Loading in Health Insurance
- What is Loading?
- Factors That Affect Loading
- When is Loading Charges Warranted?
Health insurance policy in this era has become essential for each individual in the family. As it ensures a safety net against all your odds, whether it's financial or medical. You won't want to pay hefty bills for healthcare for every individual combined. But there's a condition of paying a guaranteed premium to the insurer who promises to cover you in an emergency without worrying about financial loss.
But what if you couldn't pass the eligibility criteria of a health insurance policy? Well, in such cases, the insurance companies impose an additional charge in the form of 'loading'. But what is loading in health insurance? How does it work? Why company impose loading charges in health insurance plans? Does every health insurance policyholder need to pay loading charges to the insurer? This article covers all these questions about loading charges in health insurance, read further to know more about it.
Loading charges in health insurance is an additional cost that a policyholder agrees to pay the insurance company. In return, the insurer guarantees to provide comprehensive coverage against the financial or medical odds of the customer. But it does not apply to all the health insurance plans out there. Loading charges are only applicable in a policy where the customer seems to be a high risk to the insurer. It largely varies how much will be your loading amount, depending upon factors such as age, lifestyle, professional risks, family medical history, and the chances of you making frequent claims, etc. Therefore, the amount of risks involved for the insurance company will ultimately decide your loading charges in your health insurance policy. Let's explore more about loading and how it functions generally, in the next title.
We have seen what exactly loading means. But how does it work in a health insurance policy? Let's delve into how loading works in health insurance.
So, when a person goes to buy a health insurance policy from say, ABC company. The insurance company ABC may ask the customer about their age, health status, any pre-existing condition, the residential area where they live, and the type of profession they're in, etc. All these queries are asked before issuing the policy to an individual. If the insurance company feels, that such customers are under risky criteria, they ask them to pay additional charges carried on their regular premiums. Such that the policyholder is liberated from all the financial burdens arising due to hefty medical bills later. However, if the customer agrees to this loading charges criteria, the company issues a health insurance policy in their name. Quite confusing right?
Let's learn this through a table, as it'll help you get a deeper understanding of how loading works:
| Criteria of Loading | Example 1 | Example 2 |
| Name and gender | Rohit (Male) | Suman (Female) |
| Age | 25 | 25 |
| Health status | Smoker | Non-smoker |
| Residential specific | In a hilly region of Himachal | In the city arc of Indore |
| Occupation | A delivery guy | A software developer |
| Medical history | Diabetes and Obesity | None |
| Frequency of Making Claims | 200% higher than normal | 50% or lower than that |
| Premiums | Base premium+loading charges | Base premium only |
There might be two ways through which loading in a health insurance policy may be applied:
Here is a table that shows the factors that affect loading charges in a health insurance plan:
| Aspects | Explanation |
| Age of the Policyholder | An individual with a maximum age limit or a senior citizen is prone to more critical diseases. Hence, they are likely to get higher loading charges with their premium than a young aged policyholder. |
| Medical Condition | If a group of people with an age of 35 years has the same kind of health policy, but one of them has a medical condition of diabetes. Then he/she has more probability of passing away earlier or making frequent medical claims. Hence, the loading charges imposed on their policy will be higher than healthy ones in the group. |
| Pre-existing Medical Conditions | If the applicant of a health plan already has a pre-existing disease, the insurance company takes the case as a high-risk profile. Hence, heavy loading charges are imposed on this kind of policyholder. Since they are prone to more claims, they get higher loading charges to pay with premiums. |
| Lifestyle | People who smoke or intake alcohol frequently have more chances of passing away or getting death-threatening diseases at a young age. So, smokers/alcohol consumers usually have to pay higher loading charges than non-smokers on their health plans. |
| Gender | Women policyholders have a lower mortality rate than men around the world. Hence, they're more likely to get less premiums and loading charges on their policy. |
Other than the common factors affecting loading charges on your health insurance plans, more aspects unfold higher loading charges. These additional factors depend on the type of policy, the term of the policy, and the individual who's buying the policy.
