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How Important are Pre-policy Medical Tests in a Health Insurance Plan?

In the times we are living today, the medical expenses are rising and we are more prone to diseases due to the sort of lifestyle we are leading. Therefore, it becomes important to invest in a health insurance policy as it ensures quality health care and keeps the insured free from unnecessary mental stress. However, to ensure the right policy, one must know the basic terminologies of health insurance that aid in the buying process. One such concept is ‘Pre-policy Medical Test’.

The pre-policy medical test implies to the medical examination that is requested by the health insurance company before the health coverage is provided to the person. This is generally done to minimize the risk when covering an individual; however, this is mostly required for applicants over a certain age.

There are health insurance plans wherein a health check-up is a mandatory clause before the issuance of the policy. Moreover, before you make the buying decision you can make compare the medical insurance quotes online.

To begin with, let us primarily understand the basics of the pre-policy health check-up?

Pre-policy Medical Check-up: An Important Clause!

The pre-policy medical check-up or examination refers to the series of procedures and tests that the policyholder is expected to undergo. This is necessary so that the health insurance policy application is then accepted by the insurance provider to extend the required health cover.

The policy seekers above the age 45 years are most likely to undergo such procedures so that health insurance company is aware in regards to the person’s present medical fitness and the existence of pre-existing ailments, if any.

The other reason for a pre-policy check-up would be to understand when the person chooses a sum insured that is comparatively higher than the average sum. Which shows the risk-appetite and increases the chances of claiming the policy. So, anyone who opts for the health cover above Rs 10, 00,000 or so needs to undergo a health-test before availing the policy. However, there are insurers where pre-policy medical test is a mandatory clause, irrespective of the health cover one selects to opt for.

Why Should You Go for a Pre-policy Medical Test?

The pre-policy medical tests are mostly mandatory for most of the health insurance policies available in the market. Such tests are important as it sets a benchmark wherein the health insurance company can easily measure the health of the policyholder or the risk associated with. When any pre-existing ailments are brought into the light via such a test then the company takes a call and decides upon the cover appropriately for a particular individual.

When it comes to filing the health insurance claims, pre-medical tests then also play a vital role. Under a circumstance when the policyholder files for a health insurance claim and the insurance provider substantiates that the health complication was caused due to a pre-existing ailment, which was not disclosed by the policyholder knowingly, the claim would be repudiated. With the pre-policy test, transparency can be maintained in terms of any pre-existing illness, which further helps the insured in getting the claim settled without any hurdle.

What Kind of Tests are Usually Conducted?

Every health insurance company has a separate risk assessment policy, wherein the medical risk of the insured is measured. The risk is likely measured on important parameters’ such as the age of the policyholder and the coverage amount.

These are two key factors that determine the types of tests that would be administered to the policyholder. The test usually administered includes ECG, blood serum test, blood pressure measurement, complete blood count, lipid profile test, blood sugar, and so forth.

Who Pays for the Pre-medical Tests?

 As per the directives of the Insurance Regulatory and Development Authority of India, half of the expenses of the medical tests need to be borne by the health insurance provider and the remaining balance needs to be paid by the applicant. The market gives a tough competition and to reduce the burden from the shoulders of the person seeking insurance, the health insurers choose to cover the expenses of the test on themselves.

There are health insurance policies that stipulate that a policyholder will have to cover the expenses of the pre-existing ailments with the sum will be reimbursed once the cover is granted.

Pre-policy Tests and Thereafter!

After the pre-medical tests reports are received, the health insurance provider will decide to whether or not to a provide the coverage within the mentioned terms in the policy document. In case the conducted tests show an ailment or a certain medical condition, the health insurance company can then opt for the following options:

  • Rejection: In case the illness is at high risk or will require frequent visits to the hospitals for the treatment then the insurer might choose to reject the proposed application for a health insurance policy.
  • Higher Premium: The health insurance company would issue the policy and provide coverage to the policyholder in exchange for a higher health insurance premium. The health insurance premium amount would largely depend upon the severity of the medical condition and the age of the policyholder. You can also use a health insurance premium calculator to have a rough estimate of the premium sum.
  • Exclusions: The health insurance provider might choose to issue the policy, however, would exclude coverage for the detected medical conditions or illness. This is mostly done when the provider deems the medical condition too risky to be covered. So, this means that if the policyholder avails the treatment for a health condition that is already excluded, a claim made for the same will not be entertained.

The Bottom Line

There are health insurance policies that do not mandatorily require a pre-medical test, however, it is recommended to undergo one, as it will help you on a long-term. It also enables to avoid the chances of health insurance policy claim rejection in the coming times. Invest in the comprehensive health insurance policy in India and benefit from the extensive coverage and nominal premium. Also, before signing the dotted lines make sure that you compare the medical insurance quotes online and then make an informed decision.

Written By: PolicyBazaar - Updated: 06 November 2020
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Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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