₹11,458 | ₹12,756 |
| 35 | ₹15,865 | ₹17,208 | ₹13,916 | ₹12,705 | ₹14,537 |
| 45 | ₹18,430 | ₹20,949 | ₹17,251 | ₹19,096 | ₹20,152 |
| 55 | ₹37,620 | ₹40,515 | ₹30,863 | ₹32,548 | ₹32,723 |
| 65 | ₹64,933 | ₹69,980 | ₹54,182 | ₹62,705 | ₹55,574 |
Note: Premiums shown above are calculated for non-smoker individuals opting for a ₹15 lakh sum insured under individual health insurance plans. Rates may vary based on city, medical history, and optional add-ons, which are exclusive of GST.
Planning to buy insurance soon? This could be the best time of the year with 0% GST on life & health premiums. Check out our exclusive guide to know how the GST slash affects new policies and renewals.
Benefits of Buying an Individual Health Insurance Policy
Here are the key benefits of choosing an individual health insurance plan over a family floater or corporate cover.
1. Dedicated Coverage
Your coverage stays untouched, no matter who else makes a claim. For example, with a ₹10 lakh plan, you alone can access the full amount whenever needed. Perfect for those who value complete financial independence in healthcare.
2. Tailored Protection
Individual plans allow you to customise coverage with add-ons. Depending on your health needs and life stage, you can include riders like:
- People with pre-existing conditions like diabetes or hypertension can opt for a PED rider to reduce or skip the waiting period. An OPD rider covers routine checkups and medicines, while chronic care riders offer long-term disease management support.
- International coverage
3. Financial Security
Medical inflation in India is rising at 14% annually, nearly double the general inflation rate of 6–7%. A single hospitalisation for a surgery or critical illness can easily cost ₹5–10 lakh. Without insurance, this could drain your savings or force you into debt. An individual health plan acts as a safety net, protecting your finances from sudden shocks.
5. Tax Savings
The premiums you pay for your health insurance qualify for deductions under Section 80D of the Income Tax Act under the old regime. You can claim up to:
- ₹25,000 per year (for self, spouse, and children)
- ₹50,000 per year (if covering senior citizen parents)
This means health insurance not only protects your health but also helps reduce your tax outgo.
6. Lifetime Renewability
Most individual retail policies have lifetime renewability, including the ones mentioned above. This ensures that once you buy a plan, you can keep renewing it every year, even when you’re 70 or 80 years old. That’s especially important because medical risks and expenses are highest in old age, when you’ll need it the most.
An individual health insurance plan offers personalised protection, financial stability, and long-term peace of mind. It’s not just an expense: it’s an investment in your health and future security.
How Much Coverage Do You Need in Your Individual Health Insurance Plan?
Unfortunately, there’s no one-size-fits-all answer. The right sum insured depends on factors like your age, lifestyle, family history, and the city you live in.
Choosing too little coverage may leave you paying hefty bills from your own pocket, while choosing too much could mean paying unnecessarily high premiums.
Ditto’s Take: Recommended Coverage by Age Group
- Young Professionals (20s–30s): ₹10–15 lakh: At this stage, health risks are relatively low, but medical emergencies can still happen, like accidents, dengue, or unexpected surgeries. A ₹10–15 lakh plan is usually enough, especially if you live in a smaller city.
Example: A minor surgery or a 5-day hospitalisation in a metro can cost ₹3–6 lakh. Having a ₹10 lakh cover ensures you’re not dipping into savings. - Middle-aged Adults (40s–50s): ₹15–25 lakh: As you grow older, the chances of developing lifestyle diseases like diabetes, hypertension, or heart conditions increase. Treatments for these illnesses are expensive and often recurring. A ₹10–20 lakh plan provides a comfortable buffer.
Example: A cardiac procedure in a metro can cost anywhere between ₹8–15 lakh. Without adequate coverage, this can wipe out savings in one go. - Senior Citizens: ₹20 lakh or more: Healthcare costs are highest in this stage of life. Multiple hospital visits, age-related illnesses, and chronic treatments make it essential to have higher coverage. Ideally, aim for ₹20 lakh or more. If the premiums feel too high, consider super top-up health insurance; it’s a cost-effective way to increase your total coverage.
