Introduction: Health insurance can reduce out-of-pocket expenditure and improve equitable healthcare access, particularly in rural populations. Despite expansion of government-sponsored schemes in India, gaps in awareness and utilization persist. This study assessed knowledge, attitude, and practice regarding health insurance and their association with selected sociodemographic factors.

Methodology: A community-based cross-sectional study was conducted among 300 adults aged ≥18 years in selected wards of Puzhakkattiri village, Kerala, India, from July 2024 to March 2025. Stratified and systematic random sampling was used. Data were collected through household interviews using a semi-structured, pre-validated questionnaire. KAP scores were categorized as good or poor based on mean score cut-offs.

Results: Among the 300 participants, good knowledge regarding health insurance was observed in 58.0%, good attitude in 67.0%, and health insurance coverage in 32.0% of participants, while 38.5% of the insured participants demonstrated good practice regarding utilization of health insurance. Knowledge regarding health insurance showed significant association with age, gender, educational status, family size, chronic illness in the family, and history of hospitalization with financial loss. Attitude towards health insurance was significantly associated with age, family type, family size, presence of relatives or friends with health insurance, chronic illness, healthcare preference, and history of hospitalization with financial loss. (p<0.05).

Conclusion: The study showed satisfactory knowledge and favorable attitude towards health insurance, although utilization remained low among the rural population. Sociodemographic and healthcare-related factors significantly influenced knowledge and attitude regarding health insurance.

KEYWORDS: Health Insurance, Knowledge, Attitude, Practice, Rural Population, Health Awareness, Healthcare Utilization, Socioeconomic Factors.