May 23, 2024


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5 Things An Insurer May Evaluate Before Underwriting Your Health Insurance Policy

When necessary, health insurance shields you from expensive medical care. As a result, before making a decision, an insurer may consider several factors when deciding whether to offer health insurance coverage. It’s known as underwriting. Underwriting is the process based on which an insurance provider assesses the danger of providing health insurance to a client. It then decides whether or not to offer health insurance coverage to a person based on the risk factors involved. The pricing parameters also determine the premium a customer pays.

Let’s examine some crucial information the insurer might require to evaluate and calculate the cost of your policy:

  • Details About The Proposer: You must include information about your name, address, date of birth, marital status, first policy’s start date (if any), type of policy, and make-up of your family. Other typical personal information like the proposer’s email address, phone number, and government-issued ID must also be disclosed.
  • Information About The Insured Parties: Depending on whether you want a family or individual plan, you will need to provide information on every person covered by the policy. The report includes the insured person’s full name, date of birth, age, gender, height, weight, occupation, nominee’s name, and relationship to the proposer.
  • Zone Of Premium Payment And Geographical Restrictions: The premiums you pay may vary depending on the zone in which you live, which is categorised based on the cost of treatment in various cities. Keep in mind that this may differ from insurer to insurer. For instance, cities like Delhi/NCR and Mumbai may be included in Zone A, while Zone B may consist of Hyderabad, Bangalore, Kolkata, Ahmedabad, Vadodara, Chennai, Pune, etc., and Zone C may include the rest of India in addition to the cities in Zones A and B. Therefore, the insurer may apply a co-pay to the admissible claim if a person from Zone B or Zone C seeks treatment in Zone A. Zone-based co-payment is not required by all insurance companies. 
  • Coverage Details: This section provides information on the various health insurance benefits offered by a policy, as well as any sub-limits, waiting periods, deductibles, or other particular conditions related to those benefits. This section will also include information on any optional covers selected. You must also disclose the specifics of any current health insurance policies you may have, list the sum insured, and detail any prior claims. 
  • Medical History: The most crucial section of the proposal form is the medical history, which the underwriting team usually reviews before deciding whether to accept the proposal. The underwriting team will ask several questions about the customer’s medical background and personal habits as part of the overall risk assessment process. This includes providing a thorough history of all current and past medical conditions, including any hospitalisations, surgeries, and lifestyle decisions like smoking, drinking alcohol, and engaging in unhealthy habits that can raise the risk of developing certain illnesses.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.