Health Care

Individual Health Plan – How Does it Work?

11:08:00 PM RAWAT 0 Comments


An individual health plan is a health insurance policy for any individual. This health insurance plan cannot be bought from any employer; you can buy it from the health insurance. This program is beneficial to the company as well, as it helps them to retain the customers in this era where there are numbers of jobs open in the market. Buying the individual insurance policy under the small business health options program makes the insurance policies affordable.

Below mention points explain how the plan works along with few terms which are applied to such plans:


Network hospitals

Network hospitals are the hospitals which are listed under the insurance policy for serving the insurers. These hospitals consist of therapists, specialists, doctors, surgical centers and other such facilities. The insurance company has predetermined contracts with these hospitals for treating the insurance holders at lower rates. However, if you get the treatment from doctors who are not a part of the predetermined network, they would charge their own rates.

Submitting claims

If the network doctor has treated you, your insurance service provider will file your claim. However, in other cases you yourself have to submit the claim. You should provide the complete documentation within the decided period to get the reimbursement.

Grace periods and claims submission policies during grace periods

There are different grace periods and claims submission policies for non-subsidized health insurance exchange members and the subsidized member.

Prior authorization timeframes and responsibilities

To execute the procedures on time, the request has to be submitted by the health care professional in the given time frame. This pre-defined condition can be avoided in case of an emergency.

Exclusions of the policy

Below mentioned are the points which are excluded from the individual health insurance policy:

  • In the case of pre-existing disease, the waiting period less than three years cannot be claimed.
  • Disease diagnosed within the first 30 days of the health insurance for individual.
  • For claiming diseases like piles, hernia, sinusitis, and cataract, the waiting period will be of 2 years.
  • For claiming diseases like PIVD, joint replacement, and bariatric surgery, the waiting period will be of 3 years.
  • There is a waiting period of 6 years for any maternity expenses or new-born baby expenses.
  • Consumptions of addictive or intoxicating substances like drugs or alcohol resulting in any medical condition will not get any coverage under an individual health insurance policy.

What can you rely on for the best?

The medical condition and problems vary from person to person. While looking for the best health insurance policy in the market, the individual health insurance plan by Bajaj Finserv will be amongst the top insurance policies of India. The company works systematically, and the insurance plans are executed depending on the individual’s medical needs. The company also have a discount of 10% and 15% for family health insurance for two members and three members respectively, if you buy the Bajaj Finserv's individual health insurance plan for more than one person of your family.

Also, long-term policy discount of 4% and 8% for two years and three years respectively. Tax savings and cashless facilities are few of their benefits which you will get upon availing the Bajaj Finserv’s Individual health insurance plan. You can earn 10% of cumulative bonus for every year which is claim free. The individual health insurance plan of Bajaj Finserv’s also covers bariatric surgery, ayurvedic and homeopathic hospitalization.

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