What Is Primary Insured in Health Insurance?

Are you looking to buy a health insurance policy for yourself? Your family, perhaps? You’re likely to come across several terms to get a better understanding of the coverage. Between all the technical terms and policy features, understanding what the primary insured in health insurance stands for is very important.

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Primary Insured in Health Insurance

The term primary insured in a health insurance plan refers to the individual who is the main policyholder. This person is responsible for paying premiums and making coverage decisions.

If it’s an individual health insurance policy, the insured person automatically becomes the primary insured. However, in the case of a family floater plan, where multiple family members are covered under one policy, the primary insured is the member who pays the premium and manages the policy. The rest, such as parents, spouse, or children, are listed as dependent insured members.

Who Can Be the Primary Insured in Health Insurance?

In India, if an individual meets certain criteria, they can be eligible to become the primary insured.

Age

The primary insured must typically be at least 18 years old to purchase the policy.

Health Condition

Insurers evaluate the primary insured’s health status, which often requires a medical check-up. It’s mandatory for you to disclose any pre-existing condition like diabetes, thyroid problems, asthma, hypertension, etc. at the time of policy purchase.

Employment

For health insurance provided by an employer, the primary insured is required to be an active employee of the company offering the coverage. In most cases, when the employment ends, the policy ends too.

Income

Certain health plans, usually government-sponsored, tend to have an income-based eligibility criteria for the primary insured.

It is possible for different insurers in the market to have varying eligibility criteria. Be sure to review the policy details or contact the provider for any clarifications.

Primary Insured vs Dependent Insured

Primary Insured	Dependent Insured

Main policyholder	Covered under the same policy with other family members
Name appears on primary policy documents	Name appears under ‘Insured Members
Registered contact with the insurer	No direct contact with the insurer
Eligible for tax benefits if paying premium	Not eligible for tax benefits unless they pay the premium themselves
Can file claims for self and insured members	Can initiate claims for self, often through the primary insured

What If the Primary Insured Can No Longer Manage the Policy?

There are times, either due to death or moving to another insurance plan, when the primary insured will not be able to continue managing the policy. What happens then?

If the Primary Insured Passes Away During the Policy Term:

The insurer can transfer the role of the primary insured to another eligible family member covered in the plan.
The nominee or next of kin can reach out to the insurer for the required change.
After the new primary insured is assigned, the coverage continues for the rest of the plan members.
If no action is taken, the policy may lapse during the renewal period.

If the Primary Insured Wants to Exit the Plan:

A request can be made to the insurance company to transfer the primary insured status to another eligible family member, as per IRDAI guidelines.
The insurer may ask for updated KYC documents and a formal endorsement.

Advantages and Responsibilities of Being the Primary Insured

While being the primary insured in health insurance has its perks, it’s not without certain responsibilities that must be carried out in a timely manner.

Advantages

Direct access to and control over policy details.
Can avail tax deductions under Section 80D of Income Tax Act for premiums paid (up to ₹25,000–₹1,00,000 based on age and relation).
Can initiate a claim for self or any covered family member.

Responsibilities

Keep track of documentation, renewal and premium due dates.
Ensure all details and documents are up-to-date.
Coordinate with the insurer on policy updates and claim-related queries.

Frequently Asked Questions

What is the difference between the primary insured and the policyholder?

The policyholder owns and pays for the policy, while the primary insured is the main individual covered by the policy. In most cases, they are the same person.

Who is eligible for the tax benefit: the primary insured or the one who pays the premium?

According to Section 80D of the Income Tax Act, the tax benefits go to the person who pays the premium, not necessarily the primary insured. If a dependent insured pays from their own income, they can claim the benefit.

What happens if the primary insured misses a premium payment?

The policy may lapse, which could cause a loss of coverage and benefits. However, insurers typically offer a grace period to clear the payment and avoid cancellation.

Can a senior citizen be the primary insured in a family floater plan?

Yes. Anyone who is 18 years of age and above can become the primary insured. However, premiums may be higher if the primary insured is a senior citizen.

Written by Roocha Kanade

2.5K Linkedin Followers

Reviewed by Dr. Harshita Dahiya

Health Insurance content enthusiast who turns complex topics into easy, binge-worthy reads—fueled by SEO, creativity, and way too much chai! Loves juggling multiple projects, cracking impossible deadlines, and sprinkling humor into the mix. When not geeking out over digital trends, you'll find her lurking on Quora and Reddit, planning the next getaway, or passionately decoding all things health and insurance!