How Important are Pre-policy Medical Tests in a Health Insurance Plan?
Published On Jan 18, 2021, Updated On Apr 25, 2021
Due to the increasing medical costs, almost all health insurance companies want to get your health condition diagnosed for present illnesses. Based on the medical checkup, they offer you a policy that will assure that in the future, during dreadful situations, you are monetarily covered. Before you choose a proper health insurance policy, you must know the fundamentals of pre-policy medical checkups.
What Are Pre-policy Medical Tests?
The pre-policy medical check-up is the series of tests and procedures that the policyholder is expected to go through. This is essential so that the insurance provider then accepts the health insurance policy application to extend the necessary health cover. The policy seekers over 45 years are most likely to go through such procedures so that the insurer is aware of the person’s present medical fitness and pre-existing diseases.
Another reason for a pre-policy medical test could be if the policyholder selects a sum assured above the average amount, thus increasing the insurer’s risk. Policyholders who choose health cover above INR 10 lakhs usually need to undergo many medical tests.
Importance of A Pre-Policy Medical Tests
Pre-policy medical tests are mandatory for the majority of health policies present. They act as a standard against which the insurance company can gauge the policyholder’s health.
When it comes to filing health insurance claim, the tests are also important. If the policyholder files a claim and the company can prove that the illness was caused by a pre-existing medical condition that was not disclosed or confirms that the policyholders withheld information deliberately regarding his/her medical health, the claim could be rejected. It ensures that the policyholder’s medical health is on file, making it easier for the insurance company and the policyholder to examine and file a claim.
Tests That Are Usually Conducted Before Policy Issuance
The usual tests administered are ECG, blood serum test, lipid profile test, blood pressure measurement, blood sugar, complete blood count, etc.
Who Pays For The Tests?
As per the IRDAI (Insurance Regulatory and Development Authority of India), at least 50% of the tests’ costs are borne by the insurance company, and the policyholder pays the balance. There are several insurers as well who cover the cost of the tests themselves. Some insurers specify that the policyholder would have to cover the pre-policy testing costs, with the amount being reimbursed after the cover has been approved.
What Happens After The Tests?
After the results are received, the company will decide whether to cover the policyholder under the proposal’s terms. If the tests show an illness, the company can choose any of the following:
- Higher Premium: The company can issue the policy to the individual at a higher premium to cover the medical expenses because of the illness/condition detected.
- Permanent Exclusions: The company can choose to issue the policy but exclude cover for the illness detected.
- Rejection: For a very high-risk illness or a condition that requires frequent treatment, the insurer may choose to reject the policy proposal.
Several health insurance policies do not mandatorily require a pre-medical test, but it is recommended to go through one to help you in the long-term. It also prevents the chances of claim rejection in the coming times.
Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.