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How health insurance premium prices vary based on gender

Gender is one of the factors that determine the premium of health insurance plans.

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Home / Health Insurance / Articles / Gender-Based Health Premium Plan

The cost of medical care varies between genders due to their unique needs and medical conditions. Therefore, health insurance premiums are determined based on risk and other factors such as age, pre-existing illnesses including gender. Yes, gender is one of the factors that determine the premium of health insurance plans. Want to know how health insurance premiums vary based on gender? Read ahead to find out.

Why does gender impact the health insurance cost?
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Medical treatment or needs differ between men and women. As per a 2014 survey by ASSOCHAM India, about 42% of working women were found to be suffering from chronic, lifestyle, and acute ailments such as chronic backache, depression, obesity, hypertension, heart, kidney disease, high cholesterol, etc.

Men, women are more likely to seek medical insurance for coverage specific to their medical conditions, such as maternity cover for women, and stress-related illness cover for men. Some gender may require frequent doctor visits as compared to another gender. For example, women may need to frequently visit a doctor during maternity.

With women requiring to visit doctors and medical treatments, the chances of filing regular claims are higher than men, especially during childbearing age. As for men, the probability of falling ill during the latter part of their years is higher.

In other words, the medical expenses are based on the requirement of the gender and medical condition of the individual and thereby, impacting the health insurance cost.

Is the difference significant?
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While there is a difference in the premium for all genders, the difference is not significant. The premium depends on the type of health insurance plan that you choose. Health insurance plans are designed to meet different needs; therefore, several insurers customise plans to meet various needs.

Some insurers even curate health insurance plans that are gender-specific to meet the policyholder’s specific needs better.

Factors that influence gender rating in health insurance
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Although gender is one factor that influences the health insurance premium, it plays a vital role in determining the insurance cost. Here is why health insurance premiums are set based on gender.

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The method of charging different premiums for different genders is known as ‘gender rating.’ While calculating the premium for health insurance, risk-based profiling is undertaken by insurers to assess the policyholder for risks such as mortality, accident, and morbidity. Gender plays an essential role in these risks. Since medical conditions slightly differ between genders, it affects the likelihood of a person footing the health insurance bill. 

For example, the premium can be slightly higher for women of childbearing age than men. However, the premium is lower for women than men from the age of 60 onwards. This indicates that health insurance premiums are different based on their risk profiles. The higher the risk (probability of raising a claim), the higher the premium amount.

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Medical expenses during pregnancy are higher, which is why insurers take maternity cover into account while determining the insurance premium. Health insurance plans designed to cover maternity demand higher premiums than those that do not cover maternity. 

Medical expenses such as doctor fees, medical diagnoses, pre and post-natal care, etc., are expected during pregnancy. Hence, the premium is higher if the policy covers maternity and the premium is higher.

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As mentioned, women may have to go through the childbearing process in their lives, which may require medical care in case of complications. Apart from pregnancy, women also have other health risks that men do not have. Illnesses such as cervical cancer and breast cancer are health risks for females; hence, the premium will impact these gender-specific health issues.

As for men, when they cross the age of 50 years, they may have health complications such as cardiovascular and other lifestyle-induced illnesses. Hence, the premium is slightly higher for men who come under this category.

Life expectancy
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Besides lifestyle, the average life expectancy between genders is vital for insurers to calculate the premiums. Life expectancy assessed by the insurers is defined as how long a person is expected to live.

Health insurance plans are designed based on factors such as age, gender, and the place you live. This way, insurers are able to create plans specific to each factor based on the risks, claims, and costs.

Benefits of gender-based health insurance policies
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The benefits and features of gender-based health insurance plans are designed to meet the custom health requirements of different people. Hence, many insurers have started offering women-centric health insurance policies to cater to their unique needs. A health insurance plan designed specifically for women will cover breast cancer, maternity, cervical cancer, etc. These coverages will be either built-in or will be offered as an add-on. 

Women can get the proper medical care during such situations without worrying about the medical cost for these specific medical needs. Likewise, some policies are specific for men with coverage for diabetes, stress-related medical conditions, hypertension, etc.

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To sum up, health insurance premiums are not primarily determined by gender. Age, location, existing medical conditions, etc., are other important factors that affect the premium. The difference in premium amount based on gender is minimal and not significant. Apart from medical emergencies, you need to select the right health insurance plan that suits your requirement. If you foresee medical conditions that may require special care/attention, you need to choose a suitable plan based on your specific requirements.

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Here are some of the commonly asked questions about health insurance premiums.


Is health insurance more expensive for men or women?

Although gender is one of the factors while determining insurance cost, the premium is slightly different for men and women. However, the difference is not significantly different. Factors such as age, place of residence, existing medical conditions, etc., are vital factors while calculating the premiums.

Apart from gender, what are the other primary factors that influence the insurance premium?

Following are the primary factors that impact the health insurance cost.

  • Sum insured

  • Age of the senior-most member

  • Type of policy i.e. Individual or Family Floater Policy

  • Add-ons

  • Sub-limit

What is meant by the term ‘Annual Sum’ Insured in health insurance?

The term Annual Sum Insured refers to the maximum amount that the insurer will pay in case of hospitalisation of the policy’s beneficiaries (as per the terms and conditions).

What does ‘Waiting Period’ mean in a health insurance policy?

The duration only after which you can benefit from the health insurance plan is known as the ‘Waiting Period’. Benefits such as maternity cover, critical illnesses, etc., usually have a waiting period in a health insurance plan.

What is a Critical Illness cover in a health insurance plan?

Usually bought as an add-on cover with the health insurance plan, a critical illness cover typically covers the policy’s beneficiaries against illnesses such as heart attack, stroke, kidney failure, etc.