Factors Determine the Cost of Health Insurance

Insuring yourself to secure health through Health Insurance is the best way for everyone. Each person should know how health insurance cost is calculated. 

Major two categories of health insurance;

 1) Individual Health insurance           

 2) Group Health Insurance.


Individual Health Insurance is based on individual‘s health and lifestyle. This is assured between the buyer and the insurer. Some insurers give this type of insurance for buyer and its family.

Group Health Insurance is insured by the employer and employees group selected by human resource department of the employer. Health factors of the whole group are calculated under this policy.

The major factors, which determine the cost of the health insurance:



1) Person’s Insurability


Under Group Health Insurance, health factor of the whole group is taken into consideration in order to determine the cost.  While under Individual Health Insurance, the cost of insurance is evaluated on the basis of the person and his/her family. For this, an application form is filled out to cover the plan including some questions regarding health concern.

Under individual health insurance policy, some insurer may deny insuring the person who has pre-existing health problems.

2) Person’s Health Condition


If a person is getting covered under Health Insurance, company inquire and dig ups health history of the person. Laboratory test, urine, blood sampling etc. has been done under this process. In case, if the diseases such as Blood Pressure, Cancer, Heart Disease or any other major cause found, it will affect the premium plan of the insurance policy.

If a person is inspected using tobacco, smoke, drink, he/she will pay an additional cost based on their habit of using these products.

Generally maternity is not covered under individual health insurance. If a person wants this plan, it will also cover complication of pregnancy and many other issues.

3) Choice of Insurance Plan


Coverage also depends on the choice of plan. This will affect the premium cost. The plan is summed up by the term “Out of the Pocket Maximum”. This depends on the maximum money; a person would pay for co-payments and deductions.

4) Location of the Person


Location where the person lives such as country, city, zip code etc. will be used to determine the premium cost. In general, urban places are more expensive than rural places.

5) Age and Gender


Premium cost also varies from age-to-age. The older the age, the more premium will cost for the health of the person. The reason behind is as a person gets older, more health problems occur, in results of more visit to the doctor.

Also, premium cost also varies from gender-to-gender. Men of the same age of Women have lower premium cost. It is considerable from the facts that women are more likely to go to the doctor than men at the younger age.

When a person understands these factors in determining premium cost of health insurance, it will easier to find the best-suit plan as per person’s choice.

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