What Are The Factors To Determine Eligibility Criteria For Mediclaim Policy?


3 min read

Updated on Dec 28, 2022

Increased awareness and the covid-19 pandemic have shot up the demand for Mediclaim policies. More people than ever are looking to take a medical policy to safeguard their loved ones from sky-high medical expenses. When purchasing a medical policy, you should know the factors that determine your eligibility criteria. Read on to find out what they are.

Factors that determine your eligibility criteria for health insurance plan in India:

1. Your age:

For most medical insurance policies in India, the minimum entry age for the person buying the policy is 18 years old. In some cases, that entry age maybe 21 years. You can buy a medical policy for your family members which includes your children and parents. Coverage for children starts at 90 days or three months and usually extends to 20 years. The maximum entry age for adults is 65 years and can be up to 70 years plus in certain cases, depending on the insurance plan and insurer.

2. Pre-existing conditions:

Adults over the age of 45 are required to undergo medical tests before getting insurance coverage. If you are not over the age of 45 or are not asked to undergo tests, you will nevertheless, be asked to submit a declaration of any pre-existing conditions. Declinable pre-existing conditions may include AIDs/HIV, severe mental illness, and so on. If you hide a pre-existing condition and your insurer finds out, they will reject your medical insurance claims. Moreover, for many pre-existing conditions, there is a waiting period. So, you may not get coverage immediately but after a waiting period, your medical insurance could cover it. Coverage for pre-existing conditions varies from insurer to insurer.

Factors that do not determine your eligibility criteria:

There are many myths that surround health insurance policies in India. Here are some of them:

1. Smoking and drinking:

If you are a smoker, that does not automatically mean that you will not get health insurance coverage. This goes for drinking as well. Your insurance premium will increase as these lifestyle habits could result in medical issues, but you remain eligible for medical insurance.

Also Read: What is Group Mediclaim Insurance Policy and Its Benefits for Employees?

2. Declaration of pre-existing conditions:  

People often think that if they declare all their pre-existing conditions then they will not be able to purchase a medical policy. But this is not true. You will need to compare insurance brokers to see which ones offer coverage. Your pre-existing condition could mean a higher premium but does not mean non-eligibility.

3, Non-renewal of medical policy on a due date means no benefits:

You have a window of 15 days to renew your medical policy from the policy expiry date. If you renew it within this time, the insurer will allow your benefits such as coverage for pre-existing conditions, and so on, to continue. 

In conclusion

There are many health insurance policies available today. But before you jump to purchase the first one on offer, do your due diligence, and research thoroughly. Compare insurance brokers and what they can offer. And then only choose the one that offers you the best coverage at the best premium rates.

Also read: What is Pradhan Mantri Atmanirbhar Swasth Bharat Yojana (PMASBY) Scheme?

Found this post informational? Browse PayBima Blogs to read interesting posts related to Health Insurance, Car Insurance, Bike Insurance, Term Life Insurance and Investment section. You can visit PayBima to Buy Insurance Online.

Oct 20, 2021
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PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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