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How To Calculate Health Insurance Premium? | Pazcare

How is the health insurance premium calculated? For insuring people of a more mature age, the premium is often higher. Health insurance...

Amid the raging pandemic that we all have survived these past couple of years, the importance of having health insurance is undeniable. While many people already had themselves insured, a sudden surge in insurance could be seen throughout. This comes after many were left in financial debt over hospital bills and couldn’t afford the proper treatment. A survey released by the PhonePe in April 2021 showed that there has been a five-fold jump in sales for its Corona insurance policy in March vis-à-vis February.

What is health insurance and how is health insurance premium calculated?

Health insurance is a kind of insurance that covers hospital costs while facing any illness. It could cover hospital bills, operations, ambulance costs among other things. A health insurance premium is what the insured person is required to pay at intervals to renew their health insurance. While technology has taken over almost everything in our daily lives, insuretech is a booming industry that has combined the insurance market with technology, which in turn has given easy access to insurance for every individual. The reach has become limitless thus catering to every person’s needs. One can modify the insurance policy according to their wants and needs. It can cover smaller surgeries as well or just skip it altogether. Ambulance costs, pre and post hospitalization charges are also included in some policies. The insurers can choose how much they want to spend on their insurance and choose a plan accordingly.

Read: How to choose the best health insurance plan

Importance of health insurance

COVID-19 has turned the whole world upside down and made people realise that medical emergencies are unpredictable and sometimes unprecedented. With the rising costs in hospital expenses, it leaves a big mark on people’s pockets and becomes fairly difficult in times of emergencies to arrange for a large amount of money, leaving the person with mental stress!

To keep yourself away from the unnecessary financial hassle, it is important to invest in a good insurance policy that covers almost all of your financial necessities. In addition to having a stronghold on your financial position, for yourself and your family, a health insurance policy will also have the below-mentioned uses covered -

Medical expenses

Since inflation rates are at an all-time high, medical costs have been increasing rapidly. Health insurance will put you in a better position in an unprecedented scenario. It will cover the basic costs as well, which will not, in the long run, burn a hole in your pocket. Ambulance bills, medical equipment, registration charges often add up in a large amount and are not always easy to manage, insurance will minimize these expenses.

Good treatment

Choosing the right facility to get your treatment done could be a hassle as you will want the best service. You can choose a hospital of your liking without thinking about the expenses with the correct insurance policy.

Fixed premium costs

Health insurance policies often provide benefits with a fixed amount of premium. This means that you can get health insurance with a fixed premium amount for the whole year. It is a boon for the insurance takers as the increase in the medical sector will not affect them. They will be paying a fixed amount for the entire duration of the policy.

Tax benefits

For every health insurance policy, tax benefit is also provided under Section 80D of the Income Tax Act. For tax redemption, a specific premium amount is eligible for the same. If you pay the initial premium amount through cash, the tax benefits are not provided. But with any other payment mode like cheque or cards, you can avail the benefits under Section 80D of the Income Tax Act. On Tax Benefits, note that exemption is applicable under Section 80D only if one has opted for the Old Tax regime till (2019). Under the new Tax regime, Tax benefits under Section 80D are not applicable whether for self or parent(s)/in-laws.

How is the health insurance premium calculated?

Like the many insurance policies that are available for the Indian public, there are many criteria for calculating the health insurance premium. It varies from company to company. Personal history may or may not be taken into account by your insurance providers. For insuring people of a more mature age, the premium is often on a higher-end than for insuring someone who isn’t. Geographical rating is also taken into account which involves culture around that area and industrial development of the same. It also varies with the type of coverage and the amount of coverage. The bigger the coverage and amount, the higher is the premium.

Some reliable insurance providers who have their own health insurance premium calculators

  1. HDFC Ergo
  2. Bajaj Finserv
  3. ICICI Lombard
  4. Aditya Birla Health Insurance

Read: What is claim settlement ratio?

So how to calculate health insurance premiums for a group plan?

The health insurance premium for your group plan is calculated based on various factors like

The average age of your employees

Your insurer calculates the group health insurance premium based on the average age of your employees. According to the insurer, as the age increases, the medical risks associated with the employees go up. 

So your insurance company raises the premium to compensate for the risks. 

So according to this a younger workforce where the average age of employees is around 20 to 30 may pay lesser premiums than the ones with an average age of 40 to 50.

The type of plan you choose

In a group health insurance plan, you have options of choosing

  1. E - Employee only
  2. ESC - Employee, spouse and children
  3. ESCP - Employee, spouse, children, parents or in-laws.

The premium increases according to the increase in the dependent members. 

For instance, the premium paid towards the ESCP-plan will be higher than the E-only plan.

The sum insured 

The sum insured is the maximum amount the insurer will pay the policyholder in case of any unforeseen events.

You can choose this based on the type of hospital your employees choose, the number of dependents covered, etc. You can choose the sum insured from as low as Rs.50,000 to Rs.10,00,00 or more. 

Yes, the premium increases with a higher sum insured but the increase is not directly proportional. 

For example, let us assume that the premiums for respective sum insured are

sum insured

So, you can see there is no linear increase between the premiums of Rs.50,000 and Rs.10,00,000.


The concept of health insurance is changing dynamically. In the current scenario, it not only pays your medical bills but also covers other benefits. Now, these benefits are add-ons.

You can choose additions to your group health insurance plan like maternity insurance, health and wellness programs, dental insurance, doctor consultations and many more. 

Your premiums increase based on the add-ons you choose.

Claim history

If you are purchasing group health insurance the first time for your organization, then you need not worry about this. However, if you are not new to purchasing a group health insurance plan for your team, then your insurer may look at the claim history you had in the past to decide your premium.

In case, you have a higher number of claims raised in the past, it may lead to slightly higher premiums.

Nature of job

The type of job also influences the premium towards your group health insurance. If the health risk associated with your job is high, then the premiums you pay towards the plan may also increase. 

For instance, if you work in the mining industry, your health insurance premium may be slightly higher than that of the IT industry.

To sum up

Getting yourself insured might be the best investment you can make, keeping in mind the pandemic that arose. Even without it, the need to get yourself insured is a very practical and economical approach to take care of you and your family’s health. By paying a fixed amount every year you can get an insurance policy of your choosing, covering any and every medical treatment and ailment you require.

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