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Health insurance is one of the critical inclusions of every individual’s financial plans. Especially in today’s uncertain times, fraught with lifestyle issues, a pandemic, and exponential medical inflation, a medical insurance plan takes care of major healthcare expenses.
However, it is essential to understand the wordings of a health insurance policy before proceeding with the purchase. The jargon associated with a medical insurance plan can get confusing for a new policy seeker.
In today’s article, we seek to decode one such term - loading in health insurance. We will look at loading in insurance meaning, its types, the factors that impact it, and whether loading charges in health insurance are justified. Let’s begin.
What are Loading Charges in Health Insurance?
Loading in insurance implies the additional premium that the insurance companies charge in case of a higher risk of covering a policyholder. Built into the base policy premium, loading in health insurance is applied when covering an individual is riskier due to their age, health issues, claim history, and so on.
There are two ways in which loading charges in health insurance are applied - initial premium loading or renewal premium loading after a claim. Thus this is the loading in insurance meaning.
What is initial premium loading in health insurance?
When considering an application for a health insurance policy, insurers consider your age, occupation, gender, lifestyle, medical history, pre-existing health conditions, and certain other factors to determine the risk of insuring you. This underwriting-based premium calculation leads to a higher premium or premium loading in health insurance for certain high-risk individuals.
For instance, Mr A and Mr B both apply for the same insurance policy; however, Mr B has certain pre-existing illnesses. In this case, Mr A will pay a lower premium. Mr B, due to his higher risk of claim filing, will be applied loading charges in his health insurance plan.
What is claim loading in health insurance?
Once an insured person files a claim, the insurance company will, by default, categorise that person as high risk and apply loading charges in health insurance at the time of renewal. This is especially true for major conditions like cancer, which have a high probability of relapse and therefore repeated claims. However, this practice caused a lot of distress to policyholders as they dealt with a life-threatening illness, higher medical expenses and higher premiums simultaneously.
As per the Hospital Insurance Regulations of 2013, a health insurance company cannot change your premium for at least the first 3 years. However, after this, it is left to the insurer’s discretion to apply loading charges in health insurance due to increased health risks, higher age, etc.
Renewal claim loading has been discontinued by most leading insurers, and premiums remain constant despite claims, providing relief to the policyholders. Additionally, health insurance providers now also offer a Waiver of Premium benefit to policyholders in certain cases, such as diagnosis of critical or terminal illnesses.
What are the Factors that Affect Loading in Health Insurance?
We saw that health insurance companies apply an underwriting-based premium calculation method when determining the premium for new policies. Let us look at the factors that affect the initial premium loading in health insurance:
- Age : Higher age brings with it higher probabilities of developing serious health issues. In current times, with stressful and unhealthy lifestyle patterns, individuals start developing chronic health conditions from 35-40 years of age. As a result, to combat the higher health risks, health insurance companies have started applying loading charges in health insurance for higher age groups. The higher the age, the higher will be the loading in insurance.
- Health : Your health plays a major role in the determination of loading in health insurance. Your personal medical history, as well as your family history, certain pre-existing illnesses (diabetes, hypertension), obesity, chronic health conditions (asthma), etc., can lead to a higher premium.
- Lifestyle : If you have an unhealthy lifestyle - regular smoking, alcohol and tobacco consumption, etc. - then you will be applied a higher premium loading in your health insurance.
- Gender : Due to the prevalence of certain health issues in a specific gender and associated lifestyles, the loading in insurance is also dependent on the gender of the policyholder.
- Occupation: If you are engaged in a hazardous or accident-prone workplace or in occupations that cause prolonged exposure to certain toxic chemicals, then your health insurance premiums will be higher.
Difference Between Loading in Insurance and Exclusions
Some health insurance providers offer a choice between exclusions or loading in insurance. For instance, the policyholder can continue to receive comprehensive coverage with a premium loading in their health insurance. Alternatively, they can opt for certain exclusions; for instance, cancer and related treatment expenses will not be covered in return for lower or no increase in premiums.
Is Loading in Insurance Warranted?
A number of financial experts and insurance providers attest to the fact that loading charges in health insurance are beneficial for insurers as well as the insured.
For insurance companies, loading in insurance is a security against the higher risk of insuring certain individuals. For policyholders, premium loading in health insurance helps in two ways - fair premiums for low-risk individuals and comprehensive coverage for high-risk individuals.
For instance, two people are looking to buy health insurance, and one of them has a higher risk of health issues due to unhealthy lifestyle choices. Now, if the insurance company charges the same premium for both, it is unfair to the healthy policyholder as they might end up paying a higher premium.
Additionally, in such cases, policy rejection will be higher for people with higher health risks as insurance companies won’t be covered for the higher risks of insuring them. On the other hand, loading charges in health insurance allow high-risk policyholders to avail of comprehensive coverage.
As a policyholder, it is crucial to check the wordings and understand the exact premium outflow of your health insurance policy. Although leading health insurance companies constantly strive to ensure competitive premium pricing, features, and benefits to their customers, it is the policyholder’s responsibility to compare health insurance and verify all policy details before purchase.
So, make sure you read the policy documents, talk to the insurance experts and get a thorough knowledge of the medical insurance plan before you buy one.
If you are looking for a comprehensive health insurance policy, check out the Medicare range of health insurance plans from Tata AIG. You can choose from three different policy variants to choose the right coverage for you that fits your budget. Additionally, you can check out our super top-up plan Medicare Plus if you wish to enhance your existing medical insurance plan coverage.