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Know all About Pre-Policy Medical Check-Up in Health Insurance

Pre-policy medical tests for buying health insurance, while not mandated in all circumstances by all insurance companies, are vital as they act as a yardstick to measure the risk factor for the insurance company. If you have any medical ailments which are already existing at the time of purchasing the health insurance policy, it will be factored in by the insurance company and the total policy amount, premium and duration will be determined accordingly. Undergoing these tests are essential while filing for claims, as it will leave little scope for dispute, both on the part of the insurance company and the policyholder.

The most common tests that a pre-policy medical check-up requires

All insurance companies which provide health insurance have a different policy for a pre-policy medical check-up. However, some tests are common, such as measurement of blood pressure, lipid profile, ECG, blood serum, blood sugar, complete blood count, etc. It is based on the results of these tests that the insurance company determines the risk factor, which in turn impacts the other parameters of the health insurance policy, such as coverage amount and premium.

Who is supposed to pay for the cost of the tests?

The Insurance Regulatory and Development Authority of India (IRDAI) ordains that both the insurance company and the policyholder are supposed to split the costs of the pre-existing medical check-up equally. However, with the intense competition among the rapidly mushrooming insurance companies offering health insurance, most insurance companies choose to pay up the entire cost of the medical tests done for this purpose. Some insurance companies require the policyholder to bear the pre-policy medical test costs initially but reimburse the amount after the health insurance policy is granted.

After the tests, the ball is in the insurance company’s court

Once the tests are conducted and the results are out, it is the call of the insurance company on what terms and conditions to give the health insurance policy. The insurance company generally does one of the following three things:

  • Charges a higher premium: If any severe pre-existing medical conditions are detected in the tests, the company may still decide to give the policy but will charge a higher premium. How much extra premium the company charges would depend on how severe the pre-existing medical condition is.

  • A pre-existing condition might be excluded from cover: The insurance company may decide to give the policy but may choose not to cover the pre-existing condition. In this case, the insurance company will not entertain any claims occurring of the development of any illness related to the pre-existing condition.

  • Application for the policy may be rejected: When the insurance company feels that the pre-existing condition poses a significant risk to them or the policyholder may require repeated medical treatment, they are likely to reject the application for health insurance altogether.

It would be prudent on your part to take out a health insurance policy at a young age, as it will not only entail fewer premiums but also ensure you more comprehensive coverage. Before you buy your health insurance policy, check out the plans of Bharti AXA ; and get your ideal plan here.