Who are Low-Risk, Moderate-Risk and High-Risk People? Is Health Insurance Available for Them? | 4006


Who are Low-Risk, Moderate-Risk and High-Risk People? Is Health Insurance Available for Them?

Diseases and illnesses are uncertain and may affect any individual at any point in life. Not only uncertain, but diseases and illnesses can be distressing as you have to manage health as well as finances. It would be great if one was aware in advance if any disease is going to affect them in the near future so that they can make necessary arrangements for the same. But unfortunately, this is not the case.

We often don’t get considerable time to manage funds when a health emergency strikes. This is why having a reliable health insurance policy is deemed important. Health insurance offers a financial cushion to manage huge bills related to treatment at the hospital. In short, a heaBut the question is-can everyone gets a comprehensive cover for their medical requirements? Different individuals possess different risks, on the basis of which a health insurance policy is underwritten by an insurance company. Based on the risk he/she possesses, an individual is classified as low risk, moderate risk, and high-risk application and is dealt with accordingly.

Who are Low-Risk, Moderate-Risk, and High-Risk People?

The three categories are defined below:

1. Low Risk Applicant: Normal healthy people who are young and are not affected by any disease or lifestyle habits such as drinking, smoking, etc., are considered to be low-risk applicants. People with low risk have high chances of getting health insurance plans, in comparison to the other two categories. This is because the insurance companies have lesser liability towards them as they are comparatively healthy and might not make frequent claims under their health insurance plans.

2. Moderate Risk Applicant: People who possess a little higher risk than the people in the first category are categorised as moderate risk.

3. High-Risk Applicant: Health insurance companies see the high-risk category as the most dangerous category of all. This is because people in this category are not healthy enough and generally have some pre-existing disease. This increases the liability of the insurance company as they are more likely to make health insurance claims. People who fall into this category usually have to pay higher health insurance premiums to get the required cover.

Here are some points that classify high-risk applicants and how the insurance companies deal in such cases:

1. Existing Diseases: If the proposer is already affected with any disease at the time of buying a health insurance policy, then he/she would be classified into a high-risk category depending on the severity of the disease.

2. Family History: Insurance companies also take into consideration to determine if there is any hereditary medical condition. For instance, if someone in your family is suffering from heart ailments, then you are also at high risk for the same. Hence, you will be categorised as a high-risk applicant by the insurance company.

3. Lifestyle Habits: If lifestyle habits such as chewing tobacco, drinking alcohol, or smoking are done on a regular basis, then the person is categorised as a high-risk applicant. This means that you will be required to pay a higher premium in case you are a chain smoker or a regular drinker.

4. Occupation: The insurance company considers your occupation as a means to measure the risk associated with you. Individuals, who are occupied in risky professions are considered to be high-risk individuals. Some professions, where the possibility associated with medical contingencies is high include adventure sports instructor, aeronautics, aviation, mining, etc. The premium paid towards health insurance plans is high for these individuals whereas the coverage is usually limited.

All the afore-mentioned categories are known to be high-risk categories and insurance companies have different means to deal with applications which reflect these high-risk profiles. The insurance company may:

  • Limit the offered Coverage
  • Increase the Premium
  • Rejection of the plan

Due to the safety measures adopted by the insurance company, you should not get worried in case you fall under the high-risk category. Purchasing a health insurance policy is necessary and disclosing all the important facts is also important. In case, you hide any crucial facts which reflect any impact on your risk due to the fear of above steps, then it is important for you to know that you lie at a high-risk of getting your claim rejected.

If there is any medical emergency, the insurance company decides the nature of the claim raised and in case it is revealed that the claim is made because of any undisclosed fact, then your claim may get rejected.
Therefore, it is crucial to completely disclose the information in the proposal form rather facing the brunt of claim rejection by your respective insurance provider. It might happen that you may be required to pay a higher premium with a less coverage amount or you may not be able to get the health insurance policy altogether, however, it is still better than facing any claim rejection.

Best Ways to Purchase Health Insurance with High-Risk Profile

Purchasing a health insurance plan may become a hard deal in case you are falling under a high-risk category. Highlighted below are some of the best methods to purchase health insurance with high risk profile:

  • Certain insurance companies provide dedicated health insurance plans for certain illnesses like diabetes, heart-related ailments, hypertension, etc which offers insurance to individuals with such medical conditions.
  • Insurance providers take into account various parameters like quantity and frequency of usage of tobacco, consumption and addiction duration. In certain cases, if the policy buyer chooses to quit smoking, then the insurance provider might not charge any additional premium and treat them as a non-smoker after certain years down the line.
  • You can choose to buy a top up cover, which can act as an individual health insurance policy. While a  basic health insurance policy reimburses the expenses up to the defined sum insured, and once the decided limit is met, the top up plan offers coverage for medical expenditure. As top up plans come with deductibles, they are quite affordable. Moreover, it is advisable to get coverage for excessive medical expenditure that arises because of illnesses or diseases beyond which the current medical insurance plan does not offer coverage.


An insurance company, if you fall in the high-risk category, may take some safety measures. But as a customer, you should not get demotivated by these measures. Also note that as important as buying a health insurance policy, equally important it is to disclose all the health-related facts to the insurance company. This will save you from trouble at the time of claim settlement. So, better than suffering later at the time of claim, it is recommended to make complete disclosure in your proposal form.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.


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