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Why giving correct details is must for health insurance covers

Why giving correct details is must for health insurance covers

Information provided in the proposal health insurance form is the basis of premium calculation. Hence, customers should disclose correct information, even if it means having to pay more.

Bajaj Allianz General Insurance Chief Technical Officer TA Ramalingam Bajaj Allianz General Insurance Chief Technical Officer TA Ramalingam
Looking at the numerous options available in the market today, finding an appropriate health insurance plan can be a challenge. While the major considerations before buying a health plan are its features, credibility and claim settlement record of the insurer, hospital network, etc, the most important aspect is the premium.

Insurers charge each customer on the basis of 'risk profile,' which is determined by certain factors disclosed in the proposal form.

Let's take a look at factors which determine premium and what you should do to ensure smooth claim.

AGE
Young people are expected to have few illnesses and be less prone to developing grave health problems. Hence, a young individual is charged less than an older person for the same sum insured. Insurers charge on the basis of age bands like 26-35 years, 36-40 years, etc. The increase in premium from one band to the next can be 30-60 per cent.

BODY MASS INDEX
A simple way to gauge a person's health is the proportion between height and weight. This is commonly called Body Mass Index or BMI. A person with an abnormal BMI is either overweight or underweight. In such a case, the insurer will ask the person to undergo medical tests to rule out the possibility of ailments such as thyroid, obesity and joint problems. It will offer the cover if the tests are alright. Otherwise, it may charge more and include certain exclusions or waiting periods.

MEDICAL HISTORY
Insurers assume that people with family history of certain medical ailments share the risk. Hence, a person with a family history of high blood pressure or diabetes may be charged more.

FAMILY SIZE
Plans which offer a single cover for the entire family are called family floater plans. The premium is decided on the number of members to be covered. For instance, a cover for individual, spouse and two children will be expensive than that for a family comprising individual, spouse and single child. The age of the eldest member is also considered.

TOBACCO USAGE
Using tobacco can cause cancer, respiratory/cardio problems and several other diseases. As a result, you will have to pay more if you smoke or chew tobacco.

AMOUNT OF COVERAGE
The sum insured is another deciding factor. The higher the amount, the higher is the premium. However, the premium can be reduced by opting for a voluntary deductible. This indicates the amount the policyholder agrees to bear from his own pocket in case of a claim. For example, opting for a Rs 10,000 deductible can fetch a 10 per cent discount on premium while a Rs 15,000 deductible can get you a 15 per cent discount. A person can get a maximum discount of 30 per cent.

HONESTY PAYS
Information provided in the proposal form is the basis of premium calculation. Hence, customers should disclose correct information, even if it means having to pay more. They should check with the insurer or distributor what stands as a valid declaration in pre-existing ailments. For example, frequent headaches may not be a valid declaration, but a diagnosed migraine will be. In case any discrepancy in information is found at the time of claim filing, the claim can be rejected. This is not a situation you would want to be in especially when you or your loved one is hospitalised.

TA Ramalingam
Chief Technical Officer, Bajaj Allianz General Insurance