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High-risk Category People Can Look at These Health Insurance Plans

By Juhi Walia
19 October 2022, 2:30 PM

While underwriting a health insurance policy, insurers decide whether to approve or reject the proposal form, the sum insured and the premium based on the risk the proposer provides. They categorise each proposal as either low, moderate, or high and handle it accordingly. Young, healthy, and normal proposers with no ailments or unhealthy habits fall under the low-risk profiles. In contrast, a moderate risk profile includes those with slightly higher risks. The third category is a high-risk profile, which is the most severe type for insurers as they are generally unhealthy, have risky behaviours, and their case is subjected to the most careful underwriting. Here’s all about such high-risk patients, how insurers handle them, and which health insurance plans they can choose to keep themselves financially secure. 

What Makes Someone a High-risk Individual?

Many conditions put an individual in the high-risk category for insurers. These are:

Existing Diseases

If the applicant already has ailments they seek treatment for, they are said to have pre-existing diseases. These could be common conditions such as hypertension, diabetes, and heart disease or even serious ones such as cancers or kidney diseases. The provider sees such people as high-risk depending on the severity of the sickness. Although there is a waiting period for pre-existing conditions, it’s the insurer’s prerogative to exclude these from coverage, raise the premium price, or even deny the application if it believes the conditions are severe.

Read more - Worried If a Pre-existing Disease Can Impact Your Health Insurance?

Lifestyle and Habits

A person is categorized as a high-risk applicant if they regularly engage in harmful habits, including smoking, consuming alcohol, or chewing tobacco, as they are likely to suffer from lifestyle diseases that are on the rise. Chain smokers and alcoholics pose significant health risks, and alcohol-related ailments are already typically excluded from policies. So, you might have to pay a higher premium, and the insurance may not even cover medical emergencies caused by these habits. 

Family’s Medical History

Insurance companies consider this information to ascertain whether a medical issue is inherited. For instance, you run a greater chance of developing cardiac problems if someone in your family has them. Thus, the insurance company will classify you as a high-risk candidate.


The insurance provider uses your line of work to gauge your risk level. People are categorised as high-risk when they work in dangerous occupations as the likelihood of medical emergencies is higher. Adventure sports instructors, aeronautics, aviation, mining, etc., are a few occupations that fall in this category. 

How Insurers Tackle High-risk Applicants

Health insurance companies have guidelines to view high-risk cases and determine the course of action. The insurance provider conducts a detailed risk analysis before issuing the policy and applies the following terms and conditions in the case of high-risk lives. The insurance firm could:

  • Increased Premiums, or premium loading, is the most typical strategy that insurers use as there’s a considerable risk they take by insuring the applicant.
  • Coverage limitations whereby the insurance company may also set restrictions, like providing insurance, might be limited or impossible to get treatment for existing disease and its associated problems.
  • Waiting period extension for pre-existing conditions and providing coverage for a pre-existing condition and related problems only after that.
  • Rejecting the application if the insurer feels it’s too great a risk.

High-risk Individuals Can Get Insurance 

Individuals in the high-risk category need not fret as it would be inaccurate to state that they cannot purchase health insurance. Here’s how they can find a plan that works:

Plans for Specific Diseases

Some firms offer special health insurance policies that provide coverage for people with specific medical issues like diabetes, heart disease, hypertension, etc.. 

Quantity and Frequency of Indulging in Harmful Habits

The insurer may consider including the quantity and frequency of tobacco use, consumption, and length of addiction. If the policyholder decides to stop drinking, the insurer may not charge any additional premium and treat them as non-smokers after a specified number of years. This should also motivate you to kick bad habits for your personal and financial well-being.  

Consider Buying a Top-up

When you buy health insurance, you have the option of adding a top-up cover that covers costs that a basic health insurance policy only reimburses up to the defined sum insured once you reach that limit.

Read more - Top-up Health Insurance Benefits that No One Will Tell You

Get Riders Early

Health insurance riders are always a good idea. Buying supplemental coverage while you’re still young has its benefits when you require more comprehensive health insurance to meet the expenses after a severe medical emergency, and the existing policy becomes insufficient. After you hit the mid-40s, renewing an insurance policy with a higher insured sum than your current one following a health insurance claim becomes challenging. Even if the insurance provider agrees, you will have to undergo a rigorous medical examination, and your premium will also increase. You can set a deductible limit for the add-on, and if you make this choice early, the premium will be much lower.


A health insurance proposer will be considered a high-risk individual if they have a pre-existing health condition, harmful lifestyle habits, hazardous occupation and medical history of ailments in the family. However, not all is lost, as an increasing number of insurers have specific plans for pre-existing diseases, and options such as top-ups and add-ons can hold you in good stead. 


1. What should someone with a high-risk profile consider while buying a policy?

No matter what, be upfront and completely honest in your proposal form. Tell the insurer about your diseases, medical history and lifestyle truthfully to avoid your claim from being rejected. 

2. The only pre-existing disease I have is hypertension. Can I still get a policy?

Yes, you can. Compare health insurance plans and their respective exclusions and choose the one that will provide you coverage.  

3. What if I quit smoking at the time of buying a policy?

You would still need to disclose that you’ve been a smoker in the past because the effects take years to go after you kick the habit. If your case paper reveals the reason for your ailment as smoking, the insurer may reject your claim. 

4. Why does my family’s medical history determine my profile as high-risk?

Many diseases, including diabetes, hypertension, heart ailment, irregular thyroid, and even mental illnesses, are hereditary. If a family member suffers from one or more of these or other conditions, you are likely to inherit it too. 

5. Will an insurer insist on a medical check-up if I’m a chain smoker?

It depends on the company. Most private providers would want you to undergo a medical check-up, but standalone insurers may not even if you check the box for smoking. The premium amount for the latter may be higher. 

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