A health insurance policy is a boon in modern times when medical costs have become prohibitive. Even in case of simple hospitalisations you look at tens of thousands of rupees in medical bills and if the illness is serious, there is no upper limit to what hospitalisation costs you can incur. Health insurance plans pay for the medical expenses and spare you financial setbacks. Though anyone can buy health insurance plans, companies rate every proposer on the basis of the risk he/she presents. Whenever a proposal for health insurance is made, the insurance company assesses the risk involved. This process is called underwriting. The company tries to find the probability of a claim against each proposal that it receives and that is why you are asked a lot of questions when you fill the proposal form. What if you fall in the high-risk category? How to choose the best Health Insurance Plan for High-risk Category?
What is high-risk category?
High-risk category depicts that you or any other member you are proposing to cover in a health plan have a higher health risk than normal. Such high-risk lives would increase the claim incidence for the company and therefore the company is normally hesitant in allowing cover in such cases.
When does the company classify you to be in the high-risk category?
There are some instances in which the insurance companies would classify you to be in a high-risk category. These instances include the following –
If you have lifestyle vices-
If you are a chain-smoker or an alcoholic, you are considered to be a high-risk individual. This is because of the fact that both smoking and drinking are seriously injurious to your health. If you are a chain smoker or an alcoholic you would be prone to medical ailment and the insurance company would face a high probability of claim.
If you have existing ailments-
If you have pre-existing illnesses like diabetes, hypertension, heart-related problems, etc., you are considered to be a high-risk life. These existing illnesses also hamper your normal health and give rise to various other medical complications.
If your family has a bad medical history-
There are illnesses which are hereditary in nature. If one member of the family has an ailment, it tends to pass on to their descendants too. That is why family history plays an important role in underwriting of health insurance plans. If your family has a history of a certain illness there are chances of it affecting you would be high and you would be classified as a high-risk individual by the insurance company.
There are some occupations which increase health risks too. For instance, if you are in the armed forces or engaged in construction work, your health faces serious threats. These threats increase the chances of a health insurance claim. Health insurers, therefore, categorise some occupations to be high-risk occupations and if you are employed any such occupation you are considered to be a high-risk individual.
Health insurance plan for high-risk individuals
It would be unfair to say that high-risk individuals are not allowed to buy a health insurance policy. So, how to choose the best Health Insurance Plan for High-risk Category?
Insurance companies allow such individuals to be insured under their health plans. However, in high-risk cases the insurance company does a thorough risk assessment and the policy is issued after careful considerations. The following are some terms and conditions which the company imposes in case of high-risk lives.
Premium Increase (Loading of premium)-
This is the most common and popular measure which insurance companies take for insuring high-risk lives. The premium of the health insurance plan is increased to account for the high-risk which the insurance company is undertaking to insure that particular individual(s).
The insurance company can also impose coverage restrictions under the health insurance plan. For instance, if you are a chronic diabetic, you might be allowed health insurance coverage but coverage for diabetes and its related complications might be restricted/prohibited.
Increase in waiting period-
In case of pre-existing illnesses, the insurance company might also increase the waiting period after which it would cover the existing illnesses and their related complications.
Rejection of coverage-
In extreme cases the insurance company might also refuse to grant you a health insurance plan. A very common example is that if you are a chain smoker as a result of which you have developed lung cancer, you would not get coverage under any health insurance plan.
When you buy health insurance for you or any of your family members and you are falling in the high-risk category. Don’t lose heart. You might get health insurance plan for high- risk category coverage but there might be certain terms and conditions associated with the cover. So, understand when insurance companies classify proposers in a high-risk category, assess whether you fall in the category and then understand your health plan’s terms and conditions.