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How the Premium of Mediclaim Policy is Decided?

Wayne Whitehurst January 28, 2020

A Mediclaim policy offers the benefits of hospitalization to the insured during times of an unexpected accident, a sudden illness, unforeseen surgery and domiciliary hospitalization which generally leads the individual to get hospitalized. All of these occurrences are covered under this insurance policy. This policy also covers the individual under circumstances of an illness or an injury when they are not able to stay at a hospital due to unavailability of beds at the hospital and instead have to get treated at home instead. However, for cases like arthritis, asthma or diarrhea when the person is treated at home, those do not fall under the insurance policy claim.

The best health insurance policy available in the market covers the family members of the individual as well if he so wishes to. In exchange for all the services, there is an amount that has to be paid against it. This amount that is paid is known as premium. This timely premium that the insurance company takes, is what they use to safeguard you during times of crisis and pay your bills on your behalf.

The premium that is paid is calculated based on a number of factors like any pre-existing diseases, age of the person getting insured and family history among others. Let us understand these factors along with others, in-depth, to have an understanding of how the premium of a health insurance policy is decided.

  • The company incurs certain chargers known as marketing cost for the purpose of marketing initiatives that are undertaken to acquire a new customer as well as the ones that are done to retain an existing customer. These costs usually include the cost of designing, operations, advertisements, promotional initiatives and commission to the insurance agent among other activities.
  • There is no single type of insurance policy that caters to all. There are certain different ones within the bracket of health insurance which is specific to the target group it is designed for. There are some features of these policies that are exclusive to that particular target group and certain features that are common across all. Each of these policies are carefully designed to take into consideration all the factors that it will provide you benefit against and the subsequent premium that it will charge. Hence, the premium varies depending on which type of health insurance policy you fall under.
  • Another important factor that affects the premium is the age of the person getting insured. Higher the age, the higher the premium. This is because, with an elder person, the chances of medical emergencies are higher which also means that the expenses attached will also be more.
  • Past and present medical history of an individual also makes a difference because the premium will be more for someone who has a history of illness as compared to someone who does not.

Now that we have an idea about how the premium is decided, ensure that when you are getting a mediclaim policy for yourself, you are able to apply these factors and not let anybody give you less. In case, you already have an insurance policy in place, then being aware of these factors will help you review where your money is going and how much is going.