Eligibility Criteria for Buying Private Health Insurance

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Private health insurance is generally more flexible than government-planned health insurance (e.g. Ayushman Bharat PM-JAY). With comprehensive benefits, such as outpatient cover, ambulance cost cover, and personal accident cover, these insurance plans can become your ideal financial safety net against the rising medical inflation in India.


However, before buying this private healthcare policy, you need to understand its eligibility criteria. Based on age and medical history, without proper knowledge about these criteria, you may end up choosing the wrong policy.


What are the Basic Eligibility Criteria to Buy Private Health Insurance?



  • Residency: The policyholders have to be residents of India.



  • Minimum Age: 18 years (for Adults) and 91 days or 3 months (for Children)



  • Maximum Age: 65 years (for Adults) and 25 years (for Children)



  • Dependent Coverage: Children, spouse, parents and parent-in-law can be added as dependents in the family floater plan.



  • Medical Condition: Senior citizens have to pass a medical screening test before applying for private health insurance.


What is the Key Condition for Purchasing Private Health Insurance?


Waiting periods are the key condition of private health insurance that every policyholder has to fulfil. This period is generally a specific time when you can't claim the policy benefits. In most cases, your age and medical conditions determine the timeline of this period.



  • Initial Waiting Period: 30 days



  • Waiting Period for Pre-Existing Diseases (PED): 6 to 36 months



  • Maternity Cover Waiting Period: 24 months



  • Disease-specific Waiting Period: 2 to 3 years for diseases like osteoporosis or hernia.


Which Factors Can Influence the Eligibility of a Policyholder?



  1. Policy Type


The type of private health insurance plays a crucial role in determining your eligibility. For instance, people above 60 years old may have difficulties purchasing individual health insurance due to their high medical risks. However, they obtain comprehensive medical benefits with specialised plans like the senior citizens' red carpet health insurance policy.



  1. Lifestyle


Policyholders with negative lifestyle habits like smoking and heavy alcohol consumption have significantly higher health risks. This is why insurance companies usually may impose higher premiums or potential policy exclusions on them, even if they are young.



  1. Medical History of Family


If an individual has a family history of critical illness or pre-existing diseases, such as cancer or diabetes, it can affect their eligibility to buy private health insurance. In most cases, they may have to pass a medical screening or serve a waiting period.



  1. Occupation


For individuals involved in high-risk occupations such as mining, construction, or piloting, buying family health insurance can result in high premiums and waiting periods. Therefore, these policyholders are more suited for individual health insurance for personalised and comprehensive coverage benefits, such as personal accident cover.


Final Words


By understanding the given eligibility criteria, you can smartly invest in a private health insurance plan that perfectly meets your healthcare needs.


Moreover, considering factors such as age, lifestyle and waiting periods are equally important to determine your eligibility for family floater or individual plans. Therefore, verify these factors carefully before purchasing a health insurance plan.