Insurance Health Insurance

Risk Factors for Individual Health Care Insurance

    Age

    • The age of the applicant is an important risk factor in individual health insurance. The older the individual, the more likely the occurrence of health problems. A 60-year-old will likely pay two to four times the premium of a 25-year-old, according to KaiserFamilyFoundation.org. Many states are allowed to base an insured's premium based on age in addition to other factors.

    Denial of Coverage

    • In many states, insurers are permitted to deny coverage based on an applicant's health history if it includes certain conditions. Some of the more common past conditions include heart disease, stroke, rheumatoid arthritis and kidney stones. This can make it difficult for a person with this type of history to obtain coverage anywhere on the private market without having to pay an exorbitant premium.

    Pre-existing Conditions

    • Individual health insurers also take into consideration any preexisting conditions that may have occurred. If it doesn't deny coverage completely, the insurer may issue a policy with a rider that excludes coverage for the preexisting condition or place a time frame as to when the rider may be lifted in the future. In other cases, the insurer may "rate-up" the premium by a certain amount, such as 20 percent.

    Smoking

    • Those who smoke are considered to be a higher risk for health insurance due to the greater likelihood of contracting conditions such as heart disease, emphysema or lung cancer. Most individual health insurers have separate rate charts for smokers and non-smokers, or may issue a smoker a standard rate as opposed to preferred

    Weight

    • Weight is also a risk factor that's considered. Most health insurers make use of tables or charts that take into account how much an applicant weights in relation to height. Depending on the outcome, the individual could be issued s standard or preferred rate, be rated up, or be denied coverage completely.

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