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Diseases do not come announced or affect a pre-ordained set of individuals. Diseases and illnesses are uncertain and that is the reason why they are distressing and financially difficult to shoulder. If one knew before hand that a certain disease is going to strike at a specific time, he would have made the necessary arrangements to tackle the incidence of the disease.
Since it is not the case and any disease or medical ailment causes considerable financial crisis, a health insurance policy is deemed important. By providing a financial cushion to tackle the huge hospital bills, a health insurance plan proves to be a blessing for every individual. But, can every individual avail of a comprehensive health insurance policy for his medical needs?
A health insurance policy is underwritten by the insurer based on the risk that the proposer presents. Every proposal is either classified as a low risk, moderate risk or high risk application and is accordingly dealt with. Normal healthy individuals who are young and are not afflicted with any ailments or lifestyle habits are considered low risk profiles while people who present a little higher risk are classified into the moderate risk profile.
A high risk profile is the most dangerous profile of individuals from the insurer’s perspective and thorough underwriting is carried out for such high-risk cases. The below-mentioned points classify the high-risk cases and how the insurer deals with such cases in details:
- Existing ailments –High diabetes, hypertension, heart related ailments or any other ailments which the proposer is already afflicted with are called pre-existing ailments. If the degree of such ailments is high, it classifies as a high-risk category. Though pre-existing illnesses have a waiting period, the insurer might exclude such ailments from the coverage altogether along with a premium increase or might even reject the policy if it feels that the pre-existing illnesses are of a severe nature.
- Family history – Your family history is also given consideration to determine any hereditary medical condition. If heart ailments are a common part of your family history, your application for health insurance would be considered in the high risk category and the coverage for heart related ailments might be excluded even though you do not suffer from such ailments at the time of application.
- Lifestyle habits – Smoking, drinking or chewing tobacco are some lifestyle habits which are considered a high-risk scenario if the dependence on such habits is to a large extent. A chain smoker or an alcoholic presents a high health risk and any injury under the influence of alcohol is already a common exclusion. If you are categorized under this risk profile, you might have to pay a higher premium and medical contingencies due to such habits may even be excluded from the scope of your medical cover.
- Occupation – Believe it or not, the company also weighs your risk according to your profession. A person engaged in a risky profession is considered to be a high-risk individual. Professions like mining, aviation, aeronautics, adventure sport instructors, etc. are high risk professions where the probability of medical contingencies is very high. Premium is high and coverage for such high-risk individuals is usually limited in nature as it excludes every medical contingency which might accrue by virtue of the profession the proposer is engaged in.
The above-mentioned categories are considered a high-risk category and insurers have various measures to deal with applications which reflect such high-risk profiles. The insurer might-
- Increase the premium,
- Limit the coverage extended, or
- Reject the policy
As a customer, you should not get demotivated by the insurer’s safety measures if you fall in any high-risk category. Buying a health insurance plan is important and disclosing your facts is equally important. If, fearing any of the actions above, you hide any material information which impacts your risk, you are at a high-risk of getting your claim rejected.
In case of any medical emergency, the company determines the nature of the claim raised and if it is found that the claim is a result of any undisclosed fact, the company may reject your claim.
Rather than suffering the brunt of a rejected claim, make full disclosure in your proposal form. You might be charged a higher premium with a limited coverage or you might not get the policy altogether but it would be better than getting your claim rejected.
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