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Pre Policy Medical Check Up Procedure, Costs and Importance

Updated On Apr 02, 2021

Pre-policy medical check-up or pre-policy medical test is a medical examination, which health insurance companies request before providing coverage to an individual. 

Only applicants over a specific age are required to undergo the pre-policy medical check-up. 

Does every health insurance company demand its policyholder to take the pre-policy medical tests? No! 

Then, why is it necessary in the first place?

Need for Health Insurance Company

The pre-policy medical check up is significant as it sets a standard through which a health insurer can measure with ease the policyholder’s health and or any associated risks. Moreover, in case any pre-existing disease comes to the surface during the medical examination, then in such a case the insurance company decides upon the suitable cover for the specific person.

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Need for Policyholders

Undergoing pre-policy medical check-up is important for policyholders too. The prime reason being, ‘to gain awareness about the health condition self.’

Remember, you may be suffering from a particular illness and still unaware of it. By undergoing a pre-policy medical test, you come to know of any medical condition that might not be clear to you at the present time. 

Moreover, by going through a pre policy medical examination, complete transparency can be there in regards to any preexisting disease, which is helpful for the policyholder in getting their insurance claim settled without facing any obstacle.

Who will Pay for the Cost of Pre-Policy Health Check-up?

First and foremost, learn that as per the rules and regulations laid down by the IRDAI, at least 50% of the cost of the medical tests is to be borne by the insurance company. 

It is the responsibility of the policyholder to pay the leftover amount or the balance. 

While you may find it to be in practice with many health insurers, you may also find many covering the entire medical test cost by themselves. 

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In cases, where health insurers insist that policyholders bear the cost of pre-policy medical test, the amount is reimbursed to the policyholders once the cover has been granted. 

So, who pays the cost is totally up to the health insurer you have chosen. 

Having said that, let’s move on to the procedure associated with the pre-policy medical check-up. 

The Procedure for Pre-policy Medical Check-up

The steps include:

  • You fill up your application form and submit it to your health insurance company. 

  • If your insurer finds you applicable for a pre-policy medical check-up (based on your age and other key parameters), you will receive a call requesting the scheduling of medical tests. 

  • You will be asked to select a medical center suitable to you from a list of company-designated medical centers in your locality.

  • Any specific measures required from your end before the test, such as fasting for a specific number of hours before the test and others will be communicated to you. 

  • Your health insurance company will get back to you with the confirmed date, time and location according to their preference. 

  • You will be sent an authorization letter which would be necessary for you to carry to the diagnostic center.

  • You will be asked or not asked to pay for the medical tests, based on your company and its rules regarding medical test cost coverage.      

It is advisable to visit one of the company-designated medical centers that suits your preference so as to avoid paying the cost of medical tests.

What happens after the Pre-Policy Health Check-Up?

Once the pre-policy medical examination is over and the test reports come, the health insurance company will then determine whether or not they should offer the policy buyer the coverage as per the terms mentioned in the policy document.  

You can expect two scenarios after your pre-policy medical check-up is over:

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1. No signs of illness in results: If your test results do not showcase any illness, your health insurer will accept your proposal and inform you. 

2. Illness detected in results: In case, your medical test reports showcase a prolonged illness or a deadly disorder, you can expect either of the following:

  • Higher Premium: If your insurer is ready to provide you with cover, it may do so after increasing your premium amount. Note that the enhancement of your policy premium will depend on your age as well the severity of your illness. 

  • Permanent Exclusion: Your health insurer may accept the proposal, but exclude the illness permanently from the coverage scope. Note that due to this restriction, you will not be able to claim the payment in the future. 

  • Rejection: In case, your detected illness is critical and requires frequent medical attention, the insurer may reject your proposal. 

Hiding a pre-existing disease intentionally is giving a false declaration. If you do so and your health insurance company finds out about it later, your policy will be rejected and the claim will be dismissed. 

Final Words

There are certain health insurance plans that do not necessarily need a pre-policy medical check-up, yet, it is still advisable to go through it seeing the long term benefits associated with it. Undergoing a pre-policy medical check-up will also help you in avoiding the chances of facing claim rejection when the need arises. It is suggested that you should buy a comprehensive health insurance plan and receive the benefit of the same from the sufficient coverage offered at an affordable premium amount. Also, before signing any policy document, make sure to do a thorough comparison of the health insurance quotes from different insurance companies and then proceed ahead with buying the policy in order to make an informed decision.


Also Read

Don’t Want to Undergo Pre-policy Medical Checkup? 

Health Insurance Companies Cannot Reject Claims After 8 Years of Premium Payment: IRDAI

At last, if you have any doubts in mind regarding the pre-policy medical tests, feel free to reach out to us at 7551 1969 89.

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