Obesity and More: What Can Stop You from Applying for Health Insurance?
A higher BMI makes people more susceptible to conditions such as heart disease, diabetes and high blood pressure. Photo: Shutterstock
Are you aware that your obesity may prevent you from getting health insurance? Or that your premium may be higher if you drink alcohol or smoke? As surprising as it may seem, health insurers may deny coverage or charge higher premiums based on these factors.
Reasons why a health insurance application may be rejected
To obtain health insurance, an applicant must disclose several details ranging from personal information such as age and gender to health and lifestyle details including past medical history, pre-existing conditions and smoking or drinking habits.
“The information provided helps insurers decide whether to accept or deny an application based on their underwriting guidelines. An application for health insurance may be rejected due to inaccurate information provided by the applicant or if the applicant has serious pre-existing health conditions. If rejected, giving insurers clear and honest reasons for their decisions,” explains Vivek Chaturvedi, CMO and Head of Direct Sales at Digit General Insurance.
Can overweight people get health insurance?
Regarding the impact of Body Mass Index (BMI) or weight of a person on obtaining health insurance, Vivek Chaturvedi notes, “The age and health status of an individual are crucial factors that influence the premium of a policy. Those with a higher BMI can still get health insurance, but they may face higher premiums.”
What is the maximum BMI for health insurers?
A healthy BMI is considered to be between 18.5 and 24.9. Below this range, a person is categorized as underweight, while a BMI above 24.9 is considered overweight. If a person’s BMI is over 30, they are classified as obese. Each insurer has different underwriting criteria for applicants with a high BMI, based on their specific underwriting and risk assessment guidelines.
What should policy buyers take into account?
“Ideally, you should aim to get health insurance when he/she is young and has no health problems,” advises Chaturvedi. “This approach increases the likelihood that your application will be accepted and allows you to meet any necessary waiting periods.”
“It is important to remember that once a policy is issued and consistently renewed, its renewal cannot be denied by the insurer, ensuring the lifetime renewability of the coverage,” he adds.
Why is health insurance denied based on BMI?
A higher BMI makes people more susceptible to conditions such as heart disease, diabetes and high blood pressure. These increased health risks can lead to insurers denying a policy,” explains Vivek Chaturvedi of Digit General Insurance. He emphasizes that insurers must provide clear and transparent reasons for any application rejections.
What other factors can lead to a denial of health insurance?
Health insurance claims can be denied for various reasons.
“For example, courses for specific diseases or pre-existing conditions submitted during a waiting period are often rejected. Misrepresentation during the proposal stage is another common reason for refusal,” Chaturvedi points out.
In addition, treatments that are experimental or trial-based may also be denied by insurers.
How does tobacco and alcohol use affect health insurance eligibility and premiums?
Tobacco or alcohol use can significantly impact your health insurance premiums. Insurers may view individuals who smoke or drink as higher risks, which can lead to higher premium costs. In such cases, insurers may also require a health check before issuing a policy.
Which health conditions significantly change insurance premiums or eligibility for coverage?
“While insurers cover most health conditions, certain procedures may be excluded from your health insurance plan,” says Chaturvedi. It is essential to check the specific details of your policy as cover can vary significantly between insurers.
According to legal guidelines, even persons with disabilities, mental illness or people who are HIV positive should be offered health insurance without discrimination.
How does medical history affect insurance purchasing?
During the proposal stage, you will be asked to share extensive details about your health. This includes current medications, previous hospitalizations, diagnostic tests, undiagnosed symptoms, and any adverse medical conditions, both personal and familial.
In addition, your habits, such as drinking and smoking, are taken into account. This information helps insurers assess potential risks and pre-existing conditions that may affect the options and premiums for your coverage.
What can you do if your insurance claim is denied?
If your claim is denied and you disagree with the insurer’s reasons, there are several steps available to seek redress.
You can:
— Contact the insurer for a reassessment.
— If the problem is not resolved, please contact the insurance company’s complaints officer.
— Then contact the IRDAI Complaint Handling Cell or the Insurance Ombudsman.
If these options do not solve the problem, there are legal remedies available, such as approaching the Consumer Dispute Redressal Commission.
How can you avoid not getting coverage?
Honesty is the best policy when it comes to health insurance. Thus, the applicant must be honest and accurate in disclosing all conditions and health history. Concealing or falsifying health information may result in denial of claims.
First print: April 17, 2024 | 8:51 am IST