What is Pre-Policy Medical Checkup?

A pre-policy medical checkup is a set of medical tests that are performed before you buy your health insurance policy. This may not be applicable to all policies or to all interested buyers, but sometimes, health insurance providers may require that you 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.

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What is Pre-Policy Medical Check-up and Why you Shouldn’t Avoid It?

Circumstances that people are facing across the globe and in India re-emphasise the importance of health insurance. An adequate health plan ensures that your and your family’s medical emergencies are financially taken care of so that you don’t have to drain your life savings. When you are looking for health insurance in the market, you will observe that many insurers need you to take a medical check-up. It is a mandatory process and is known as pre-policy medical check-ups.

In simple words, 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, as it will help choose the correct sum insured amount based on your health condition.

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

A pre-policy health check-up is important in many ways. Some of the reasons why a pre-policy medical test is important are:

  • It helps insurers determine the Health Insurance Plans

  • 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

The following points will help you understand why buying medical insurance with pre-policy health check-ups is beneficial:

1. It 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 to do this. When you decide to skip the medical examination, the insurer may consider you as a high-risk applicant and hence charge a higher premium. Therefore, getting a medical check-up done when buying health insurance will prevent you from paying hefty health insurance premiums.

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

As explained above, when buying a health insurance plan, if you avoid taking a medical examination just to save time, the insurer considers you as a high-risk applicant. This is irrespective of whether you are suffering from any critical health conditions or not. Hence, it would be best if you get a medical check-up done when buying health insurance as it helps determine whether you fall under a high or low-risk profile.

3. It helps recognise 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. It helps you 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. It makes it easier for insurers to investigate claim requests

Pre-policy medical examinations are important during insurance claims. If you file a claim and the insurer proves that your illness was caused by a pre-existing disease that was not disclosed, your insurance claim could be rejected. By undergoing a pre-policy health check-up, your medical history will be documented, making 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 (the applicant) will have to pay for half of the cost of the pre-policy medical heck-up and 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 suggests 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.

Things to Remember

Let’s revisit the important details of pre-policy medical check-ups that you must remember while buying a health insurance policy:

  • Pre-policy medical check-ups are a set of tests that you need to go through before your insurer accepts your application for health insurance coverage.

  • Do not ignore pre-policy medical tests as non-essential procedures. Skipping these tests for faster approval and lower insurance premium may seem attractive, however, this may lead to a lower sum insured.

  • As discussed in the earlier sections, pre-policy medical check-ups offer many attractive benefits.

To Sum it up!

Taking a medical examination before buying health insurance is very necessary. It would be best if you do not avoid/skip it at any cost when the insurer requests a health check-up. It prevents you from paying hefty health insurance premiums and warns you of any potential health risks. That way, you can seek appropriate treatment at an early stage and recover from it soon.

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FAQs on Pre-Policy Medical Check-up

  • ✔️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?

     You will be unaware of your current medical status if you avoid taking a pre-policy check-up. This may be bad for your health in the long run and may lead to claim rejections. Hence, it is not advisable to avoid 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 the 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 cover 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 wordings of your health insurance policy.