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Factors that Impact Child Health Insurance Premiums

TeamAckoSept 1, 2023

Child health insurance is a vital investment that provides financial security and peace of mind for parents, ensuring that their children receive proper medical care when needed. However, the cost of child health insurance premiums can vary significantly based on several factors. In this article, we will delve into the various aspects that impact child health insurance premiums in India. By gaining insights into these factors, you can make informed decisions about securing the best possible coverage for your child's healthcare needs.



Factors that Impact Child Health Insurance Premiums in India

Child health insurance premiums in India are influenced by a variety of factors that collectively determine the cost of coverage. Understanding these factors can help parents make informed decisions regarding insurance plans. Let's explore these influential elements:

  • Age of the Child

The age of the child is a critical factor in determining health insurance premiums. Generally, younger children have lower premiums compared to older ones. This is because younger children are statistically less prone to severe health issues, leading to reduced insurance risks for the provider.

  • Medical History and Pre-existing Conditions

The child's medical history and any pre-existing conditions play a significant role in premium calculation. Children with pre-existing health issues might require more frequent medical attention, leading to higher insurance costs. A detailed medical history review helps insurers assess potential risks accurately.

  • Type of Coverage

The type of coverage parents choose significantly impacts the premium amount. Comprehensive plans that cover a wide range of medical services tend to have higher premiums. On the other hand, basic plans with limited coverage might have lower premiums but may not provide all-inclusive protection.

  • Network Hospitals

Insurance providers often have a network of hospitals where policyholders can receive cashless treatments. Premiums can vary based on the network of hospitals available. Plans with a broader network usually have higher premiums due to increased convenience and accessibility.

  • Sum Insured

The sum insured, or coverage amount, is the maximum limit up to which the insurer will reimburse medical expenses. A higher sum insured leads to higher premiums. It's crucial to strike a balance between the coverage amount and the affordability of premiums.

  • Geographical Location

The geographical location of the insured residence plays a role in premium determination. Medical costs can vary between cities and regions, impacting the overall insurance costs. Urban areas generally have higher medical expenses, leading to potentially higher premiums.

  • Family Coverage

Opting for family coverage, where the child is insured along with parents, can impact premiums. Family coverage offers a bundled insurance package, often at a more affordable rate than separate individual policies for each family member.

  • Waiting Periods

Insurance plans often have waiting periods for specific treatments or pre-existing conditions. Longer waiting periods might lead to lower premiums, but they can also limit immediate access to certain medical services.

  • Policy Duration

The duration of the insurance policy—whether it's a one-year plan or a longer-term policy—can affect premiums. Longer-duration policies might offer premium discounts compared to annual policies.

  • Lifestyle Factors

Certain lifestyle factors such as smoking or exposure to hazardous environments can contribute to higher premiums. Insurers take these factors into account as they can impact the child's health in the long run.

  • Claim History

The claim history of the policyholder can impact future premiums. A higher number of claims might lead to increased premiums as it indicates a higher likelihood of requiring medical services.

  • Economic Inflation

Economic inflation can impact medical costs and subsequently influence insurance premiums. As medical expenses increase over time, insurance premiums may also rise to accommodate these changes.

  • Add-on Benefits

Insurance providers offer add-on benefits like coverage for critical illnesses or ambulance services. While these benefits enhance coverage, they can also lead to higher premiums.

  • Co-payment and Deductibles

Co-payment and deductibles refer to the portion of medical expenses that the policyholder must pay out of pocket. Opting for higher copayments or deductibles can lead to lower premiums.

What is the ideal sum insured for a child health insurance plan in India?

The ideal sum insured for a child health insurance plan in India can vary based on several factors. Here are more details.




Medical Inflation

Account for rising healthcare costs over time.

If current hospitalisation costs are ₹50,000, estimate it to be ₹75,000 in 5 years due to inflation.

Hospitalisation Costs

Estimate expenses for hospital stays, surgeries, and treatments.

A major surgery may cost around ₹1,00,000 or more.

Healthcare Trends

Consider prevalent health conditions and treatments.

Rising prevalence of lifestyle diseases might require additional coverage.

Type of Coverage

Different plans cover various aspects of healthcare. Choose coverage that aligns with your needs.

Room rent, ICU charges, doctor's fees.


Coverage should be affordable without straining your finances.

Monthly premium should not exceed 5% of monthly income.

Add-On Benefits

Additional coverage like critical illness might require a higher sum insured.

Critical illness rider adds ₹5,00,000 to the sum insured.

Future Needs

Anticipate future medical requirements, such as vaccinations or therapies.

Orthodontic treatment costs ₹50,000; factor it in.

Wrapping up

Navigating the landscape of child health insurance premiums in India requires a deep understanding of the various factors that influence costs. By considering aspects such as the child's age, medical history, type of coverage, and lifestyle factors, parents can make well-informed decisions to secure the best insurance plan for their child's healthcare needs. Remember that each family's situation is unique, so it's important to explore multiple options and choose a plan that strikes the right balance between coverage and affordability.

Here are some common questions about Child Health Insurance Premiums in India.


How can I lower my child's health insurance premiums?

To lower premiums, consider choosing a higher deductible, maintaining a healthy lifestyle, and comparing policies from different insurers.

Are pre-existing conditions a barrier to affordable child health insurance?

While pre-existing conditions can impact premiums, insurers offer plans that cover pre-existing conditions, although they might have higher costs.

Can I switch from an individual policy to a family health insurance plan?

Yes, switching to a family plan can provide cost savings and comprehensive coverage for your child and family members.

Does the child's age affect the coverage options available?

Yes, the child's age can impact the available coverage options. Some policies have age-specific features and limitations.

How do waiting periods affect coverage?

Waiting periods can delay coverage for specific treatments or conditions, so it's essential to understand these terms before purchasing a policy.

Can I customise my child's health insurance plan with specific benefits?

Yes, many insurers offer customizable plans with add-on benefits that you can tailor to your child's healthcare needs.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.


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