Individual Health Insurance
Protect your health with a comprehensive individual mediclaim policy. Get cashless treatment at 10,000+ hospitals, coverage from ₹3 Lakh to ₹1 Crore, and tax benefits under Section 80D.
Your Health Deserves the Best Protection
Medical emergencies don’t come with a warning. With healthcare costs skyrocketing by 14% annually in India, a single hospitalisation can drain your life savings. Individual health insurance provides financial security by covering hospitalisation expenses, daycare procedures, pre and post-hospitalisation costs, and much more — so you can focus on recovery, not bills.
What Is Individual Health Insurance?
Individual health insurance (also called personal mediclaim) is a policy that covers a single person’s medical and hospitalisation expenses. Unlike family floater plans, the entire sum insured is exclusively available to you.
Key characteristics:
- Covers a single insured individual
- Sum insured ranges from ₹3 Lakh to ₹1 Crore+
- Includes hospitalisation, daycare, and ambulance charges
- Cashless treatment at network hospitals
- Tax deduction under Section 80D up to ₹25,000
- Lifelong renewability guaranteed by IRDAI
Why Is Individual Health Insurance Important?
Rising Healthcare Costs
Hospital bills in India have increased by 14% annually. A 3-day ICU stay can cost ₹2-5 Lakh. Health insurance absorbs these expenses completely.
Supplements Employer Coverage
Corporate health policies often have low sum insured and limited coverage. Personal mediclaim ensures protection even after job change or retirement.
Lifestyle Diseases on the Rise
Diabetes, hypertension, and cardiac conditions affect millions in India. Early health insurance means lower premiums and fewer exclusions.
Tax Benefits Under 80D
Save up to ₹25,000 in taxes annually (₹50,000 for senior citizens). Health insurance premiums are fully deductible under Section 80D of Income Tax Act.
Key Benefits of Individual Health Insurance
Cashless Hospitalisation
Get treated at 10,000+ network hospitals without paying upfront. The insurer settles bills directly with the hospital through TPA.
Ambulance Cover
Emergency ambulance charges up to ₹2,500 per hospitalisation are covered, ensuring you reach the hospital safely without worrying about transport costs.
Pre & Post Hospitalisation
Medical expenses incurred 30 days before and 60 days after hospitalisation — including diagnostics, consultations, and medicines — are fully covered.
Daycare Procedures
570+ daycare procedures like chemotherapy, dialysis, cataract surgery, and angioplasty that don't require 24-hour hospitalisation are covered.
No Claim Bonus (NCB)
Earn a cumulative bonus of up to 50-100% on your sum insured for every claim-free year, rewarding you for staying healthy.
Lifelong Renewability
IRDAI mandates lifelong renewability for all health insurance policies, meaning your coverage can never be terminated due to age or claims.
Features of Individual Health Insurance Plans
- Room rent coverage — single private AC room or no sub-limits on select plans
- Initial waiting period of 30 days (except accidents) for new policies
- Pre-existing disease waiting period of 2-4 years depending on the insurer
- Co-payment clause — you pay 10-20% of the claim in some plans
- Restoration benefit — sum insured restored if exhausted during the policy year
- Free annual health check-up after claim-free years
- AYUSH treatment (Ayurveda, Unani, Siddha, Homeopathy) covered in most plans
- Domiciliary hospitalisation for treatments at home when hospital is unavailable
- Organ donor expenses covered in many comprehensive plans
- Mental healthcare coverage as mandated by the Mental Healthcare Act 2017
Coverage Details — What's Included?
Types of Individual Health Insurance Plans
Basic Mediclaim Policy
Entry-level plans with ₹3-5 Lakh sum insured covering hospitalisation, daycare procedures, and ambulance charges. Ideal for young, healthy individuals on a budget.
Comprehensive Health Plan
High sum insured (₹10-50 Lakh), no room rent sub-limits, restoration benefit, worldwide emergency cover, and OPD expenses. Best for professionals and families.
Top-Up & Super Top-Up
Affordable add-on plans that kick in after a deductible threshold (e.g., ₹5 Lakh). Best used to enhance existing employer or base policy coverage.
Hospital Cash / Daily Allowance
Pays a fixed daily amount (₹1,000-5,000/day) during hospitalisation for incidental expenses like food, travel, and attendant charges.
Eligibility Criteria
- Entry Age: 18 years to 65 years (some plans cover up to 80 years)
- Residency: Must be a resident of India with a valid address proof
- Medical Underwriting: Pre-medical tests may be required for age 45+ or high sum insured
- Renewal: Lifelong renewability guaranteed regardless of age or claims
- Pre-existing Conditions: Covered after a waiting period of 2-4 years
- Sum Insured Options: Available from ₹3 Lakh to ₹1 Crore+ depending on the insurer
Documents Required for Health Insurance
📋 For Buying Policy
- Aadhaar Card / PAN Card / Passport
- Recent passport-size photograph
- Address proof (Aadhaar/Utility bill)
- Age proof (Birth certificate/10th marksheet)
- Medical reports (if age 45+ or high SI)
🏥 For Filing a Claim
- Duly filled claim form from the insurer
- Hospital discharge summary
- Original hospital bills and receipts
- Diagnostic and lab test reports
- Pharmacy bills and prescription copies
How to File a Health Insurance Claim
Step 1: Intimate the Insurer
Notify your insurer or TPA within 24-48 hours of hospitalisation. For planned procedures, intimate 48-72 hours in advance for pre-authorisation.
Step 2: Submit Pre-Auth Form
For cashless claims, the hospital submits a pre-authorisation form to the TPA. Approval is typically received within 2-4 hours.
Step 3: Get Treatment
Receive treatment at the network hospital. The insurer settles the bill directly with the hospital for cashless claims.
Step 4: Submit Documents
For reimbursement claims, submit all original bills, discharge summary, and claim form within 15-30 days of discharge.
Step 5: Claim Settlement
The insurer processes your claim within 7-30 days. For cashless, no action needed. For reimbursement, amount is credited to your bank account.
Common Exclusions in Health Insurance
- Pre-existing diseases during the initial waiting period (2-4 years)
- Cosmetic and aesthetic treatments (unless medically necessary)
- Self-inflicted injuries and suicide attempts
- Dental treatments (unless requiring hospitalisation due to accident)
- War, nuclear hazards, and participation in hazardous activities
- Treatments related to substance abuse and alcohol addiction
- Weight management and obesity surgery (excluded in basic plans)
- Spectacles, contact lenses, and hearing aids
Why Choose FMC Insurance Bazaar?
Frequently Asked Questions
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