Understanding Health Insurance Eligibility


Jan 03 2021


The urban lifestyle is majorly characterized by irregular sleeping patterns and unwise eating habits. Such a sedentary mode of living has made us prone to frequent illnesses. The purchase of well-rounded medical insurance can cover us against repetitive visits to the hospital.

An individual health insurance policy is a necessity owing to the surge in healthcare costs. With the option to pay a health insurance premium in installments, one can steer clear of any financial burden while buying it. Thus, an individual health insurance policy can secure us against financial worries and medical woes.

You must fulfil certain tests and conditions to pass the health insurance eligibility criteria. Before enrolling for any policy, one has to know about health insurance eligibility. Follow the list of criteria given below to understand the health insurance eligibility.

Criteria for health insurance eligibility

Below are the essential criteria for health insurance eligibility:

Age: The age limit for becoming a policyholder ranges from 18 to 65 years. The health insurance eligibility for children is from 90 days to 18 years. Depending on the type of policy, there are plans for senior citizens above 65 as well. With the increase in demand for health insurance, several custom-tailored plans have spiralled up. Thus, one can choose between individual and health insurance plans for family or group.

Medical tests: To cater to our healthcare needs in a better way, the health insurance companies call for a round of medical exams. The various diagnostic tests on urine, blood and major functional organs give them an idea about the possible health risks. According to the medical report, the insurer can certify a plan to the customer that gives optimum coverage.

On the other hand, many policies do not require any medical tests. If the insured is aged 45 or less, he/she need not undergo medical procedures to qualify. Such cases require the person to submit a declaration about their good health. Many insurance companies even offer extra incentives and benefits to such healthy individuals.

Scanning pre-existing conditions: Most health insurance companies do not cover pre-existing medical conditions. When one does not undergo the round of medical exams, they must disclose their pre-existing conditions. This is mandatory as it enables the insurance company to serve you better. The insurer must have a definite knowledge of any physiological problem you may have. Also, when you opt for higher medical coverage, you need to undergo extra tests. Proper medical screening at the time of enrollment makes claim settlement easier in the future.

Common myths about eligibility for health insurance plans

Below are some common myths surrounding health insurance eligibility:

Smoking makes one ineligible to buy a health insurance policy: A large group of people having smoking or drinking habits believe they are not eligible to get insurance coverage, which is not true. As smoking puts you at a greater risk of having medical problems, you may be required to pay a higher premium or give strict medical tests. But that doesn’t make you ineligible for health insurance.

You can make a claim only after 24 hours of hospitalization: With advancements in medical science, doctors can do a number of treatments such as cataract surgery, lithography, chemotherapy, etc., in less than a few hours. And most insurance companies allow coverage for treatments done under a day's hospitalisation.

Declaring pre-existing conditions makes one ineligible for health insurance: An insurer can offer great premium rates only when you are in good health. And when you disclose your PED, the company can cover your existing condition by charging you a higher premium.


The objective of a health insurance policy is to guard us against unexpected health risks. Fluctuating health conditions and medical inflation have paved the way for different types of insurance plans. Thus, one should invest sufficient time and brood over selecting an individual health insurance policy.

It is better to start early as young individuals are prone to get a better insurance policy easier and faster. Moreover, the earlier one begins, the lower is the monthly premium charged. So, with this information on health insurance eligibility, take charge of your present and prepare for your future.

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