Your Guide to Pre-Policy Medical Check-Ups in Health Insurance

Health insurers requires pre-policy medical exams. This reduces their coverage risk for offering health insurance. Only older applicants need this.

Today’s professionals are considering health insurance to ensure quality medical care at a lower cost due to rising medical costs and disease susceptibility. There are many health insurance companies offering plans for every budget and need.

Most health insurance policies require a pre-policy physical. Why is this pre-policy health check-up required?

What’s a pre-policy medical exam?

The prospective policyholder must undergo a series of tests and procedures before the insurance company accepts the policy and provides health coverage. If the policyholder is over 40 or 45, the insurer must perform these tests to determine medical fitness and pre-existing conditions. You can use a medical insurance app to check these details in detail. They usually are pretty clear about it; in case of specific medical issues, they may ask for more tests.

If the policyholder chooses a Sum Assured above average, the insurer’s risk increases, necessitating pre-policy checks. Health cover above Rs. 10 lakhs requires a battery of medical tests. *

Why a pre-policy medical exam?

Most health insurance policies require pre-policy medical tests. These tests help insurance companies assess policyholder health. Such a test would reveal pre-existing medical conditions, allowing the company to determine coverage.

Claims depend on the tests too. The claim could be denied if the company can prove that the illness was caused by a pre-existing medical condition that was not disclosed or that the policyholder intentionally withheld medical information. A pre-policy test records the policyholder’s medical history, making it easier for the insurance company and policyholder to investigate and file claims. *

Health insurance pre-policy exam: what tests are done?

Each insurer assesses a life assured’s medical risk differently. The policyholder’s age and coverage amount determine the risk on a grid. Policyholder tests depend on these two factors. Blood pressure, ECG, lipid profile, blood serum, complete blood count, blood sugar, etc. You can see the full list on your mobile by using any app for health insurance. 

Medical tests: who pays?

The insurance company must pay at least half of the test expenses while the policyholder pays the rest, according to IRDAI rules. Due to market competition and to reduce policyholder burden, some insurers pay for tests. Some health insurance policies require policyholders to pay for pre-policy testing before being reimbursed. #

After the tests?

The company will decide whether to cover the policyholder under the policy proposal after receiving the results. Usually, if tests show an illness or medical condition, the company can choose the following options:

Higher premium: the company could issue the policy and cover the individual but at a higher premium to cover the condition/illness detected. The policyholder’s age and illness severity determine the premium increase. This information will not be present on a medical insurance app since it is about a specific case. *

Permanent exclusions: the company could issue the policy but exclude the condition/illness detected. If the company’s underwriters consider the illness too risky, this is done. If the policyholder receives medical treatment for the excluded illness, they cannot file a claim.

Rejection: the insurer may reject the policy if the illness is high-risk or requires frequent treatment. 

While some policies don’t require pre-policy medical exams, they’re worth it and can prevent a claim rejection later on.

You can also check the details of tests on the bajaj allianz mediclaim app. If it is for a specific case, you may need to contact the insurer directly.

Financial services are subject to 18% GST starting July 1, 2017. Disclaimer: Age, location, and taxes/GST affect premiums. *

* Standard T&C Apply

# Visit the official website of IRDAI for further details.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.