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What is Health Insurance with High-Risk Cover?

Jagrity Sharma Jagrity Sharma 12 November 2019

Health insurance policies are classified into three different categories – low risk, moderate risk and high-risk profile. Read more to know about health insurance with high-risk cover.

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Diseases come unannounced and are uncertain, which is why they are distressing and put a financial burden on our shoulders. If we knew beforehand that a certain disease or illness is going to strike at a specific time, we would have made the necessary arrangements to tackle uncertain medical emergencies.

Since that is not the case, and medical ailments may cause considerable financial crises, a health insurance policy is important. By providing a strong financial cushion, a health insurance policy proves to be a blessing for the policyholders and all the members included in the health plan.

It is important to know that the insurance company underwrites a health insurance plan based on the risk that the policyholder presents. Every policy is either classified as moderate risk, low risk or high risk, and it is dealt with accordingly. Young, healthy people who are not suffering from any ailments or do not have any lifestyle habits such as smoking, drinking alcohol, etc. are considered low-risk profiles. On the other hand, individuals who represent a higher risk are regarded as moderate risk profiles.

A high-risk profile is considered dangerous from the insurance company's perspective, and detailed underwriting is carried out for such high-risk cases. Following are the points which classify the high-risk profiles and how the insurance company deals with such situations.

Pre-existing conditions: Hypertension, high level of diabetes, heart-related ailments or any other condition which the individual is already affected with before availing a health insurance policy are called pre-existing conditions. If the degree of these ailments is high, the insurance company classifies it as a high-risk category. Though pre-existing conditions have a waiting period, the insurance provider might exclude such conditions entirely from the coverage or can increase the premium amount. The company might even reject the application if the pre-existing illnesses are severe.

Family history: Your family history in terms of a health condition is also considered to determine any hereditary ailments. If heart diseases are the most common part of your family history, your application for a health insurance policy may be considered as a high-risk category. In this case, the coverage for heart-related ailments might be excluded from the policy, even if you do not suffer from such diseases at the time of application.

Lifestyle habits: Chewing tobacco, smoking, and drinking alcohol are some lifestyle habits which are considered high-risk in the dependence of the applicant on such habits is to a large extent. An alcoholic or a chain smoker represents a high health risk, and any injury or illness under the influence of alcohol and drug is already a common exclusion from health insurance plans. Hence, if you are categorised under this category, you might have to pay a higher premium. Moreover, medical contingencies arising due to such habits may even be excluded from the scope of policy coverage.

Occupational risk: The health insurance companies also consider the risk according to your occupation. A person engaged in a risky occupation is considered a high-risk profile. Professions like aviation, mining, adventure sports instructor, aeronautics, etc. are considered high-risk professions where the possibility of medical emergencies is quite high. The premium for such high-risk applications is high, and coverage for such applicants usually excludes every medical emergency which might occur due to the profession the policyholder is engaged in.

The categories mentioned above are considered high-risk categories and insurance companies have several measures to deal with policy applications which reflects high-risk profiles. In such a case, the insurance company might-:

  • Limit the coverage extent,
  • Increase the premium amount, or
  • Reject the policy application

As a customer, you should not get discouraged by the insurance company's safety measures in case you fall in the high-risk category.

Buying a health insurance policy is important and disclosing the facts is equally important. If you fail to disclose any relevant information about your lifestyle habits or health conditions to the insurance company at the time of application, you are at a high risk of getting your health insurance claim rejected.

Buying a health insurance policy may become difficult if you fall into the high-risk category. What can you do in such a situation? Here are some best possible ways to buy health insurance with a high-risk profile.

  • Insurance companies take into consideration parameters such as quantity and frequency of tobacco use, manner of consumption (chewing tobacco or smoking), and the period of addiction. In some cases, if the policy applicant decides to quit smoking, the insurance company may not charge an extra premium and treat him/her as a non-user after a few years.

  • Some insurance companies offer dedicated health insurance cover for specific ailments such as heart-related ailments, diabetes, hypertension etc. which insure people with these medical conditions.

  • You can consider buying a top-up cover. It is an add-on coverage that acts as an individual health insurance plan. While a standard health insurance policy compensates the expenses up to the defined sum insured, a top-up plan covers the medical expenses after a decided threshold is met. Top-up plans are affordable as they come with deductibles. It is wise to cover the excessive medical expenses arising due to a disease beyond which the existing medical insurance doesn’t cover you.

The high-risk health insurance cover is costlier than the standard health plan; however, it is a lot more economical than having to pay all your hospital and medical bills from your pocket. If you have a high-risk profile, it is advisable to buy a health insurance policy with high-risk cover by disclosing your lifestyle habits and existing ailments, if any. Moreover, you can also buy a critical illness cover that comes handy until waiting periods associated with high-risk cover are exhausted.

Recommeded Link: What is Health Insurance with High-Risk Cover?

Jagrity Sharma
Written by Jagrity Sharma
A bibliophile who hates alliterations, but loves cream, comics and content immensely! On another note, a content marketer who leverages the power of words to explain...almost anything!