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Are You Eligible to Buy Health Insurance?

By Vikas Chandra Das
15 November 2022, 10:05 AM

Having health insurance has various benefits. It has tax deductions, various add-on facilities depending on your plan, and most importantly, medical emergencies never look at your pockets before knocking on your door. In such times of crisis, health insurance enables you to get world-class medical facilities. The best part is that some health insurance covers all your medical expenses, including prescription drugs, medicines and other costs. But before getting your hands on a health plan, you must know about the eligibility requirements of health insurance companies. The criteria vary from company to company and plan to plan, but there are some general criteria which you should be aware of.

What is the Age Criteria to Get Health Insurance?

Anyone of age 18 to 65 can purchase health insurance policy. However, the amount of the premium paid varies with age. Younger people pay lower premiums, as younger people have better immunity and fewer doctor visits.

But What if You Don’t Fall in the Age Bracket? 

It’s possible to get health insurance at an older age. But you must meet the criteria, which mainly need you to be in excellent health. This is primarily because older people need more medical attention. Studies have shown that people who are 65+ spend lacs of rupees per year on medical expenses. This, in turn, can be expensive for the health insurance company. On the other hand, for those under 18 years, different companies offer unique plans catering to their requirements. 

Can People with Pre-existing Conditions also Avail an Insurance Plan?

Yes, people can get health insurance with a pre-existing health condition, just like any other person. The only difference is that the benefits and the premiums might vary depending on the health condition, its degree of severity and the amount of medical attention the conditions require.

What are the Prerequisites to Get Insurance?

Medical Examination: Physical examinations, blood and urine tests. These tests are more than enough to explain a person’s health. For example, it can quickly determine how functional one’s liver and kidneys are. They can also identify a rise or fall in blood sugar levels and whether or not the insured consumes alcohol or tobacco. When the insured person chooses high insurance coverage or reaches the age of 55, they may be subjected to additional tests. The test might differ from company to company, policy to policy and might have special requirements if you are subjected to a unique health condition.  

Be wary of insurers who promote their plans with taglines like “get insured, no medical test required.” It’s good news that you won’t have to go through those arduous tests. But, if you’re a wise consumer, you’ll always wonder what the insurer stands to gain by providing such a feature. Such policies have a catch. For starters, such plans offer less coverage than traditional ones requiring the insured to undergo tests. Second, in lieu of the exemption from the medical examination, the insured must submit a declaration of good health. The declaration is written proof of the insured’s agreement to accept responsibility for any pre-existing condition.

Declaring All Pre-existing Health Conditions: If you're in good health, can your insurance company offer you competitive premium rates? Failure to disclose pre-existing health conditions may result in the company dismissing your claim. On the other hand, if you reveal your condition, the company will charge you a higher premium, and the policy will cover the condition. 

Can People with Nicotine or Alcohol Addiction Apply for Health Insurance? 

Yes, they can. But it totally depends on the insurer to either accept or reject their proposal as such people will be at higher risk. However, many people who smoke or drink believe they are ineligible for insurance. That, however, is not the case because addiction puts one at a higher risk of developing medical problems. Like excessive alcohol consumption can lead to the development of chronic diseases and other severe conditions like hypertension, heart disease, stroke, liver disease, and digestive issues over time. Breast, mouth, throat, oesophagus, voice box, liver, colon, and rectum cancer. Immune system deterioration increases the likelihood of illness. Hence one may be required to pay a higher premium or undergo more stringent medical tests. They are, however, not ineligible for health insurance.

Here are a Few Things Which We Tend to Overlook While Buying Health Insurance

Family Discount

This discount is provided when the proposer's coverage is extended to another family member. The discount amount, however, is flat and doesn't change as the number of family members does.

Cumulative Premium Payment Discount

Some insurers will give you a discount if you purchase a health insurance policy and pay the first two years' premiums at once.

Discount Vouchers

 Some insurance companies provide discount coupons for purchasing medications and receiving medical care at designated locations.

Wellness Rewards

 Certain insurers will give you benefits if you live a healthy lifestyle.


Health insurance is always suggested as it opens a broader set of facilities. As medical science ascends its way to develop advanced tools, the more expensive it gets for one to reach them without exhausting their hard-earned money and savings. Health insurance can simply minimise that cost multifold. One must know the baseline criteria to access these facilities to get the proper medical insurance. 


1. What happens if one hides their pre-existing medical conditions to get lower monthly premiums?

In such a case, the company can refuse to provide benefits, depending on the severity of the situation. One can be subjected to a fine or face some legal problems.

2. Will the company cover all my expenses made in the hospital?

Although this appears correct, hospital bill coverage is subject to policy conditions. For example, the policy does not cover consumables such as bandages, oxygen masks, nylon gloves, thermometers, etc. Anything above and beyond is reimbursable by the insurance company.

3. Can I access the benefits if, due to some circumstances, I cannot renew the policy in time?

Even if the policy is not renewed on the due date, the policyholder can renew it within 15/30 days of the policy expiry date, which is considered “continuity” for benefits such as pre-existing condition coverage, waiting periods, etc. However, any claim for the period between the due date and the date of actual renewal will be denied even after renewal.

4. Are pregnant women eligible to get health insurance?

Yes, some comprehensive policies do cover pregnancy as well. However, you can go for an independent maternity health insurance also.

5. Do people with mental health issues get access to health insurance?

There are specialised insurance policies offered by some insurers which do cover mental health.

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