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’.

Read More

Get ₹5 Lac Health Insurance starts @ ₹200/month*
Tax Benefitup to Rs.75,000
Save up to 12.5%* on 2 Year Payment Plans
7 Lakh+ Happy Customers

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply
*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Get insured from the comfort of your home No medicals required
I am a

My name is

My number is

By clicking on ‘View Plans’ you, agreed to our Privacy Policy and Terms of use
Close
Back
I am a

My name is

My number is

Select Age

City Living in

    Popular Cities

    Do you have an existing illness or medical history?

    This helps us find plans that cover your condition and avoid claim rejection

    Get updates on WhatsApp

    What is your existing illness?

    Select all that apply

    When did you recover from Covid-19?

    Some plans are available only after a certain time

    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: 30 July 2021

    Health insurance articles

    Recent Articles
    Popular Articles
    11 Easy Tips to Save Money on Your Health Insurance Premium

    30 Nov 2021

    Health insurance has become imperative today with the cost of...
    Read more
    Health Insurance Vs Medical Loan – Which is Better?

    16 Nov 2021

    Medical emergencies always come unannounced. With medical...
    Read more
    8 Important Tips to Maintain a Healthy Diet for Your Kids

    15 Nov 2021

    For a parent, nothing is more important than the well-being of...
    Read more
    PMASBY Scheme: All You Need to Know About Pradhan Mantri Atmanirbhar Swasth Bharat Yojana

    25 Oct 2021

    The PMASBY or the Pradhan Mantri Atmanirbhar Swasth Bharat Yojana...
    Read more
    Is Dermatology Covered by Health Insurance Plans?

    21 Oct 2021

    The prevalence of dermatology has risen significantly in India...
    Read more
    PMJAY Scheme: Ayushman Bharat Yojana Eligibility & Registration Online
    Prime Minister Shri Narendra Modi announced the launch of (PMJAY) Ayushman Bharat Yojana in his Independence...
    Read more
    Best Health Insurance Plans in India 2022
    Finding the best health insurance plan from so many different health insurance companies can get confusing for many...
    Read more
    Best Maternity Insurance Plans
    Maternity or pregnancy is an important phase of life, and one needs to prepare in advance to embrace parenthood...
    Read more
    Covaxin vs. Covishield vs. Sputnik vs. Pfizer: Which one should you get?
    Covaxin vs. Covishield vs. Sputnik vs. Pfizer, the speculation continues regarding the difference between the...
    Read more
    Best Health Insurance Plans for Senior Citizens in 2021
    Considering the increase in medical inflation in India, buying adequate health insurance for your loved ones has...
    Read more
    Close
    Download the Policybazaar app
    to manage all your insurance needs.
    INSTALL