Pre-Policy medical check up in Health insurance

Insurance companies nowadays are offering an array of health insurance policies keeping in mind the budget and health requirements of every individual. However, before issuing a policy to anyone, health insurers ask you to undergo a pre-policy medical check-up which helps them to decide your coverage and the policy premium. So, if you are wondering about what pre-policy medical check-ups are and why it is mandatory, then read the below guide to know everything about this concept in brief.

What is a pre-policy medical check-up?

A pre-policy medical check-up or examination is a pre-policy issuance procedure that a policyholder is required to undergo before the insurance company issues a health policy to him/her. These tests are required for the individuals who are above the age of 40 or 45 years so that the insurer is aware of the policyholder’s current state of medical fitness and to know whether there are any pre-existing medical conditions. 

What medical tests are usually conducted?

Each insurance company has a different risk assessment policy for a pre-medical check-up to determine the risk factor, which in turn impacts the other parameters of the health insurance policy, such as coverage amount and premium. 

However, some of the medical tests which are usually conducted by every health insurance company are blood pressure, ECG, lipid profile test, blood sugar test, complete blood count, routine urine, stress test, USG-whole abdomen, PAP smear for women, blood sugar, etc.

Who pays for the tests?

As per the rules laid down by the Insurance Regulatory and Development Authority of India (IRDAI), at least 50% of the expense of the pre-policy medical tests is paid by the insurance company, and the remaining balance is paid by the policyholder. But it has been seen that most of the insurers bear the complete cost of the pre-policy check-ups to lower the financial burden on the policyholders. According to some health policies, initially, customers need to bear the costs of the pre-policy testing which is reimbursed by the insurer.

What happens after the tests are conducted?

Once you undergo the specified tests mentioned by the insurer, the company will decide on whether to cover the insured under the terms mentioned in the policy proposal. If no ailment has been detected, the policy is issued to you at a nominal premium rate. However, if any ailment is detected, the following scenarios are likely to Charges a higher premium: If the policyholder is detected with some severe pre-existing medical conditions in the test. The insurance company will ask you to pay a higher premium. The increase in premium charges would depend on the severity of the illness and the age of the policyholder.crop up.

A pre-existing condition might be excluded from cover: The insurance company may decide to give you the policy but may choose not to cover the pre-existing disease. In this case, the company will not entertain any claims occurring in the development of any illness related to the pre-existing condition.

Application for the policy may be rejected: When the insurer feels that the pre-existing condition poses a significant risk to them or the policyholder may require repeated medical treatment, they are likely to reject your policy proposal.

Bottom Line

It is imperative and beneficial to go for the medical check-up before opting for any health insurance plan. It will not only safeguard you from the risk of claim rejection but will also make you aware of any health condition that you may be suffering. So, it is advisable to go for a pre-policy medical check-up to keep yourself on the safer side and reap the benefits of your insurance plan.