Individual health insurance has evolved into a critical tool for safeguarding one's health and financial stability in today's world. With rising healthcare costs, having access to comprehensive health coverage that includes full hospitalisation benefits and specialist consultation is no longer a luxury but a necessity. Individual policies are particularly useful for those who want personalised healthcare benefits without being tied to group or corporate plans.

What is individual medical insurance?

Individual medical insurance is a health insurance plan purchased by a person to cover their own medical expenses. Unlike group insurance offered by employers, this type of plan is tailored to meet the specific needs of an individual. It includes coverage for hospital stays, doctor consultations, surgeries, diagnostic tests, and in some cases, outpatient department (OPD) expenses.

This type of insurance is particularly useful for self-employed individuals, freelancers, or anyone not covered under a group health scheme.

Key features of individual medical insurance plans

Full hospitalisation coverage

One of the main attractions of Individual medical insurance is comprehensive hospitalisation cover. This includes:

• In-patient hospitalisation: Covers room rent, ICU charges, nursing fees, and consultation charges.
• Pre- and post-hospitalisation expenses: Most plans reimburse expenses for diagnostics and medicines incurred before and after hospitalisation.
• Day-care procedures: Modern medical technology allows many surgeries and treatments without a 24-hour stay. These are covered under day-care procedures.
• Ambulance charges: Emergency transport to the hospital is usually included.
• Cashless facility: If admitted to a network hospital, you can access cashless treatment where the insurer settles the bill directly.

Specialist consultations

Access to specialists such as cardiologists, dermatologists, neurologists, and orthopaedics is increasingly necessary for early detection and timely treatment. Many best health insurance plans now cover specialist consultations, either through OPD cover or as part of regular in-patient benefits.

Some plans allow multiple consultations annually without needing hospital admission. These are particularly useful for chronic conditions or routine health monitoring.

Outpatient department (OPD) cover

Many individual policies include OPD benefits, which offer:

• Coverage for GP and specialist consultations
• Diagnostic tests like bloodwork, ECG, MRI, and X-rays
• Pharmacy expenses
• Minor treatments like wound dressing, fractures, etc.
• Dental and ophthalmic consultations

Some leading insurers offer OPD as a built-in benefit, while others provide it as an add-on at an additional cost.

Benefits of individual medical insurance

Customisable sum insured

Individual health insurance plans allow flexibility in choosing the sum insured based on your medical history, age, and financial capability. You can choose from Rs. 3 lakh up to Rs. 1 crore depending on your needs.

No claim bonus

Many insurers reward policyholders with a no-claim bonus by increasing the sum insured for every claim-free year. This can range from 10% to 50% annually and is a great way to enhance coverage over time.

Preventive health check-ups

Leading plans also include annual check-ups to detect health issues early. Some even cover lifestyle-related tests such as thyroid profiles, cholesterol, and glucose levels.

Lifelong renewability

As per IRDAI guidelines, all health insurance plans now offer lifetime renewability. This ensures continuous coverage, especially critical in later stages of life when medical needs increase.

Tax benefits

Policyholders can claim deductions under Section 80D of the Income Tax Act. A premium of up to Rs. 25,000 per year is deductible for individuals below 60 years, and up to Rs. 50,000 for those above 60.

Who should buy individual medical insurance?

An Individual medical insurance plan is ideal for:

• Young professionals without employer coverage
• Self-employed individuals
• Freelancers and gig workers
• People with specific health conditions requiring frequent specialist consultations
• Retirees looking for standalone health coverage

Factors to consider when choosing a plan

Network hospitals

Ensure the insurer has a wide hospital network with top-rated healthcare facilities in your region. This is important for accessing cashless services and reducing out-of-pocket expenses.

Waiting periods

All insurance plans come with waiting periods for pre-existing conditions and specific illnesses. Shorter waiting periods ensure quicker access to benefits.

Co-payment and sub-limits

Some policies come with clauses where the insured must bear a percentage of the claim. Choose a plan with minimal co-payment and no restrictive sub-limits on room rent or treatment type.

Premium vs benefits

Do not opt for the lowest premium. Instead, balance cost with comprehensive coverage. Check if the policy includes specialist consultation, diagnostics, ambulance, and OPD benefits.

Popular individual health plans in 2025

Several insurers offer plans that combine hospitalisation and OPD benefits. Notable options include:

• Aditya Birla Activ Health Enhanced: Includes hospitalisation, wellness coach, OPD add-ons.
• Care Plus: Covers up to Rs. 25 lakh with no-claim bonus and unlimited cover restoration.
• ManipalCigna Prime Active: Designed for pre-existing diseases like diabetes and BP with OPD cover.
• HDFC ERGO Day2Day Care: OPD-focused plan with daily doctor access and medicine discounts.
• Niva Bupa GoActiv: Offers tele-consultations, specialist access, and health coaching.

Filing a claim

You can file a health claim in two ways:

Cashless claim

• Visit a network hospital
• Provide health card and identity proof
• The insurer will directly settle the bills with the hospital

Reimbursement claim

• Pay all expenses upfront
• Submit claim form with bills, prescriptions, and test reports
• The insurer reimburses the eligible amount after verification

Conclusion

Choosing individual medical insurance with comprehensive hospitalisation benefits and specialist consultation is essential in managing healthcare costs effectively. With OPD coverage, access to a wide network of hospitals, and cashless claim services, these plans empower individuals to manage both routine check-ups and emergency care. Evaluate your needs, compare plans carefully, and invest in a best health insurance policy that provides peace of mind and robust medical protection.