Understanding Pre Policy Medical Check Ups and its Importance

A health insurance is one of the best ways to meet expenses which arise from health issues. Most insurance providers have made pre-policy checkups mandatory. But, the moment …

A health insurance is one of the best ways to meet expenses which arise from health issues. Most insurance providers have made pre-policy checkups mandatory. But, the moment a person hears about a pre-policy medical checkup, he becomes wary. It has been witnessed that most people avoid the checkups out of lack of awareness. Customers are unsure of what this requirement entails and start wondering what the outcome of the tests will be.

Pre policy check-up is mandatory

Most insurance companies require customers to undergo a medical checkup before they offer the cover. The check-up is mandatory if the customer opts for a higher coverage or if he is of a certain age. If the coverage amount is above 8 to 10 lakhs or if the applicant is above 40 years of age he may have to undergo a medical check-up. Higher the age and the coverage amount, higher are the number of tests which are required in health insurance policies. Some common pre-medical tests include ECG, blood serum test, complete blood count. Fasting blood sugar, blood pressure and routine urine analysis.

Cost of the Checkups

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The IRDAI or the Insurance Regulatory and Development Authority has laid down that the insurer will bear atleast 50% of the medical cost. But, it has been seen that many insurers bear the complete cost of the pre-policy checkups to lower the financial burden on the applicants. According to some policies, initially customers will bear the costs of the test and after acceptance of the policy, 50% to 100% of the cost will be reimbursed by the insurer.

Follow the Right Procedure

A health insurance applicant can avail the benefit of the free medical checkup which is offered by the insurer. They can call up the insurance company or write to them to schedule a health checkup. The insurance company will revert back to the applicant with the confirmed date, time and location as per their preference. Then they will send them an authorization letter which they need to carry to the diagnostic center.

It is advisable that the tests are conducted at an empaneled diagnostic center. The applicant will not have to pay for the tests if they are done at an empaneled center. Additionally, it is important to check the amount which will be reimbursed under the policy as different diagnostic centers will have different charges. At times insurers may specify the tests you need to opt for.

If an Ailment is Detected

Once the test is completed, the reports are sent to the insurance company where the reports are reviewed by the underwriting department. Whether the proposal will be accepted depends to a large extent on the test results. If the results indicate an ailment, three scenarios may crop up:

Resulting in Higher Premium: If it is a common ailment and it is not severe, the company can raise the premium and include the ailment within the coverage.

Exclusions: If the insurer considers the ailment to be risky it will accept the proposal after excluding the disease permanently from the scope of coverage.

Rejection of the Proposal: If it is a very high risk case where medical contingencies may occur at frequent intervals, the insurance company may reject the proposal.

If a proposal is accepted the insurer will inform the prospective customer. If the policy seeker agrees to the conditions which are laid down by the insurer, he can sign the acknowledgement letter and send it back to the insurer. If a proposal is rejected, the insurer will inform the applicant and state the reason for rejection.

If you opt for a health insurance policy which does not require a medical checkup, the insurance company will seek a declaration from you about the pre-existing diseases. If you are suffering from a pre-existing disease you are expected to disclose it in the declaration and the premium will be fixed accordingly. By hiding preexisting diseases you would be giving a false declaration which is an unlawful act.


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