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The unabated increase in healthcare services, the rise in incidences of lifestyle issues, and the onset of the pandemic have turned health insurance into a pressing priority. While buying a health insurance policy is fairly simple, sometimes your health insurance provider may ask you to undergo a pre-policy medical checkup.
These health check-ups can play an important role when it comes to establishing your coverage eligibility, but at the same time, keep in mind that a pre-policy health checkup is not always a mandatory requirement. There are a number of factors that may affect your health insurance coverage. Read on as we discuss pre-policy checkups, their importance, and how they can help in easing the claim process.
But before digging into deep let’s consider-
What’re Pre-Policy Health Check-Ups?
As the name suggests, a pre-policy checkup is a kind of medical screening, where the insurance seeker has to undergo a few medical tests that are carried out by a medical professional. Through these tests and investigations, the insurer can get a fair idea of the overall health of the applicant. In case the applicant suffers from an illness, that he/ she is aware or unaware of, it will be brought to light through these tests and investigations. The insurance company would be in a better position to decide if the applicant is to be given coverage or not.
Wait, there’s more!
Even if your health insurance provider has not requested a medical check-up before you buy the policy, it does not mean that you can hide any kind of information from them. Not disclosing your health issues at the time of policy purchase is considered to be fraud. It can lead to claim rejection, policy termination as well as legal trouble. Under no circumstance should you hide/ miscommunicate any kind of medical information or a pre-existing illness.
Importance of Pre-Policy Health Check-Ups
You may have noticed that not all health insurance companies ask you to undergo medical screening in order to buy a health insurance policy. While this may seem alluring, sometimes it may lead to trouble at the time of making a claim. Let us see how.
How does Pre-policy Check-ups work in Health Insurance?
When you buy a health plan without any screening, it becomes your responsibility to declare any kind of illness that you are suffering from. Sometimes, it may happen that you are unaware of any illness that you may be suffering from when you buy a policy. Such illnesses, also called pre-existing illnesses, are not covered by health insurers unless the waiting period is served. After purchasing the policy, if the illness is discovered, any claim made for it may be rejected.
Therefore, apart from being beneficial for the health insurance company, a pre-policy medical check-up is quite beneficial for a health insurance seeker as well. The individual will not only get their medical report, but the check-up can also help them when it is time to file a claim. Coverage for pre-existing illnesses is an important aspect of health insurance coverage. When you get a medical check-up done, you will be fully conscious of your health as well as your ailments. This would help you be in good standing, your insurance provider will be able to assess you correctly and allow you the right coverage.
Buying health insurance without pre-policy medical check-ups may lead to the possibility of a higher premium, as the insurer is taking a chance by offering you health coverage. Only through a medical check-up, the insurer comes know about your health condition. As offering health cover to a person with less risk appetite would be beneficial for the insurance company this transparency, thus, may enable you to get a discounted premium.
Tests under Pre-Policy Health Check-ups
When it comes to the types of tests that are conducted, the list may vary depending on different factors. The age of the applicant, the coverage that is being offered, the sum insured, etc. are a few things that may determine the kind and number of tests that you may have to go through. In most cases, the following tests are usually conducted, keep in mind that, the list may vary:
- ECG
- Blood sugar
- Blood pressure
- Lipid profile
- Complete blood count
- Blood serum test.
Payment of the Pre-Policy Health Checkups
The IRDAI, which is the Insurance Regulatory and Development Authority of India, has issued clear directives regarding the expenses of the pre-policy medical check-up. About 50% of medical tests cost is paid by the insurance company, while the remaining is borne by the applicant. Some companies stipulate that the expenses are borne by the applicant, however, when a health insurance plan is purchased, the specified expenses are reimbursed. As the cost of these medical investigations can vary from hospital to hospital and city to city, it is highly recommended that you confirm the same with your insurance provider.
Results of the Pre-Policy Health Check-ups
Getting an ‘All Clear’ on your test report sounds good. You’ll be eligible for comprehensive coverage with reasonable coverage. Even if you’re diagnosed with some illnesses, fret not; there is insurance coverage especially designed for the people with pre-existing illnesses as well By paying slightly a higher premium, you can easily cover yourself against life threatening diseases.
But do not let this make you hide any information from your insurer.
Many a time, when a pre-existing ailment is found, the insurance company may still offer coverage, but with some waiting period clauses. This means up to a certain period, the coverage wouldn’t be provided.
Remember that in cases where the ailment is too severe or risky, the insurance provider has the right to refuse or reject the application.
Over to You!
In the last decade, medical inflation in the country has risen to a whopping 14%. Having adequate medical insurance is a must. If your insurance company asks you to undergo a medical check-up, do not feel apprehensive about the same. Having a health cover without a proper medical test may cause disputes at the time of raising a claim on grounds of miscommunication. If your insurer finds any kind of loopholes or concealment of information, the raised claim may be rejected.
Going through a pre-policy medical checkup, is not just a good way to find out about your health issues, if any, it can also be very helpful in making a health insurance claim settlement process easier and quicker.
Disclaimer: The percentage of medical test costs to be paid by the insurance company solely depends on the IRDAI or the insurance company.
