Why Medical Test Required When Buying a Health Insurance Plan?

Many reputed insurance companies ask the policy proposer to undergo a pre-policy medical check up before issuing the insurance policy to them. These medical tests are necessary for you to get cover for health insurance as they are a big factor in deciding the eligibility of the proposer for health insurance. However, it does not mean that the proposer cannot get an insurance plan without any medical tests and it might appear easy to buy a health plan without a pre-policy medical test, however the truth is otherwise. As the insurance provider who asks the proposer to undergo a medical test are known to be most customer friendly at the time of claim settlement process.

At first skipping the medical tests may seem like a good option as it saves you from the trouble of going to the diagnostic centre and also saves your money. However, it may cost you greatly at a later stage. So, if you are a healthy person, then undergoing these tests will prove to be beneficial for you as the costs of health check up will get reimbursed by your insurance provider if the test reports come out to be good. Additionally, if you are suffering from any pre-existing ailment, then you will become aware of the waiting period and exclusions pertaining to your health illness. Although, you may be required to pay a little higher premium, it is all worth it as you would save yourself from facing claim rejection at the time of need.
Let’s have a look at what a medical check-up is, then we will discuss why it’s essential for you. 

Pre Policy Medical Check-Up

A medical test or pre-medical check-up is a medical examination. Health insurance companies request it before providing coverage to the policy buyer. They require the test to assess a person’s eligibility.

The test includes a detailed health check-up of the person, which further leads to making the claim procedure easy and reduced premium rates. 

However, the medical test is applicable only for applicants over a specific age and not all insurers in India ask for this test.

Why are Pre-Medical Health Check Ups Conducted?

Risk assessment policy of each health insurance company differs, based upon which healthcare risk is measured for a life assured. The risk associated is measured on the basis of the parameters such as coverage amount and the age of the policyholder. Depending upon these factors, the type of test would be suggested to the insured individual. The general tests that are suggested to the insured individual includes ECG, measurement of blood pressure, blood serum test, lipid profile, blood sugar, complete blood count, etc.

Who pays for the Pre-Medical Tests?

As per the rules by Insurance Regulatory and Development Authority of India (IRDAI), the insurance provider is required to bear at least 50% of pre-heath check-up cost and the remaining cost needs to be borne by the insurance company. With the rising competition in the insurance sector and in order to lessen the burden from the policyholders, some of the insurance companies have chosen to get the costs of tests covered all by themselves. Other than this, there are some insurance companies stipulated policies such as the cost of the pre-policy medical tests needed to be covered by the policy buyer initially, which can later be reimbursed once the cover is granted to them.

What Happens after the Pre-Medical Tests are Performed?

After receiving the results of the medical tests, the insurance company will then decide whether they wish to offer coverage to the policy proposer as per the terms and conditions mentioned in the policy document. In case, the test results depict any pre-existing illness or medical conditions, then the insurance company can choose any of the below mentioned options:

1. Rejection of Policy Proposal

In case the illness or disease is at a considerably higher risk or would demand periodic treatments, then the insurance company can decide upon rejecting the insurance policy proposal altogether.

2. Higher Premium Amount

The insurance provider can choose to issue the insurance plan to the policy proposer with an extended coverage, however, at a higher premium amount to meet the expenses cost that can arise because of the detected illness or health condition. The increase in the premium amount would be basically dependent upon the severeness of the disease or illness or the age of the insured individual.

3. Exclusion of Pre-existing Illness

The insurance provider can choose upon issuing the insurance policy yet they may exclude the coverage for the detected illness or health condition. This step is undertaken by the insurance company in case the company's underwriter deems that the disease is too risky to be offered coverage. In such a situation, in case the insured individual undergoes any medical treatment due to that illness, then in that case they will not be able to file a claim for the same.
While there are many insurance plans that do not require a necessary pre-policy medical check-up, it is recommended to undertake the medical tests as in the long run, they pay dividends and also to avoid the possibility of getting the claim rejected at a later stage.

Note: Remember premiums may differ based upon factors such as location, age, prevalent taxes etc.

Why the Medical Test Is Important for You?

The pre-health checkup is essential because it sets a benchmark against which insurers measure the health of the policyholders. 

These tests bring to light any existing medical conditions and illnesses, which enable insurance companies to provide applicants with the most suitable cover. 

Here are a few facts about why a medical test is necessary before buying health insurance in India. 

Read here the differences between a mediclaim policy and health insurance.

Smooth Claim Settlement

Medical check-up lets you have an update on your health and a reference point for insurers. It ensures a smooth claim settlement procedure. 

For example, 

Disputes, in the absence of medical examination, may arise when it comes to settling the claim. The disputes happen because policyholders can conceal or misrepresent ailments. And if the insurance company proves the concealment of the pre-existing medical condition, the claim gets rejected.   

Therefore, medical health checkup is required.

Lower Premium Rates

A pre-medical checkup also means lower premium rates against your health insurance policy. Remember, an insurer decides the premium based on risk perception. 

When the test is done, your insurance company can determine the risk of your health and sets fairer pricing. 

besides, in the absence of medical tests, an insurance provider can fix the premium rates based on the diseases that you’re actually not suffering from. 

Let’s take an example. 

Assume that Rajeev with normal sugar level buys a health policy without undergoing a medical test. 

It may be that the insurance company sets his premium rates applicable to a person with borderline sugar. In that case, Rajeev will be paying a higher premium. 
 
This generally happens because the insurance company assumes a possibility of ailment like sugar, etc. in policyholders (depending on his/her age), thereby hiking the premium rates. 

With a pre-policy medical checkup, Rajeev can prove that he is a low-risk candidate. 

Adequate Cover

A policy without medical tests usually offers inadequate coverage. No matter you’re below or at 30 with very good health, you can hardly get coverage of more than Rs. 5 lakh.

Usually, no insurance company in India offers a cover of more than five lakh in the absence of a pre-medical test. The threshold without the medical test for policy buyers in the age bracket of 30-40 years may be lower at Rs. 2 lakh. 

Such low-value plans in most cases can’t feed the needs in an emergency medical condition. 

In addition, even if you’re diagnosed with a certain pre-existing condition in your medical report, you'll become aware of the waiting period and specific exclusions related to your condition. 

Though you’ll have a slightly higher premium, it's all for the good. Incurring higher premium rates and getting coverage is better than denying coverage altogether at the time of claim.  

Rewards and Discounts

Even if you’re healthy, a pre-medical check-up can be fruitful to buy the best health insurance in India at discount premium rates.

Many premium health insurance companies offer rewards and discounts to the policy buyers who pass the medical tests with flying marks. This means that you’ll happen to get a health plan at a certain discount on the premium.

Health-check up is a must for maximum cover and minimum premium.

Reduced Stress 

It may sound wired. But, it’s true that with a medical test report, you don’t need to worry about your ill-health. 

This is because the responsibility of being aware of a pre-existing condition is passed on to the insurer. Thus, you’ll no longer worry about the disease. 

In addition, without the medical report, you’re not aware of your health condition. Thus, your health condition worsens by every minute. 

Final Words

After considering the benefits of a pre-policy health check-up, we can conclude that medical tests are essential before getting insured. It may seem like a pain initially, but it’s not.  

The more stringent an insurance company is while selling its policy, the better. With such insurance providers, the chances of approval of your health insurance claim are higher. 

In a nutshell, the insurer that asks for a health test before issuing a health policy is more customer-friendly while making a claim. So, better undergo a medical checkup before opting for a health insurance plan. 

For more information, feel free to contact InsuranceDekho. We’re happy to help you. 

Also Read:

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