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Is a Medical Test Required When Buying a Health Insurance Plan? Research Team | Posted On Thursday, August 08,2019, 04:20 PM

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Is a Medical Test Required When Buying a Health Insurance Plan?



What is a Pre-Policy Medical Test?

The health insurance companies in India have made it mandatory for customers to undergo a pre-policy medical test; before the insurer accepts the health insurance policy proposal and issues health insurance cover.

The medical screening is required if the customer belongs to a particular age group and also if high insurance cover is availed. If you fall in the age group of 40-45 years and have opted for a lower sum insured, you must undergo medical tests; as at this age, people often fall prey to genetic and chronic ailments.

In some other cases, if a fairly young applicant has opted for higher insurance coverage for example Rs 8-10 lakhs, then he must undergo medical tests as a higher sum insured increases the risk for the insurer. The tests are conducted at hospitals having tie-ups with the insurance company. The cost of the tests is partly or fully borne by the insurance company.

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Why is the Pre-Policy Medical Test Important?

The pre-policy medical test is mandatory for almost all health insurance policies. The medical tests are important as insurers get the right information and access the current health status of the health insurance policyholder.

The pre-medical test serves as a criterion against which the insurer measures the policyholder’s health. The pre-policy medical tests reveal whether the person has health issues, any pre-existing ailment and helps the insurer make a proper decision vis-a-vis premium amount, sub-limits and so on.

The medical tests are necessary while filing health insurance claims. When the policyholder files a claim, the insurer must pay all the hospitalization expenses. However, if the insurance company finds out that the medical condition is caused due to a pre-existing medical condition or an undisclosed illness, the claim will not be honored.

Such situations are dicey as often the insured may not be aware of his health condition. To avoid such confusion a pre-policy medical test helps. Once the medical test is done, the policyholder’s medical reports are on file. This helps in quick settlement of health insurance claims.

What are the Tests Usually Conducted?

The medical tests conducted by insurance companies differ. The insurers have separate risk assessment norms to determine the medical risk.  The insurance companies have implemented a specified grid which helps them understand the types of medical tests required.

The grid consists of two crucial parameters i.e. age and amount of coverage opted. Based on these two factors, medical tests are conducted. The younger the policyholder, lesser are the number of tests. However, some common tests across groups of policyholders are blood pressure, ECG, lipid profile test, blood sugar, thyroid, blood serum test and so on.

See Also: Why Does One Need Health Insurance Policy?

What Happens After the Tests are Conducted?

The main objective of the medical test is to make an informed decision on whether or not to cover the policyholder, under the terms of the health insurance policy. In case any pre-existing medical condition or ailment is found; the insurance company can take the following steps:

  • Charge a Higher Premium: The insurer can issue the policy provided the policyholder pays higher insurance premiums to enjoy the health insurance benefits if he is detected with a health condition. The premiums charged will depend on the severity of the ailment and the age of the policyholder.
  • Permanent Eclusion: The insurer can issue the policy, but may opt to exclude insurance cover for the medical conditions detected. This is done in case the insurer believes that the ailment is too risky to be covered. In such a case; the policyholder can only file insurance claims for illnesses covered in the policy. The treatment availed for excluded diseases (pre-medical conditions) cannot be claimed.
  • Rejection of Policy Issue: The insurer may choose to reject the insurance application and may not issue the policy, if they believe that your pre-existing health condition is highly risky and needs frequent treatment.

See Also: Why is a Medical Test Important While Buying Term Insurance?

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