Example: Cancer treatment can cost upwards of ₹20–25 lakh in private hospitals. Having a strong base plan plus a super top-up ensures you’re well-protected.
Eligibility Criteria for Individual Medical Health Insurance
Most insurers keep the eligibility criteria straightforward, but it’s important to know the details before you buy a policy. Here are the key factors:
1. Entry Age
- For adults, the entry age usually starts from 18 years.
- For children, many insurers allow coverage from as early as 3 months, provided at least one parent is insured under the policy.
- Some policies even offer newborn coverage from Day 1 as part of maternity benefits, though this often comes at an additional cost.
Buying early means lower premiums, fewer medical checks, and shorter waiting periods.
2. Medical Tests
- Most insurers require a pre-policy medical test if you are above 55–60 years, or if you have certain pre-existing conditions. In case you do not qualify after the test, your premium is refunded after deducting the cost of the medical examination.
- These tests usually include blood sugar levels, blood pressure, ECG, and other routine health check-ups.
- In some cases, insurers may waive medical tests if you have no declared conditions and fall within a younger age bracket.
These tests help insurers assess your health risk. If results show existing health issues, your premium may be slightly higher, or some conditions may come with exclusions or longer waiting periods.
3. Pre-Existing Diseases (PEDs)
- Health conditions you already have (like diabetes, thyroid, or hypertension) are called pre-existing diseases.
- Almost all insurers cover these, but only after a waiting period of up to 3 years, depending on the policy.
- Some modern plans offer add-ons to reduce waiting periods, which is useful if you want quicker access to coverage.
If you already have a condition, check the waiting period carefully so you know when you’ll actually be covered.
| Pro Tip: Healthcare costs and insurance premiums vary by location. A surgery that costs ₹3 lakh in a Tier-2 city might be ₹7–10 lakh in a metro. Since the location of residence matters, Tier-1 cities have higher premiums than Tier-2 or lower. It’s wise to opt for at least ₹10–15 lakh coverage if you live in metros like Mumbai, Delhi, or Bangalore. |
Ditto’s Take
At Ditto, we believe individual health insurance works best for single people. But once you’re married, it usually makes more sense to convert your individual plan into a family floater. It’s advisable to increase the coverage, as the sum insured will now be shared between two people.
The reason is simple. Family floaters are more cost-effective and much easier to manage. Instead of juggling between two separate policies, a couple can maintain a single plan that covers both, ensuring convenience and continuity under one product.
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Frequently Asked Questions (FAQs)
Do I need an individual health insurance policy if I already have employer-provided health insurance?
Yes. Employer-provided health insurance is helpful, but it ends when you change jobs or retire, and often the coverage is limited. An individual plan ensures continuous, independent protection that stays with you for life.
Can I add my family members to individual health insurance policies?
Yes, an individual plan can usually be converted into a family floater by adding spouse or kids to it; it is usually allowed at renewals, and the insurer does a fresh underwriting evaluation for each member based on their age and health. Premiums also go up proportionately.
Does an individual health insurance plan cover pre-existing diseases?
Yes, but only after you complete the waiting period, which usually ranges from 1 to 3 years, depending on the insurer. Some plans also offer add-ons to reduce this waiting period.
Can I port my individual health insurance policy to another insurer?
Yes. IRDAI allows you to port to another insurer at renewal without losing waiting period benefits. Apply 30–45 days before renewal. The new insurer will assess your age, health, and claims before approval.
Can I increase my individual sum insured amount?
Yes, usually at renewal. Fresh medical tests may be required, and new waiting periods apply to the increased amount. Existing cover continues, but if you’ve been diagnosed with a major illness, the insurer may decline the request.
How is an individual health insurance plan different from a family floater plan?
In an individual plan, the entire sum insured is reserved for one person. In a family floater, the sum insured is shared among all covered members, which may reduce availability if one person uses a large portion of it.
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