Health Insurance Eligibility: A Quick Guide

Today the need for a health insurance policy is felt almost in every household. Even though people used to think that investing in medical insurance is unnecessary, researching and then opting for the best health insurance plan in India is prudent.

Keeping in mind the current pandemic scenario and also the rise in medical costs and diseases everywhere, it’s better to be safe than sorry! Also, such health insurance plans can offer the financial protection needed during any emergency medical mishaps.

We’ve had a steady rise in medical costs all over the country. Getting treated in a good healthcare facility is important to get well soon. Unfortunately, the high medical bills make it impossible to choose the right hospital for treatment. Thus, a health insurance policy can come in handy and keep all financial worries at bay!

Also, with the cashless hospitalisation benefit offered by most insurers in India, like Tata AIG, the policyholder can get treatment at one of the network hospitals without stressing about paying the huge bills beforehand.

Health Insurance Eligibility Criteria

Here are some of the necessary eligibility criteria that are considered by the insurer while offering health insurance plans to an individual –

  • Age – A policyholder needs to be anything between 18 years to 65 years to be able to opt for a medical insurance plan. For children, the criteria for age are from 90 days to 18 years. There are certain plans solely curated for senior citizens as well. Again, certain tailor-made and comprehensive health plans with better coverage are also rising these days. Hence, considering the policyholder’s age is important to choosing a policy.
  • Medical Check-up – To cater to the healthcare needs of the policyholders in a better manner, insurers generally ask for a complete health check-up before offering a plan to the policyholder. So, according to the diagnostic test reports, the insurer can certify a medical insurance plan to the policyholder with the best coverage benefits.
  • Pre-existing Medical Conditions – Most insurers in India will not offer coverage for pre-existing medical conditions. To purchase a policy, one must disclose their pre-existing health condition. Insurance companies are mandated to serve customers better. Therefore, they have to be aware of physiological issues in their policyholders to offer the right medical coverage benefits.

Myths Related to Health Insurance Eligibility Verification

Below are a few common myths related to the health insurance eligibility criteria –

  • Smokers cannot buy health insurance – People with smoking and drinking habits are not exempted from buying medical insurance by insurers. However, these habits can put one at a higher risk of getting serious ailments. Hence, they are required to pay more premium amounts.
  • Declaration of pre-existing health conditions makes one ineligible to buy insurance – Insurers can only offer better premium rates when the policyholders are in good health. So, declaring pre-existing health conditions is necessary to cover any pre-existing illness that may get serious. However, the insurers might charge a higher premium in such cases.
  • Claiming is possible only after 24 hours of hospitalisation – Certain medical treatments can be done in just a few hours, such as lithography, cataract surgery, chemotherapy, dental procedures, etc. And most insurers in India offer coverage for such OPD medical procedures.


Now that you know the eligibility criterion to buy a health insurance policy in India, it’s better to start looking for options online. You can also check the premium amounts on a health insurance calculator online. Such a health insurance premium calculator in India will help you understand your premium costs and policy inclusions and exclusions.