Factors that affect your health insurance premium

Health insurance generally aims to protect a person’s health by providing financial support for the costs incurred during medical treatment, ranging from routine checkups to more critical surgeries or hospitalizations. People buy the insurance to reduce the risk of having to pay higher fees out of pocket for this care, but in return, health insurers also measure their risk of covering an individual.

To calculate this risk of coverage for an individual, insurance companies look at stored data to create risk profiles to decide whether or not to provide coverage and at what cost. If the insurance company provides coverage, there are some obvious factors that companies consider when determining premium costs, which generally include physical, medical, lifestyle, and personal risk factors.

Some of the physical and medical risk factors that can play a role in health insurance include:

  • Body weight
  • Tobacco use
  • Sex
  • Age
  • Pre-existing medical conditions
  • Family history

In general, people with a high body mass index have to pay higher premiums than people with a normal level. Obesity can lead to diseases such as diabetes, sleep apnea, and heart and joint problems. Insurance companies are not allowed to take this into account and charge a person more for their health insurance because of the increased risk of these diseases and medical problems.

The specific gender and age of the customer also play an important role. Women tend to pay higher medical premiums than men because they tend to have more reason to visit the doctor regularly, use more prescription drugs and are at higher risk for certain chronic diseases. Younger individuals generally have lower premiums because they have fewer visits to the doctor, fewer diagnosed conditions, and fewer health problems.

Pre-existing medical condition and family history can also play a role in health insurance premium costs. When the insurance company sees a pre-existing condition on a person’s risk factors, they know it can be costly to them. The insurance company may not cover the condition, but as the person increasingly has additional problems related to the condition, the insurance company may increase the cost of premiums. People with a family history of cancer or other hereditary diseases are likely to have higher premiums.

Other factors that are generally taken into account are lifestyles that affect insurance costs. What the customer does for a living can affect coverage. For example, if you work in a factory or laboratory where you are exposed to hazardous chemicals or are at increased risk of injury, your health insurance will be more expensive than if you have an office job with limited risk to your health.

See also  How To Brush Your Teeth Correctly - Personal Dental Care

Insurance companies pay close attention to statistics about health trends in specific areas, which means where you live can affect your coverage costs. If their data shows that people in your area are healthier than others, your health insurance costs may be lower than if you live in an area that is considered a high health risk.

If you’re buying health insurance for the first time and were previously uninsured, your rates will likely be higher. Research shows that people who are married live longer and are healthier than unmarried people, which means that married couples see their premiums fall.


These are some general factors that can affect your health insurance premium. When you sit down with your local independent health insurance provider, be sure to ask about these factors and how they may affect different coverage options. HDFC ERGO’s health insurance plans ensure you more benefits at affordable prices.