India has witnessed remarkable improvements in healthcare facilities, leading to the rise of world-class hospitals and skilled doctors. While advancements in treatment have made it possible to manage critical illnesses like heart disease and cancer, accessing these treatments often comes with a hefty financial burden.

Health insurance plays a vital role in providing economic security against medical expenses. When purchasing a health insurance policy, one of the key terms you’ll come across is the primary insured. One key advantage of health insurance is that it empowers policyholders to receive timely and necessary medical treatment without worrying about financial strain, making quality healthcare accessible to all.

Also Read: Points to check before buying health insurance

Who is primarily insured?

The primary insured in health insurance is the actual policyholder in a health insurance plan who is responsible for paying premiums to the insurance company and making coverage decisions. This individual typically enrolls in the policy and may be the sole insured or include dependents such as a spouse or children.

Age

The primary insured must typically be 18 years or older to purchase a policy. Eligibility criteria may vary across insurers, so reviewing policy terms or consulting the insurer is essential.

Health Condition

Insurers assess the applicant’s health, often requiring a medical checkup. Disclosure of pre-existing conditions like diabetes, hypertension, asthma, thyroid disorders, or high blood pressure is mandatory at the time of purchase.

Employment

For employer-sponsored health insurance, the primary insured must be an active employee of the company providing the policy.

Income

Certain government-sponsored health plans have income-based eligibility criteria for the primary insured.

Responsibilities of the Primary Insured in availing of the benefits of health insurance

As the policyholder, the primary insured has several key responsibilities, including:

  • Premium Payment: Ensuring timely premium payments to keep the policy active.
  • Understanding Policy Terms: Knowing the policy’s inclusions, exclusions, deductibles, co-payments, and waiting periods.
  • Filing Claims: Initiating and managing claims for medical expenses covered under the policy.
  • Updating Information: Keeping the insurer informed about any changes in personal details, health status, or family composition in the case of a family floater plan.

Bottom Line

Understanding the role and responsibilities of the primary insured is essential for making informed health insurance decisions. Whether opting for an individual or family floater plan, the primary insured ensures that medical expenses are managed efficiently, providing peace of mind and financial security.

Choosing the right health insurance plan is crucial, so always compare policies, read the fine print, and seek expert advice or a health insurance advisor before making a decision.

FAQs

What is the difference between the Primary Insured and the Policyholder?

Primary insurance pays first, while secondary insurance covers remaining costs like co-pays or deductibles.

What is Primary and secondary health insurance?

Primary insurance pays first, while secondary insurance covers remaining costs like co-pays or deductibles.

Can the primary insured add family members to the policy?

Yes, in a family floater health insurance plan, the primary insured can add dependents such as a spouse, children, or parents.

Can the primary insured be changed?

Most insurers do not allow changes to the primary insured during the policy term, except in special cases like the policyholder’s death.