Eligibility for Health Insurance

At present, most of the health insurers don’t require the insured below 45 years of age to go through a medical exam for getting a health cover. But it doesn’t mean the insurance company doesn’t account for one’s pre-existing condition. In cases where the insured doesn’t have to take the medical tests, he is supposed to submit a declaration of good health and also disclose if he has a pre-existing condition like diabetes and hypertension. Sure it comes as good news to those who are completely healthy as the insurers provide such individuals competitive premium rates. But it’s eventually beneficial even for the individuals with a pre-existing condition as it helps to ease out the things for them at the time of making a claim.

The medical screening consists primarily of physical examinations, blood and urine tests. These seemingly simple tests can reveal a lot about human health such as detecting any abnormality in liver and kidney functions, a rise or fall in blood sugar levels and whether or not the insured consumes alcohol and tobacco. The insured might have to bear additional tests when he opts for high insurance coverage or crosses the age of 55.

Be wary of the insurers who advertise their plans with taglines such as ‘get insured, no medical test required’. Well, it’s good news that you do not need to go through all those painstaking tests. But if you are a smart consumer, you’ll always ponder what’s in it there for the insurer in offering such a feature. There’s a catch to such policies. Firstly, such plans offer a lower coverage compared to the conventional plans requiring the insured to undergo through tests. Secondly, the insured has to submit a declaration of good health in lieu of the exemption from the medical test. The declaration is a written proof of the consent of the insured to take the responsibility of any pre-existing condition. Here’s an example to illustrate the same.

About 7 months ago, Latika bought an individual health insurance plan that didn’t require her to go through the medical tests. For the last 1 month, she had severe coughing that revealed that she had tuberculosis for the last 1.5 years and that it has become severe and virulent. She failed to note about this condition herself as the symptoms started showing just now. Anyway, she filed a claim with her insurer. Now what do you think, would the claim be approved or rejected?

In such a case, as her condition was a pre-existing disease, the insurer has every right to reject her claim signing it off as suppression of a medical fact. The moral of the story is that getting through a medical test before getting a health cover can be tiring and time-consuming but it’s all worth it. The claims filed for plans with medical tests stand at much higher chances of being approved.

At present, there has been an increasing trend of employees being offered free medical check-ups under employer-sponsored insurance at regular intervals. It’s a win-win situation both for the employers and the employees. Going a step further, many corporate organizations are now taking up the initiative of inspiring their employees to participate in corporate health and wellness programs.