Eligibility Criteria for Buying Health Insurance

What are Some of the Things Insurance Companies Look at While Offering their Health Insurance Plans

Health insurance companies help you tide over difficult times during a medical emergency, by ensuring a cashless payment of expenses. However, even after witnessing the situation during Covid-19, the health insurance penetration in India is still very low.

If you are looking to secure your and your family’s health, do keep in mind some of the eligibility criteria that most insurance companies take into account while offering a health insurance plan.

Buying a health insurance policy as one gets older becomes expensive. Some policies may also have an upper limit on policy renewals. This, however, may vary from insurer to insurer and plan to plan.

Let’s look at some of the important points that can affect your eligibility for health insurance.

1. Pre-existing Medical Condition

Pre-existing medical condition refers to some existing illness, even before the purchase of the health insurance policy. In case an individual is suffering from some illness like diabetes or a heart condition, even before the purchase of a health insurance policy, the insurer may put forth some conditions before approving his/her insurance plan.

One can declare his/her condition instead of hiding it, and take a medical cover to include them as well. However, this may also lead to an enhanced premium in some cases. Some insurers may also offer a co-payment plan in such cases. In such a plan, the policyholder shares the cost of medical expenses with the company. 

What is a Co-pay Plan

Under the co-pay plan, the policyholder is required to pay some percentage of the expenses incurred, before the insurer pays the rest of the amount.

For example, let’s say the policyholder holder agrees on an 80-20 co-pay model, and the total bill is Rs. 10,000. In this case, 20% of the total expense which is Rs. 2000 will be paid by the policyholder first, before the insurance company pays the rest.

A co-pay model can be a good way to reduce your premium as well, as they are generally lesser expensive than other plans. The burden of paying the medical expenses though can be higher for the policyholder in such cases. So, do your research carefully before choosing such a plan.

2. Age

A large number of health insurance companies prefer offering health insurance plans to customers between the ages of 18 and 65. There are several benefits of buying health insurance at an early age. One not only gets to pay a lower premium but also benefits from remaining insured for a longer time. Buying health insurance after 65 can be challenging and thus, it’s advisable to do so as soon as you turn 18.

3. Medical Test Result

A lot of insurance companies also prefer customers who have cleared the medical tests before agreeing to insure them. People above a certain age (generally between 40-45) have to compulsorily undergo a medical examination before the health insurance policy could be issued against their names.

4. Exclusions concerning certain illnesses

Some insurance companies may also exclude certain types of illnesses from health insurance coverage, as a part of their eligibility criteria. This could include certain specific treatments or procedures and even some types of diseases.

Is Age one of the Critical Eligibility Criteria when Buying Health Insurance?

There is an old saying,

“Do not leave for tomorrow, what you can do today.” 

This is especially true with health insurance as your eligibility is directly impacted by increasing age. The earlier you start, the less expensive it will be, while allowing you to reap the maximum benefits from your health insurance policy.

Let’s look at some of the benefits of buying a health insurance plan early in your life.

1. Wide range of benefits

A younger policyholder has the advantage of including many add-ons as a part of the health insurance policy. These benefits, however, aren’t available after a certain age. The reasons include higher chances of being afflicted with various illnesses and diseases as you grow older. Also, with increasing age, one becomes more prone to lifestyle-related illnesses as well.

2. Lesser Premium

People who take health insurance at a young age can afford to pay a much lesser premium when compared to individuals who take insurance at a later age. The premium will be the lowest for people below 25, and reasonably priced for people in their thirties and before forty. After 50, however, the premium becomes pretty high, and a lot of people opt for a co-pay model in such cases.

3. Higher Sum Insured

The amount of sum insured is generally high at a lesser premium when one is younger.  The sum insured, however, continues to become expensive with age. Once, someone is above fifty, they may even have to undergo a mandatory medical examination before a policy can be issued to them.

4. Waiting Period

A lot of health insurance plans have a waiting period which can range from a few months to even a few years. A pre-existing ailment may turn severe with age and thus may lead to higher medical expenses, as it will remain uncovered because of the waiting period.  A health insurance plan taken at an early age can help you ensure maximum coverage of all kinds of ailments even with an extended waiting period.

Eligibility

Eligibility for health insurance thus depends on various factors including age, previous medical history, and even the results of the medical examinations. The premium continues to increase with increasing age and affects the kind of coverage you can avail. 

It is thus advisable to buy your health insurance early and avail all the benefits that come with an early start.

Aditya Birla Health Insurance (ABHI) also understands the importance of providing the right kind of health insurance to you and your family. Out of the multitude of health insurance plans available, it provides you with an option to choose the one that is best for you.

You can go through the Aditya Birla Health Insurance website and learn more about the health insurance plans suiting your eligibility and needs. 

Aditya Birla Health Insurance (ABHI) takes into account your unique needs to let you opt for the best health insurance plan. ABHI believes in “Health insurance that cares beyond financial protection” and has a presence in more than 2300 cities across India. 

ABHI is also one of the leading and trusted health insurers in India. The health insurance plans offered by ABHI also reward you for your healthy lifestyle choices, when you choose to buy insurance from Aditya Birla Health Insurance.

Given below is a list of some of the popular health insurance plans from Aditya Birla Health Insurance. Please click on the link below and get more information about them before choosing the best coverage for you.

1. Activ Assure Diamond - https://www.adityabirlacapital.com/healthinsurance/activ-assure-diamond
2. Super Health Top-Up - https://www.adityabirlacapital.com/healthinsurance/super-health-topup
3. Active Health Enhanced  Insurance - https://www.adityabirlacapital.com/healthinsurance/active-health-enhanced-insurance
4. Activ Fit - https://www.adityabirlacapital.com/healthinsurance/activ-fit