Pre-policy Medical Checkup

Find out why you should get a pre-policy medical checkup before getting insurance!

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A pre-policy medical checkup is a set of medical tests that are performed before you buy your health insurance policy. This may not apply to all policies or all interested buyers. However, health insurance providers may require you to undergo a medical investigation before you buy a cover. This will help them determine the level of risk that you pose, and they can then set the premiums accordingly. Find out more about pre-policy medical checkups in this article.

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

What is a Pre-policy Medical Check-up and Why You Shouldn’t Avoid It?

In simple terms, a pre-policy medical check-up is a set of medical tests requested by your insurer before issuing the policy. This helps insurers determine whether you are a high-risk applicant or not and thus determine your premiums.

A medical check-up is usually mandatory if you are seeking health plans after the age of 40 years. However, you can still undergo a medical examination even if you are below the age of 40 years. This will help you choose the correct sum insured amount based on your health condition.

Importance of Choosing Health Insurance with a Pre-Policy Medical Test

Some of the reasons why a pre-policy medical test is important are:

It helps insurers determine the applicable health insurance plans for you
It updates you on your health condition and may reveal any pre-existing health problems that you may be unaware of
The pre-policy medical test reports act as important documents during health insurance claims

Benefits of Buying Medical Insurance Coverage with Pre-Policy Health Check-Up

Here are the reasons why a pre-policy medical test is important:

1. Prevents you from paying hefty health insurance premiums

While skipping medical tests before buying health insurance may seem a quick and easier way to get the policy, it is not recommended. When you decide to skip the medical examination, the insurer may consider you as a high-risk applicant and hence charge a higher premium. Getting a medical check-up done when buying health insurance will prevent you from paying hefty premiums.

2. Helps determine whether you are a high-risk applicant or not

when purchasing a health insurance plan, opting out of a medical examination for the sake of convenience could label you as a high-risk applicant by the insurer, regardless of your current health condition. Therefore, it's advisable to undergo a medical check-up during the health insurance application process. This assessment aids in accurately categorising your risk profile. Whether it's high or low, this ensures you receive appropriate coverage.

3. Assists in recognising critical health conditions in advance

Getting a pre-policy medical examination done helps you discover any health condition you may have that you were unaware of. If the symptoms of such conditions are diagnosed early, you can start getting the appropriate treatment at an early stage.

4. Enables you to get adequate health coverage

Taking a medical examination will provide you with a good insight into your health condition and warn you about any potential risks in advance. Based on the results, you can then determine the amount of health coverage that you need to tackle any medical expenses in the near future and avoid the risk of being underinsured.

5. Makes it easier for insurers to investigate claim requests

Pre-policy medical examinations are important during insurance claims. Imagine if you file a claim and the insurer proves that your illness was caused by a pre-existing disease that was not disclosed. In this case, your insurance claim could be rejected. By undergoing a pre-policy health check-up, your medical history will be documented. This makes it easier for both you and the insurer to file a claim and investigate it, respectively.

Types of Tests Conducted in the Pre-Policy Medical Check-up

The insurance company determines the type of medical tests that you need to undergo during the pre-policy health check-up. Here, your age and the coverage you are opting for are the two determining factors. Usually, the types of tests conducted in the pre-policy medical check-up include:

Blood pressure
Blood sugar
Blood serum test
Complete blood count
ECG
Lipid profile test

Who will pay for the Test?

As per the guidelines set by the Insurance Regulatory and Development Authority of India (IRDAI), you will have to pay for half of the cost of the pre-policy medical check-up. The insurance provider will bear the remaining cost. Hence, this reduces the financial burden on you as well as the insurance provider. Moreover, some insurance companies in India also offer to pay the entire cost of these medical check-ups upfront for their applicants.

What Happens After the Pre-policy Medical Check-up is Done?

Once you undergo the pre-policy health check-up, the insurer will either accept or reject your health insurance application. If the application is accepted, the medical check-up result will help the insurer determine your premiums. So, if the results show that you are suffering from any critical health condition or suggest that you may suffer from any critical health disease in the future, the insurer will charge a higher premium. However, if the reports suggest that you have a specific health condition that requires expensive medical treatments, the insurer may reject your application.

How to Avail Medical Check-Up Under Health Insurance Cover

Generally, health insurance providers allow free medical check-ups only after you (the policyholder) have completed a predetermined claim-free period. However, certain insurance providers offer free medical check-ups with their health insurance policies every year or once every three to five years, irrespective of the number of claims made. If your insurance plan provides this feature, you can avail it using your health insurance card at any diagnostic centre that falls under your insurance provider’s network.

Taking a medical examination before buying health insurance is necessary. It is recommended to not avoid/skip it at any cost when the insurer requests a health check-up. Doing so prevents you from paying hefty health insurance premiums and warns you of any potential health risks. If you are looking for a health insurance plan to cover your medical expenses, browse through the health insurance plans available at Bajaj Markets You can benefit from features such as cashless claim settlements, reinstatement benefits in case you exhaust your sum insured amount, extensive coverage, and more.

Why are medical examinations needed before buying a health insurance policy?

The insurer asks you to undergo certain medical tests before buying a health insurance policy to determine your current health status. This helps them in providing you with better health coverage and reduces the chances of claim rejections.

Should I avoid pre-policy health check-ups?

Avoiding a pre-policy health check-up means remaining unaware of your current medical status. This can have detrimental effects on your health in the long term and may result in claim rejections. Therefore, it's strongly recommended not to skip a pre-policy health check-up.

How can I check the reports of my pre-policy medical check-up?

When your application is accepted, the insurer will provide your pre-policy medical check-up either online or they will send hard copies of the documents to you.

In India, is it legally mandatory to buy health insurance?

No, in India it is not legally mandatory to buy health insurance. However, it is always a smart choice to buy health insurance coverage for yourself and your family as it provides the necessary financial assistance in the case of a medical emergency.

Can the insurance company reject my health insurance application after the pre-policy health check-up?

The insurance company may choose to reject your health insurance application after a pre-policy health check-up if the results suggest that you have a high-risk illness or would require frequent treatment.

How can I check the list of tests available under the annual check-up facility provided by my health insurance?

If your health insurance provides you with an annual health check-up facility, you can check the list of tests available on your insurance company’s website. You can also find this list in the policy wording of your health insurance policy.