Read further, what are the factors that may create a huge impact on the loading charges:
| Factors | Supporting Statement |
| Field of Occupation | If the policyholder is associated with a dangerous or high-risk occupation, the chances of sudden/unexpected death become nearly inevitable. In such cases, the insured needs extended care, resulting a higher compensation from the insurer. As an outcome, you are getting more coverage but only with higher loading charges. |
| Residential Region of the Policyholder | Some of the regions or cities have a higher risk of health complexity with their people where climate, food, security, and administrative support are vulnerable. For example, Delhi is one of the most polluted cities, so the policyholders residing around Delhi would be more sensitive. Hence, they are likely to pay more loading charges against coverage of their health insurance policy. |
| Physical Appearance | People with heavy body appearance and suffering from obesity are prone to diabetes, hypertension, and other critical illnesses. So, they tend to get additional charges with premiums. |
| Medical History of the Family | A policyholder with an extended medical history from generations, such as cancer, TB, diabetes, etc is considered a high-risk profile. So, they could get health insurance with loading charges. |
Many times, a policyholder may get a health insurance plan with the clause "exclusions" instead of "loading". But what does it mean? This means the policyholder needs to pay only a standard amount of premium against their health insurance policy. But it may not cover certain medical conditions under the same. Meaning, that the particular condition will be excluded or not covered in the policy.
Let's understand this with an example: If you have a health insurance policy that says "cancer-related medical care is excluded". It means you won't be able to get any claim amount for cancer.
Generally, insurance companies keep the maximum age of buying health insurance up to 65 years. But, depending on the insurer, the maximum age can vary or get extended to 80 years or more. However, it's self-understood that these policyholders have a high risk of suffering from major critical health issues. Such as, elderly people are prone to hypertension, cancer, diabetes, asthma, low blood pressure, etc. Even if they have an adverse family medical history, they fall under a special category of consumers.
Hence, providing them with additional coverage against frequent claims and potential medical care regularly is much needed. This is the explanation that justifies loading charges in health insurance plans on special terms.
At the time of issuance, the customer or policy applicant undergoes medical underwriting. Medical underwriting is the process where the customer is asked about any pre-existing medical disease or a family medical history, etc. If the individual is not found with any medical condition, their health insurance premium will be normal or the same.
However, if they already have a pre-existing condition, they will be asked to pay additional charges on the base premium amount which is called loading. When the applicant agrees to pay loading charges against their policy coverage, the insurance company issues a health policy in their name. Let's understand this with an example:
Consider, that Manish has a pre-existing condition of diabetes and he takes frequent insulin injections. Additionally, he also takes diabetic drugs as medication that ranges above 1200 mg of daily usage. The insurance provider will impose loading charges on the health plan that he's buying. Because he has more risk of getting ill with diabetic diseases, he will be charged an additional amount over the base premiums in the form of a loading.
The right amount of loading charges is considered to be beneficial for both the insurer and the insured. As it allows the insured to get comprehensive coverage incorporated with claims for frequent medical care.
On the contrary, it secures the insurance providers' side against highly risky financial loss, associated with the anticipated risk of the insured. Getting higher medical claims in this case is prominently possible. So, if they do impose high loading charges, they will end up paying a hefty amount for high-risk customers.
Even when all the criterion of loading charge imposition is justified, the policyholder needs to assess loading charge conditions in advance. These are a few tips to consider checking out about loading charges while buying a health insurance policy:
Insurance providers may charge an additional fee on your health insurance policy, depending on age, occupation, pre-existing diseases, medical history, etc. The charges of loading are usually imposed when the policyholder is more likely to make frequent claims against medical care. In the end, they end up paying extra charges with their monthly premium due to particular circumstances. But in return, it ensures that both the insurance provider and the policyholder are mutually saved from high-risk financial loss.
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