The Significance of Pre-Policy Medical Examinations in a Health Insurance Scheme

The increase in medical inflation and rise in lifestyle-related health concerns have made health insurance a pressing priority. With multiple insurance companies offering several types of medical insurance depending on your needs and budget, there are plenty of health insurance plans in India to choose from.

Whether you wish to buy, renew or compare health insurance from a trusted brand like Tata AIG,  the processes have become rather straightforward, thanks to digitalisation. These pre-insurance health check-ups are essential for obtaining the policy as they play a significant role in establishing your coverage eligibility.

What is a Pre-Policy Health Check-up in Health Insurance?

Also known as a pre-insurance medical check-up, it is a set of medical assessments or investigations licensed medical professionals perform to understand an applicant’s overall health status. Based on this, the insurance provider may take the following decisions:

  • Whether the applicant qualifies for the insured coverage
  • The extent of coverage (sum insured)
  • The premium payable

Two factors determine the number of pre-policy health check-ups required:

  • The age of the applicant: If the applicant is above 45 years old, most insurance companies ask for medical tests, whereas individuals below this age may get a policy without having to undergo a pre-insurance test.
  • The policy coverage: The type of policy selected and the coverage also determine whether an applicant must undergo pre-policy medical tests.

Why Should You Choose Health Insurance Plan with a Pre-Insurance Health Check-up

Not all health insurance providers request pre-policy medical tests. Moreover, many individuals may find the medical screening procedure rigorous and time-consuming. However, these tests are essential in many ways, including:

  • These medical screening tests act as a standard against which the insurance provider can determine the policyholder’s health.
  • Very few individuals undergo a routine health check-up. While buying a health insurance policy, these tests reveal any pre-existing medical illness or underlying condition the applicant is unaware of.
  • These tests help you choose the right coverage depending on your health condition.
  • The insurance company may sometimes reject your claim, citing a non-disclosed pre-existing disease. However, if pre-policy medical tests are conducted, it provides clarity to the insurance company on the pre-existing disease, thus reducing your chances of claim rejection.
  • Some insurance companies may also offer discounts if you are healthy with no pre-existing conditions.
  • The pre-policy medical check-up reports often act as an essential claim settlement document.

What Happens After You Take Pre-Insurance Medical Check-Up?

Depending on the pre-medical test reports, the insurance provider shall decide whether the applicant is eligible for coverage per the policy’s terms and conditions.

Depending on the ailment and the gravity of it, the insurer may opt for the following stance:

  • Application rejection: If the report suggests a medical condition that is extremely high risk or requires multiple hospital visits, there is a high probability that the application might be rejected.
  • High premium: If the individual is found with a particular condition or illness that is not extremely severe, the insurance company may decide to offer coverage but at a higher premium. The higher the risk to the insurance company based on the applicant’s age and the seriousness of the illness, the higher the premium.
  • Exclusion: In some cases, if the insurance company decides to offer policy cover even if diagnosed with a specific illness or condition, it may do so by mentioning the condition as a part of the exclusion. Hence, if the policyholder receives treatment for that illness, the policy shall not cover those expenses.

Who Pays for Pre-Policy Medical Check-Up?

According to the directives of the Insurance Regulatory and Development Authority (IRDAI), the insurance company must bear at least half of the pre-insurance medical check-up cost. The applicant pays the remaining 50% or less. This reduces the financial burden on the applicant.

Also, due to extreme competition in the sector, many health insurance companies bear the entire expense of such tests. If the insurance company does not cover the entire test costs or the tests are conducted at a non-listed centre, the expense is usually reimbursed to the applicant once the cover is offered.

Since the medical tests required may differ based on the insurance provider, the plan selected, the age of the applicant and the coverage, the costs of medical assessments also vary. However, the assessment may cost minimal or may even be free for most policyholders.

Bottom Line

Having adequate health insurance is highly essential. If your insurance provider asks you to undergo a pre-policy health check-up, do not hesitate to go for it. Instead, a pre-insurance check-up may help you in more ways than one.

Also, if the insurance provider does not request to undergo any tests, it does not mean you are not prone to any pre-existing disease. Ensure complete transparency and proper communication with the insurance provider about your health status to avoid disappointments at the time of claim.